Preparing a Child with Asperger Syndrome for Medical Appointments

Going to the doctor’s/dentist’s office or the hospital is anxiety-producing for most people, but especially so for children. Not only is the child possibly sick or injured and needs care, but she is in a new setting and everything around her is unfamiliar. The sights, sounds and smells are new; the routine is different. People come and go, and the child quickly becomes the victim of fast-paced decisions that are often made without considering her level of understanding. As a result, even an otherwise well-adjusted child can become anxious.

Children with Asperger Syndrome in the Medical Environment

Now imagine that an individual with Asperger Syndrome (AS) enters the hospital. Similar to neurotypical peers, the child or adolescent will be impacted by all the new people, sounds, smells and expectations. In addition, the child with AS usually has higher levels of anxiety and generally reacts negatively to novel situations. The result is a highly stressed, anxious child who may soon become unable to cope in this confusing environment and become hyperactive, act nervous or silly, withdraw or have a tantrum, rage or meltdown.

This situation is exacerbated by interactions with medical personnel who are not trained specifically to work with individuals with AS. Medical personnel, without understanding the unique characteristics of those with AS and how they perceive the environment, often unintentionally increase the child’s anxiety and promote behavior problems. The purpose of this brief article is to provide an overview of some easy-to-use strategies that parents or medical personnel can use to minimize the trauma associated with medical care for children and youth with AS.

Four Easy Steps for Making Visits Easier

Individuals with AS present with myriad challenges across domains, ranging from social to sensory to visual learning. These characteristics revolve around not understanding the environment, experiencing the environment in an unfriendly manner, and not understanding how and when to react. Thus, interventions that can address these challenges are essential. Strategies that can make medical visits easier for individuals with AS include priming, predicting, wrap-up and countdown (Sakai, 2005). Because the medical environment is often stressful, it is sometimes helpful to use visuals to communicate to the child. Visuals can include brief stories or scripts, pictures, lists, memos, photographs or drawings.

Priming

Priming is a method of preparing the individual for an activity that she will be expected to complete. Priming accommodates a preference for predictability by promoting awareness of what is going to happen. With the emphasis placed on previewing activities before they occur, the child is often less likely to experience anxiety and stress about what lies ahead. With anxiety and stress at a minimum, the child can focus her efforts on successfully completing the activities. Because the individual with AS is a visual learner, a picture schedule of activities (see Figure 1 at the end of article) or a narrative that describes the activities can be very helpful. A narrative describing an event can be presented as a brief story with digital photos or a simple drawing showing equipment or procedures. Another priming activity would include allowing the child or adolescent to take along a favored item to the activity. In this way, the individual with ASD is more prepared for the new environment because the favored item makes the setting more familiar.