My three-year-old boy (newly diagnosed with high functioning ASD) has to go for his yearly bloodwork (he has to have his liver enzymes and vitamin D monitored regularly). He’s newly terrified of doctors (inconsolable at the pediatrician), and I can’t wrap my head around how I’m going to get him to cooperate this time—he was so little in the past. Any advice? —Jacqueline
Dear Jacqueline,
I’m sorry your son (and you) have to go through these procedures and do so as frequently as you do. Medical procedures can be stressful for everyone involved, especially when you have a child who is hyper-responsive and overly emotional in any way. Different children need different things, but the following are some suggestions I have that might be supportive of your son.
1. Prepare both the doctor’s office and your child
Call ahead to inform the medical professional that he has autism and is fearful and reactive to medical procedures. Ask if you could bring him by once or twice ahead of time to get acquainted with the surroundings and to possibly meet the people who will be performing the blood work. Let them know this may sound excessive and you trust them but familiarity of people and places will likely help him relax.
Reassure the staff you won’t take much of their time, if any, so you don’t need an appointment; you would simply like to look around. The day of the appointment, I recommend leaving lots of time to get ready and out the door with time for you to arrive a few minutes early. Having enough time and more than you need, means you can avoid rushing, which increases everyone’s stress level.
“Pacing” of a stressful experience and your own interactions with him can send strong signals of “safety” and “calm,” which will help him feel more secure throughout the process. In preparation for the appointment, I might offer something for him to look forward to after the procedure is finished. If he has a favorite restaurant, plan to stop there for lunch afterward.
If he has a favorite park or place in town, plan to visit there afterward and remind him that when the appointment is done, you will be going there. Do not make the special outing contingent on his behavior during the appointment, however. Doing so could cause extra stress and send the wrong message or lesson if the appointment doesn’t go well. The outing is not to be considered a reward, as much as it is about helping him move past the difficult event in his thinking and plan for the day.
2. Use Books and a Social Story to prepare the child
Using picture books can be a very powerful way to help children prepare for and cope with difficult experiences. Ask your local librarian or google picture books or articles online for “children’s books needles”. Children with autism often benefit from using what’s called a “Social Story”. Carol Gray, an educator and the developer of this evidence based approach to supporting children with autism describes social stories as “a social learning tool that supports the safe and meaningful exchange of information between parents, professionals, and people with autism of all ages”. You can view more information about this method here: https://carolgraysocialstories.com/about-2/carol-gray/
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3. Use imaginary play to practice situations
Young children may have a hard time expressing themselves using words and language and even children who are verbal struggle to connect words with experiences and emotions. Another way to help them make sense of and process challenging situations, besides books, is to play. Use a pretend doctor kit with stuffed animals and/or dolls or with each other. Encourage your son to be the doctor and the patient but follow his lead on which role he prefers.
You can take a turn being the patient and have him comfort you. This gives him practice being in different roles and working through the various emotions that might arise in that situation as well as his fear of the “unknown” or the “known” factors from his past that are contributing to his anxiety.
4. Be honest about the doctor visit
if he asks questions about the appointment, answer honestly and with a neutral or positive tone of voice. Try not to “sugar coat” or be insincere because avoiding the truth about what will happen in any given situation, might increase his fears and anxiety.
5. Support your child and the healthcare team
Do your best to be supportive of him and follow the lead of the health care team performing the bloodwork. Remember to do for yourself what you need to feel less anxious so you can feel confident and calm for your son. Unfortunately, what’s good for our children won’t always feel good to them and he may not co-operate, but he will take his cues from you, even if/when he is afraid.
“Rescuing” your son completely sends a message that he can’t handle it and even if it’s hard for him, getting through it will hopefully build resilience and experiences of being able to do hard things. It may not prevent meltdowns the next time even, but over years he will likely become more confident and able to manage these and other difficult things.
6. Work with an occupational therapist
If you have an occupational therapist, ask him/her if he/she has any suggestions re: ways to calm him and/or ask if his sense of touch is over-responsive. If so, there are some strategies that might help to calm the sense of touch before, during and after the procedure, that might be helpful. Deep pressure touch can be helpful (teaching him to self-massage) or warmth (use a warm cloth vs. a cold or a soft warm towel, over the area.
I hope these suggestions are helpful and good luck at the doctor!
This article was featured in Issue 102 – Supporting ASD Needs Everyday
