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.
Predicting
When a child or adolescent is primed for an event, she expects it to happen in exactly the way she was shown. Often schedules or procedures change, so it is important that predicting be a part of the routine. Predicting answers the “what if …” question. Medical personnel may ask parents of children with ASD to bring along with them the indicator for change that they use at home or that their child uses at school (see Figure 2 at the end of article). This can be inserted into a picture schedule of activities or even into a story describing a procedure. Parents of verbal individuals with ASD can ask or write out “what if …” questions to prepare the child. “What if …” questions could include:
- What if the doctor is late for the appointment?
- What if the doctor takes your temperature before she listens to your heart?
Predicting helps the child increase flexibility and provides some semblance of routine in the face of change.
Countdown
A simple countdown of 5, 4, 3, 2, 1 using a countdown strip can help the child understand that an event will last only a short while. For quick, one-time use, the numbers could be written on a piece of paper and crossed off as the events happen or as time passes (i.e., such as time passage to take the child’s temperature). For children with special interests, the special interests could be incorporated into a countdown strip. One mom we know whose son liked teddy bears carried with her a small cup and plastic teddy bears. As time passed, she would count down by putting the teddy bears in the cup.
Wrap-Up
Wrap-up is a celebration of the completed activities. Most often the wrap-up should include reinforcers—items that the child prefers. They could be presented in the form of a first/then card (see Figure 3 at the end of article) or a series of cards that have pictures of potential preferred items. This step is essential—the child or adolescent with ASD has completed a very challenging activity, overcoming many ASD-related obstacles. The wrap-up ends the experience on a positive note.
Summary
Priming, predicting, countdown and wrap-up are strategies that can be easily incorporated into medical visits. Compatible with the needs of individuals with ASD, these four easy-to-use strategies have the flexibility to be easily implemented in doctors’ or dentists’ offices or hospital settings.
References
Hudson, J. (2005). Prescription for Success: Supporting Children with Autism Spectrum Disorders in the Medical Environment. Shawnee Mission, KS: Autism Asperger Publishing Company.
Sakai, K. (2005). Finding Our Way: Practical Solutions for Creating a Supportive Home and Community for the Asperger Family. Shawnee Mission, KS: Autism Asperger Publishing Company.
A version of this article originally appeared in the free, online national newsletter on ASD, the OARacle, April 2008 issue (www.researchautism.org/).
Figure 1. Picture schedule of activities
(from Hudson, 2005, p. 19)
Figure 2. Change symbol
(from Hudson, 2005, p. 19)
Figure 3. First/then chart
(from Hudson, 2005, p. 19)
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Reprinted with the permission of the Autism Society.
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