Emma takes medication that requires quarterly visits to the lab so they can draw blood to ensure her medication is within a therapeutic range. Emma does not like going to the lab. The day of the lab appointment, her father does not tell her where they are going because he knows she will cry and sit on the floor when it is time to leave for the appointment.
Emma and her father get into the car and drive in the direction of the lab, instead of driving in the direction of her school. She immediately recognizes where she is going and begins to cry and bounce in her seat. When they park and her father tries to get her out of the car she continues to cry and flail her arms. Because she is still young and fairly small, he carries her into the lab; but he knows she’ll eventually get too big for him to carry.
Once in the waiting room, she continues to cry and tries to leave the office. Her father hopes they do not have to wait a long time to be called back to the room where her blood will be drawn. When it is time for the blood draw, her father has to restrain her which causes her to become even more upset and combative. When it is over they are both tired and emotionally drained. Her father would like to take her home, but he needs to get to work so he takes her to school. He fears she will not have a good day due to having become upset at the lab.
If this scenario sounds familiar, the following suggestions may help to make your next trip to the doctor, dentist, lab, or other medical appointments easier.
1. Communicate with the office. You may be fortunate enough to have doctors or dentists in your community who specialize in treating children with autism. But if you don’t, you can still work with the office to make the appointment as smooth as possible. Most of us dislike waiting to be seen by the doctor and this can be an especially difficult thing for your child. When making the appointment, explain your child’s situation to the person you are scheduling your appointment with. Ask them if it would be possible, when it is time for the appointment, for you to sit in your car and wait until it is time to be seen by the doctor. When it is time to be seen, have the office staff call your cell phone to let you know it is time to bring your child in. While you are in the car you can listen to music, read your child a book, play a game, or engage in another activity that your child enjoys. This way your child is waiting in a familiar setting instead of an office. Also, see if the office would be willing to have you call in the day of the appointment and see if the doctor is running late and give you an estimate of what time you will actually be seen so that you do not arrive too early. Talk to office personnel about the best way to talk to your child, e.g., explain to the dental hygienist how your child may react to criticism or be told what to do. Ask them to give lots of positive feedback to your child during the appointment.
2. Help your child to know what to expect at the appointment. One way to do so is through role play. Purchase a toy doctor’s kit and practice giving each other shots, looking in each other’s ear, and listening to each other’s chest. Make the experience fun and relaxing. To practice prior to dental trips you might gently probe around your child’s mouth with a dental swab to let her know what the dentist might do. The library most likely has books about going to medical appointments. Check some of these books out and read them to your child prior to the appointment. You may want to consider reading your child a Social Story ™ about going to the doctor or creating one yourself. You may want to look on YouTube for a short video of a child going to the doctor so your child will know what to expect.
3. Think about sensory issues that may affect your child’s ability to tolerate the appointment. If your provider’s office does not already offer them, see if you can bring headphones to listen to music during a dental cleaning or sunglasses to block out bright lights. Perhaps a fidget or stress ball would help your child during a blood draw or dental exam. Practice relaxation techniques prior to the appointment. Help your child to learn to take deep breaths or use mental imagery to think of a calming scene. You might want to rub lavender-scented lotion into the arm or hand to help him/her relax. Then when you are at the appointment you can remind him/her to use these techniques.
4. Plan a fun activity following the appointment to help motivate your child to cooperate during the appointment. For example, let your know child that you are going out to breakfast following a morning lab appointment, or that following a dental appointment you are going to the park.
5. Prior to the appointment, talk about what is going to happen and how you expect your child to behave. For example, you might say; “Emma, we are going to the doctor so he can look in your ears and listen to your chest; just like we practiced. I would like you to do the best you can to stay calm by taking deep breaths; just like we practiced. I know you can do it because you’re a big girl. When we are through, we are going to go to the playground. “
By using these techniques, visits to the doctor, dentist or other medical professionals will be less stressful for you and child. By working as a team with the office personnel, you can make necessary environmental changes tailored to your child. By preparing your child for what to expect, he will be less anxious about the appointment and better able to manage his behavior in the office. And, having a fun outing following the appointment will help to end the experience on a positive note.
Dr. Carter is a clinical psychologist. Ms. O’Shaughnessy is a psychology associate. They are co-authors of PREP for Social Success: A Guide for Parents of Children with Autism, which is a social skills manual available exclusively through Amazon Kindle at http://www.amazon.com/gp/product/B00WQANRI4. You can follow them on Twitter @Prep4SocSuccess and on Facebook at https://www.facebook.com/PREPforSocialSuccess.
This article was featured in Issue 51 – School: Preparing Your Child for Transition