PFA Tips: At the Doctor’s Office
By Shelly McLaughlin, Program Director, Pathfinders for Autism
Any doctor visit, no matter how routine, can raise one’s anxiety. There’s the disruption to an individual’s schedule, the potential for an overstimulating environment, the unsureness of what the exam will entail and if any part of the experience will be painful. What accommodations can we ask of the doctor to make the visit less stressful?
Plan for the waiting room
No one enjoys waiting rooms. But it can be especially difficult for patients that have a low tolerance for crowds, harsh lighting, and not knowing how long they will be sitting there. If you know your child would do better waiting someplace else, ask the staff if they can call you when it’s your child’s turn. Or if they have a quiet room other than the waiting room.
Discuss the goals of the visit
Talk with your doctor and agree on what you want to accomplish with this visit, and which procedures are priority (such as lab work). This should drive the order of the actions taken during the exam.
Have a backup plan
Along with your doctor, determine at what point you might consider halting a procedure. If that is not an option, plan if additional staff will need to be brought in to assist, or what other arrangements or accommodations can be put in place.
Do an environmental assessment
Look around and take cues from your child. Is the lighting too bright? Is the exam room next to a noisy copier machine? Is the overhead music too loud? Are there items in the room that will be too distracting for your child? If the exam room presents challenges, ask your doctor if they can accommodate your child in another room.
Medical terminology can be difficult for any patient to understand, much less someone who may experience a language processing disorder. When describing an ailment or procedure, use age appropriate models and illustrations.
Provide step by step instructions
Give directions one at a time, and remember to allow for processing time between each step. If your child processes better visually, provide the steps in a checklist or visual board. Use first/then language to help prepare you child for next steps and make upcoming actions predictable.
Model procedures on a surrogate
Before each procedure, ask the doctor to “perform” it on you, another caregiver, or stuffed animal. During this practice, describe each step so the patient can connect the terminology with the procedural steps.
Slow down abrupt transitions
Doctor’s offices can be very busy places and things can move quickly during an exam. This can create tremendous stress for a patient with autism. Try using a timer and give transition warnings or countdown cues to help make transitions more predictable.
Be aware of pen lights and seizures
Pen lights can trigger seizures in patients susceptible to them (Kagan-Kushnir, Roberts and Snead, 2005). Talk with your doctor if your child experiences seizures and ask if a different technique can be used.
Bring visual supports
Some doctor’s offices may have them available, but best to be safe and bring them. For patients that do not use verbal communication, pictures of body parts, symptoms, and pain scales can be useful, even necessary, communication tools.
Weight it out
We know that some individuals with ASD respond well to deep pressure as it can help them feel calmer and more relaxed. It might be worth draping the person with an x-ray apron (if available) if they appear agitated to see if that helps.
Implement a reward system
Sometimes patients find it more manageable to get through a situation if they know something they want is waiting for them at the end. Consider positive reinforcements to move through each procedure.
Advocate, advocate, advocate
No one knows your child better than you. You know your child’s triggers and calming strategies. You may need to request accommodations if you know that certain practices may escalate your child’s behaviors. For example, ask if your child can wear his own clothing if a gown or paper scrubs will send him into a meltdown. If you have concerns or questions, speak up.
After the vist
Take a few moments to call or email the doctor’s office to let them know what techniques worked well and what didn’t. That way you aren’t starting all over when you prepare for your next visit.
Thank you to Beth DeLauter for her contributions to this article.
© 2019 Pathfinders for Autism