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Medical Appointments Can Be Made Less Challenging for Children with Autism
By Alan Harchik, Ph.D., BCBA

Even the most basic healthcare activities can become quite challenging for children with autism and their families. For example, medical and dental office visits, blood tests, haircuts, and even fingernail and toenail clipping can be extremely uncomfortable to a child with heightened sensitivities. Putting the child in these kinds of situations may sometimes result in severe behavior problems, including tantrums, aggression, and toilet accidents. As a result, parents may fear or avoid these situations, and may not know where to turn for help.

If an activity is discontinued because of the child’s response, the child may learn to use problem behaviors to escape from these situations. Although physical holds and sedating medications may be recommended in some circumstances, most parents don’t like these procedures. What else can be done?

Below are some methods that the professionals at May Institute have found helpful. They can be used individually or together, based upon the child’s needs. Many physicians, dentists, and hair stylists are patient and willing to work with children and families once they understand that a child has special needs.

One method is called desensitization. It means gradually exposing the child to the situation that is feared. Michelle Pratt, director of May Institute’s School Consultation Program in Western Massachusetts, recommends that parents with a child who has difficulty with medical appointments start with short, frequent visits that end with a reward or preferred activity, such as a favorite toy or treat.

The appointment can be broken down into a sequence of steps. Have the child complete only the first step on the first visit. On the next visit, try to complete the first two steps, and so on. Recent research by Carole Conyers, a child development researcher from North Dakota State University, showed success with this method when dividing a dental visit into 18 steps. Steps included waiting, walking to the chair, opening mouth, and allowing a dental mirror to be placed.

A second method involves teaching the child about the situation in advance of the visit. One way this might be done is by creating a series of pictures that present appropriate behaviors in a story format. Ms. Pratt recommends making a book with photos of the child, or someone the child knows and likes, going through all of the steps of the activity in the actual setting, including receiving the treat at the end of the activity. A variation is to make a video for the child to watch.

Another teaching method is to create a simulated pretend situation. Research suggests that if the situation is made realistic, it can result in improved behavior in the real setting. Simulation allows for many more practice opportunities than what might be available if traveling to the actual location. Simulation also enables the child to practice with a variety of materials and instructors.

A third method involves modifying the environment to make it feel more comfortable or safe for the child. Examples include letting the child sit on a parent’s lap or hold a favorite item or toy during the office visit, talking about a favorite topic, telling the child what will be happening next, and supervising his or her holding some special item, such as a stethoscope, prior to its use.

A fourth method is to provide specific positive rewards for participation. This is an important component of the desensitization and instructional procedures described above. Examples include a coupon for a local ice cream store and access to a favorite video.

Researchers and practitioners are exploring a fifth method – providing the child with 10-to-20-second “breaks” from the activity, whether or not he or she is cooperating. Initially, the breaks may occur every 15 to 30 seconds. Over time, they can be spaced further apart.

At May Institute, we have found that concentrating on successful outcomes is more beneficial than focusing on the problem as an anxiety or sensory processing disorder. We need to treat each problem as a skill deficit that children with disabilities (and adults, too) can overcome with systematic use of effective teaching and reward procedures. Teaching a child to master each of these situations makes that child happier, more independent, and better able to function in the world. That is the ultimate goal for providers and parents alike.

May Institute is a national nonprofit organization that provides educational, rehabilitative, and behavioral healthcare services to individuals with autism and other developmental disabilities, brain injury, mental illness, and other behavioral healthcare needs. May Institute operates six schools for children and adolescents with autism and other developmental disabilities, including one in West Springfield, Mass. For more information, call 800-778-7601, or visit www.mayinstitute.org.

Dr. Harchik can be contacted in West Springfield at 413-734-0300, or at aharchik@mayinstitute.org.

The information presented on this site is intended solely as a general educational aid, and is neither medical nor healthcare advice for any individual problem, nor a substitute for medical or other professional advice and services from a qualified healthcare provider familiar with your unique circumstances. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition and before starting any new treatment.

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