• Christopher Lynch

Medical Appointments for Kids on the Autism Spectrum: A Better Way


Simple to Implement Strategies Can Reduce Anxiety for Kids on the Autism Spectrum During Medical Visits


Going for a medical visit can be a scary proposition for any child. Children may not fully understand the reasons why they going to see a doctor and, during the visit, they may not understand the reasons for the procedures that are carried out.


A child on the autism spectrum has to cope with all of the usual fears of seeing a doctor. However, for the autistic child there are a host of other factors that can make seeing the doctor not only unpleasant but really terrifying.

Some of these factors are:


Waiting

For many kids, waiting at the doctor's office is unpleasant. However, for the autistic child waiting can result in very high distress. Children on the spectrum may struggle with the concept of time and, thus, may not find comfort when told that they will be seen in X number of minutes. Waits at the doctor’s office also tend to be unpredictable and this unpredictability often creates high anxiety for autistic kids.


Unclear and changing expectations

You know how it is when you go to see the doctor: you’re expecting to be in and out quickly but then the doctor decides that you need a particular test or a particular procedure, and you need to go to another room or another part of the medical building to get things done. This kind of unpredictable change can cause great confusion and distress for the child on the spectrum.


Abrupt transitions

Doctor’s offices are busy places. When it is time to move from one part of the visit to another the expectation is that the patient will do it quickly, without any warning. These types of abrupt transitions can be very unsettling for the autistic child.


Sensory sensitivities

Doctor’s offices are not very sensory-friendly places: bright fluorescent lighting, loud sounds (such as equipment or crying babies), and unpleasant smells can be very difficult for an autistic child to process and cope with. In addition, there are often multiple intrusions on a child’s tactile senses during a medical exam (examples: the squeeze of a blood pressure machine, feel of a stethoscope, having reflexes tested, and so on).


Language processing

The way that healthcare providers solicit information from children and their parents can also be problematic. Being asked multiple questions-often at a quick pace-can quickly overwhelm the language processing capacity of a child on the spectrum. In addition, the use of abstract language or unfamiliar terms by healthcare providers can be confusing for the child and lead to further anxiety.


The Consequences of Healthcare Anxiety

As we saw from above, there are many aspects of doctor’s visits that can daunting for a child with autism. The degree of anxiety experienced during a typical doctor’s visit can have significant consequences. The child may be distressed not only during the visit but for days (or even weeks) before. Challenging behaviors during the visit (due to anxiety-not intentional) can prevent healthcare providers from conducting a thorough evaluation and it may also result in parents not being able to ask enough questions or to fully express their concerns.


A Better Way

Fortunately, there are a number of strategies that parents and healthcare providers can use to substantially reduce the anxiety associated with medical visits for autistic children. Ideally, parents and providers should work together in developing a plan that will target each individual child’s needs. Some of these strategies include:

Schedule appointments during less busy times (for example: the first appointment of the day). The will help to reduce the anxiety associated with waiting as well as cut down on the level of overall sensory stimulation in the office setting.

Bring comfort items. A favored toy or stuffed animal that provides comfort can help to reduce anxiety during procedures.

Use distraction. Distraction can help divert a child’s attention away from fearful procedures. Distractions can be physical items such as toys or videogames or a familiar person that the child feels comfortable with.

Before a first-time appointment to a new medical setting, schedule a “dry run” sessions during which the child gets used to the setting and can meet staff.

Healthcare providers should use clear language when asking questions or explaining something to the child and use a conversational pace that is manageable but fluid. Be sure to answer questions honestly but at a level that the child can understand and process.

For less verbal children, bring whatever communication system they use to the appointment. Practice using words and phrases that they may need to use at the appointment beforehand.

Use a visually support schedule for what will happen during the appointment. This can help children to understand what will occur next.

Try to ensure that familiar staff that the child feels comfortable with will be available during the scheduled appointment.

Parents may want to bring along a family member or trusted adult to distract and comfort the child so that they can take time to communicate with the doctor and other healthcare staff.

The office can send any paperwork ahead of time for completion to reduce wait time in the office.

Healthcare providers and office staff should address all sensory aspects of the visit and minimize unnecessary noise, smells, and other forms of stimulation.

Prepare the child for the visit by re-enacting aspects at home (for example, by using a toy doctor kit)

Pair medical visits with something pleasant e.g. out for icecream or to near by playground

Wrap up points and conclusions

What will use will vary, in general the younger the child the more distraction, the older the more you focus on knowledge and coping but this will vary and individual preference as well


Going for a medical visit can be a scary proposition for any child. Children may not fully understand the reasons why they going to see a doctor and, during the visit, they may not understand the reasons for the procedures that are carried out.


