Pediatric providers are accustomed to patients who are anxious about their doctors’ visits. The prospect of temporary separation from a parent and fear of the unknown or of a painful shot can trigger anxiety in many young patients. For children with autism spectrum disorder (ASD), these fears can be compounded by the additional challenges of sensory issues, aversion to physical contact, or a change in routine and can lead to behaviors that make for a challenging office visit for all involved.
The good news is that there are small things that providers can do to make patient visits more positive and productive. Reducing negative experiences in a medical setting during childhood makes it more likely that individuals with ASD receive appropriate preventive medical care throughout their lifetime and that adults with ASD will continue to make and keep regular medical appointments.
Throughout CHOP’s inpatient and outpatient clinics, we’re implementing procedures to better support staff and patients with ASD to create a smoother patient flow for all. Ask critical questions at the time of scheduling:
- Does the child have a developmental or behavioral diagnosis that staff should know about?
- Does the child have any special communication needs?
- Does the child usually have difficulty with going to the doctor, dentist, haircuts, or similar appointments?
If any of these questions elicits a positive answer, it should be a cue to build in an extra time cushion around this visit and to ask a few follow-up questions to understand specific needs or triggers. Some specific questions your staff can ask are:
- Does the child do best following a rigid routine, and if so, is there a time of day that would fit that routine best?
- Are there sensitivities to light, sound, or touch?
- Does the child react to specific triggers?
Based on these answers, consider small adjustments you might make during the child’s visit, such as trying to minimize wait times, dimming lights, or scheduling during a quiet time of the day.
Let parents know what to expect:
- Send paperwork and questionnaires in advance to minimize wait times.
- Discuss specifics about what will happen during the visit, so parents can help prepare their child.
- Ask parents to bring along appropriate distractions, comfort items, or rewards/reinforcers as well as any special communication devices the child may use.
- Ask if there are specific things that help calm down the child when they are anxious.
During the visit:
- Keep a sensory toolkit of toys (squishy, light-up or spinning) and games ready in your office and have it handy in case a distraction or soothing prop is needed for an anxious child.
- Go slow and take some extra time if needed for breaks or to help patients acclimate to the environment or procedures.
The way this visit goes will impact future office visits with you and other providers. Particularly for individuals with ASD, difficult experiences with healthcare visits as children carry into adulthood, so creating positive experiences really has a life-long impact.
CHOP has resources to help patients prepare for visits that may be helpful for you. At chop.edu/autism, go to the Resources tab to find some short videos that can help your child prepare for an inpatient stay, X-ray, EEG, or surgery. Autism Speaks also has some helpful toolkits used throughout its Autism Treatment Network, in which CHOP participates.
References and suggested readings
Tips for Treating Patients with Autism. Today’s Hospitalist website. Accessed May 18, 2017.
Your ATN@Work: Easing clinic visits for kids with autism. Autism Speaks website. Accessed May 18, 2017.
CAR Autism Roadmap™ article: “Going to a Medical Appointment.” Center for Autism Research website. Accessed May 18, 2017.
CHOP Autism Integrated Care Program Resources. Children’s Hospital of Philadelphia website. Accessed June 8, 2017.