PFA Tips: Preparing for a Visit to 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. How can we help prepare someone with autism for an upcoming visit?
First, determine if this is the appropriate doctor and office for your child
Treat this as you would a job interview, with the purpose being to determine if this doctor and office are the right fit for your child. Do they have experience with patients with autism? Are they willing to make accommodations for your child both prior to and during the appointment? Share with the doctor the medical, emotional and behavioral concerns your child may have and ask her to assess her comfort level with those issues.
A visit’s success may completely rely on whether a doctor and office are willing to make the accommodations your child needs. Necessary accommodations are unique to each person. Here are some to consider:
- No wait situation. Can you wait in the car, or go to a nearby fast food place and receive a call when it’s your turn?
- Check in/out. What steps can be put in place to minimize the check in/out time? Can you do a check in (insurance, registration, questionnaires) by phone or online prior to the appointment?
- Bright lights. Can the lights in the exam room be dimmed? Are there windows which would allow for natural lighting?
- Music. Can the overhead music be turned off while your child is in the office?
- Ask the experts. You spend the most time with your child, so you are the experts on his triggers and calming strategies. Will the doctor follow your suggestions in handling examination techniques?
- Order of procedures. Can the exam procedures be done in an order that’s most comforting to your child? For instance, if your child hates having his ears touched, can his ears be checked either first or last depending on your child’s preference?
Check online for pictures of the doctor’s office
The doctor’s office website may have pictures of the office, exam rooms and staff. Showing your child pictures of the office and people will help familiarize her so everything won’t seem so new and strange.
Create a social story
Social stories break down situations into understandable steps and help make an experience more predictiable. Here is an example for a social story about going to the doctor. It may be more effective to create your own using pictures from your actual doctor’s office. Try to include as many procedures as you know will happen during the appointment.
Schedule a pre-visit
If your doctor’s office allows, ask if your child can come for a pre-visit for an
opportunity to see the staff, the waiting and exam rooms without the added pressure and anxiety of an actual exam. Familiarizing the patient with the environment and people might help ease tensions on the day of the real appointment.
Seriously, there are YouTube videos for EVERYTHING. Search the popular video site to see if your child’s procedures are demonstrated.
Practice with toy doctor equipment
You can help familiarize your child with some of the equipment he or she will be exposed to in the hospital by playing “hospital” at home with a toy doctor’s kit. During your play, reinforce that doctors help us and make us feel better.
Have pretend sessions at home where you can practice doctor’s office scenarios. This can be especially helpful if you know something unpleasant will happen during the exam – such as a shot. Here is an example of how one dad prepared his son Max for his flu shot. His dad showed him that the shot was three steps: wipe, shot, bandaid. He pretended to wipe Max’s arm with an alcohol pad, give the shot, and then cover the injection area with a bandaid. They repeated the steps and the words over and over. Max was allowed to practice those same steps on his dad. They role played the shot scenario for about a week prior to the doctor visit. When they arrived at the doctor’s, Max asked if he could wipe the area on his arm. The nurse allowed Max to be empowered and engaged in the procedure.
When appropriate, make your child part of the planning process
My son is adamant that if his yearly physical exam calls for a shot, that we schedule the injection as a separate appointment. Hunter wants to dictate what that date is (after presented with the possible options). Do I want to have to fit in another appointment? No. But because he was empowered to make that decision, he does not fight me when it is time to go.
Practice coping strategies
Despite all of the preparation you may do, your child may still have moments of high stress and anxiety during the visit. Practice calming techniques prior to the visit so that your child won’t be faced with something else that’s new in the middle of the appointment. Which techniques will be successful are dependent on your child, but you might try deep breathing exercises, squeezing a stress ball, playing with a fidget item, or getting lost in a preferred video.
Pack a goodie or rescue bag
Prepare a bag of familiar, highly preferred items/toys/snacks for the visit. Then you have it handy if you need a redirection or distraction, or a reward at the end.
Prepare an appointment checklist
Prepare a checklist, visual schedule or white board which lists step by step directions that can be checked off when completed.
Prepare information to share with the doctor
Write down your list of questions, medications your child is taking, and contact information of your child’s specialists and therapists so that information can be sent to your child’s entire care team. If there are behaviors you want to discuss with the doctor, try to video your child during those episodes. If possible, ask if you can email all of the information ahead of time.
Be first or last
The first appointment of the day is typically on time and requires little waiting. However, the last appointment of the day might allow the doctor to spend more time with your child and not hold up the next patient. It may also be a calmer time at the office during that time of day. Talk with your doctor about which is a better option for you.
Thank you to Beth DeLauter for her contributions to this article.
© 2019 Pathfinders for Autism