A child on the autism spectrum has to cope with all of the usual fears of seeing a doctor. However, for the autistic child there are a host of other factors that can make seeing the doctor not only unpleasant but really terrifying.

Some of these factors are:


Waiting

Unfortunately, waiting seems to be an inescapable aspect of going to medical visits. For many kids, this is unpleasant. However, for the autistic child waiting can result in very high distress. Children on the spectrum may struggle with the concept of time and, thus, may not find comfort when told that they will be seen in X number of minutes. Waits at the doctor’s office also tend to be unpredictable and this unpredictability often creates high anxiety for autistic kids.


Unclear and changing expectations

You know how it is when you go to see the doctor: you’re expecting to be in and out quickly but then the doctor decides that you need a particular test or a particular procedure, and you need to go to another room or another part of the medical building to get things done. This kind of unpredictable change can cause great confusion and distress for the child on the spectrum.


Abrupt transitions

Doctor’s offices are busy places. When it is time to move from one part of the visit to another the expectation is that the patient will do it quickly, without any warning. These types of abrupt transitions can be very unsettling for the autistic child.


Sensory sensitivities

Doctor’s offices are not very sensory-friendly places: bright fluorescent lighting, loud sounds (such as equipment or crying babies), and unpleasant smells can be very difficult for an autistic child to process and cope with. In addition, there are often multiple intrusions on a child’s tactile senses during a medical exam (examples: the squeeze of a blood pressure machine, feel of a stethoscope, having reflexes tested, and so on).


Language processing

The way that healthcare providers solicit information from children and their parents can also be problematic. Being asked multiple questions-often at a quick pace-can quickly overwhelm the language processing capacity of a child on the spectrum. In addition, the use of abstract language or unfamiliar terms by healthcare providers can be confusing for the child and lead to further anxiety.


The Consequences of Healthcare Anxiety

As we saw from above, there are many aspects of doctor’s visits that can daunting for a child with autism. The degree of anxiety experienced during a typical doctor’s visit can have significant consequences. The child may be distressed not only during the visit but for days (or even weeks) before. Challenging behaviors during the visit (due to anxiety-not intentional) can prevent healthcare providers from conducting a thorough evaluation and it may also result in parents not being able to ask enough questions or to fully express their concerns.




A Better Way

Fortunately, there are a number of strategies that parents and healthcare providers can use to substantially reduce the anxiety associated with medical visits for autistic children. Ideally, parents and providers should work together to develop plans that will target each individual child’s needs.





"Playing Doctor" is just one of many stragtegies that can reduce anxiety duuring medical visits for kids on the spectrum.


Some of these strategies include:


  • Schedule appointments during less busy times (for example: the first appointment of the day). This will help to reduce the anxiety associated with waiting as well as cut down on the level of overall sensory stimulation in the office setting.


  • Bring comfort items. A favored toy or stuffed animal that provides comfort can help to reduce anxiety during procedures.


  • Use distraction. Distraction can help divert a child’s attention away from fearful procedures. Distractions can be physical items such as toys or videogames or a familiar person that the child feels comfortable with.

  • Before a first-time appointment to a new medical setting, schedule a “dry run” session during which the child can get used to the setting and can meet staff.


  • Healthcare providers should use clear language when asking questions or explaining something to the child and use a conversational pace that is manageable but fluid. Be sure to answer questions honestly but at a level that the child can understand and process.


  • For less verbal children, bring whatever communication system they use to the appointment. Practice using words and phrases that they may need to use at the appointment beforehand.


  • Use a visually supported schedule for what will happen during the appointment. This can help children to understand what will occur next.


  • Try to ensure that familiar staff that the child feels comfortable with will be available during the scheduled appointment.


  • Parents may want to bring along a family member or trusted adult to distract and comfort the child so that they can take time to communicate with the doctor and other healthcare staff.

  • The office can send any paperwork ahead of time for completion to reduce wait time in the office.


  • Healthcare providers and office staff should address all sensory aspects of the visit and minimize unnecessary noise, smells, and other forms of stimulation.


  • Prepare the child for the visit by re-enacting aspects at home (for example, by using a toy doctor kit).


  • Pair medical visits with something pleasant e.g. out for icecream or to near by playground


Conclusion

Doctor visits do not need to be filled with dread for kids on the autism spectrum and their parents. Some relatively simple to implement strategies can help to make the visit much more comfortable. The use of these strategies will help to ensure that the child on the spectrum will get the level of healthcare that they need.


For Additional Resources to Help Kids on the Spectrum to Manage Anxiety Please See my Website:

www.morethanbehavior.com



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