at the doctor’s u:11 l:1. unpredictability – unfamiliar place & people – unsure of routine...

At the Doctor’s

U:11L:1

• Unpredictability – Unfamiliar place & people– Unsure of routine

• Toys present sharing

• Unexpected/sudden noises coughing, sneezing

• Long wait

• Multiple transitions required – (car waiting room exam

room to car)

• Change in normal routine (unnerving)

• Florescent lighting may cause discomfort

• Presence of others– Noise level– Other children or babies crying

Do you know these places?

• Hospital• Clinic• Dispensary

Advices

What Can You Do» Preparation – Child and Parent

» Feasible Environmental Modifications

» Positive Associations, pairing

» Social Stories

» Power Cards

» Priming

» Pretend Play/De-sensitization

» Visual Supports and Schedules

» General Guidelines

• Schedule appointment times carefully.

Consider:• Times of day (fatigue, irritability) • Time of the month (menses)• Disruption to child’s routine

– After school appointment vs. leaving school early. – Research the upcoming environment.

• Duration of visit– Know your child’s tolerance level – Multiple visits of shorter duration if needed

• Sensory sensitivities (if any)

Preparing for the Visit

– Familiarize yourself with the staff• How experienced /knowledgeable they are about ASDs• Are they open to education?• Tell them about your child.

– Call ahead of time to learn the routine• Typical wait time?• Can accommodations be made?• Let them know about your concerns ahead of time.

Do your homeworkAdvanced preparation is an asset!

• Bring along additional support– Preferably adults

• Spouse, relative, friend• Program staff/home therapy staff

• Try to determine possible obstacles/problematic situations you may encounter– Develop some contingency (backup) plans

• Of course we cannot plan for everything, but the more advanced prep you can do, the better!

• Look for precursors/rumbling behaviors (warning signs of distress)

Things to consider prior to visit:

• Bring material/items to address sensory issues– Head phones; fidget items; weighted blankets

• Keep bag o’ tricks as distracters

Come Armed!!

Increases child’s familiarity with various situations they may encounter; how they may feel; what may happen during the visit

Provides them with possible things they can try to do if encounter difficult situations

Its providing them with advanced preparation for themselves!

Social Stories

• Power cards can also be made• Depicting favorite character/hero describing the

situation• Provide list of suggestions/things to remember

when at the doctor– E.g., child can carry it around as reminder

Power Cards

• Practice with your child-in a relaxed setting (no demands)

• Go through what they might experience during the visit.

Priming

• Play pretend doctor/dentist visits– Doctor or dentist toy kits• Familiarizes child with some items

they may encounter at doctor’s office– Reduces uncertainty; helps make it

less frightening– Enhancing predictability; making it

less overwhelming

Pretend Play

– Read books about going to doctor/dentist

– Watch videos that deal with doctor visits

Read Some Books!!!

An Array of Visual Supports

• Use visual supports whenever possible & appropriate!

• Enhances predictability• Reduces uncertainty & anxiety• Helps child prepare for what is going

to happen & when the visit is finished• Fosters independence • Minimizes the need for problem

behavior!

Schedules and Checklists

• Displays activities before & after doctor’s appointment– Prepares child for the visit, and shows them what they

will be doing following the appointment• Variety of formats:

– Wallet schedules– Object schedules– Small photo albums– Key ring schedules

Activity Schedules

Use “looking forward to…”approachAccess to highly preferred reinforcer or activity following visit to doctor’s office

Example: see the doctor play favorite computer game!

Sample Task Analysis: Going to the Dentist

Task analysis of dentist appointment

Pictures/written symbols of various steps involved in visit

Describes what will happen next

Helps child visualize what is remaining & what parts they have completed

• Use weekly/monthly calendar to signify when appointment is scheduled for

• *Be cautious some children may NOT find this helpful; Know what will work for your child!

• Advanced warnings/use timers – Indicate upcoming transition or end of disliked portion

of exam

More Visual Supports!

Tell them what to do vs. what not to do!

• Use clear, concise, specific instructions

• Ensure expectations are clearly understood

• Reduce ambiguity/uncertainty

• Prior to the event, during teachable moments

– Relaxation techniques

– Access preferred/calming materials

– Communication skills

– Teach coping skills

Coping Skills

• Catch them being good approach

• Provide frequent behavior-specific praise whenever they are displaying appropriate

behavior!

• Provide physical & verbal reassurance • Rub their back & explain how well they are doing!

Praise and Reinforcement:

Let them know when they are on the right track!

Monitor your small and large successes

• Keep track of what works and what doesn’t work.

• Certain strategies might be successful in other settings as well.

• Eventually you will develop a pool of resources that you can teach your child to access as part of their own coping strategies.

• Remember to reward yourself too!