Appointments Can Be Made Less Challenging for Children with Autism
Alan Harchik, Ph.D., BCBA
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.
an activity is discontinued because of the childs 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 dont like
these procedures. What else can be done?
are some methods that the professionals at May Institute have found
helpful. They can be used individually or together, based upon the
childs 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.
method is called desensitization. It means gradually exposing the
child to the situation that is feared. Michelle Pratt, director
of May Institutes 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.
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.
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.
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.
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 parents 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.
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.
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
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
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.
Harchik can be contacted in West Springfield at 413-734-0300, or
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.