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Behavioral Compliance Training for Children
with Autism to Tolerate Routine Medical Examination
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In the last section, we discussed Two Goals of Floor-time. These included following the child’s lead and bringing the child into a shared world.
In this section, we will discuss doctors and long waits. This will include flexibility, appointments, and during sessions. What suggestions do you make to clients who have to wait in doctors’ offices with their autistic children for long periods of time?
Amelia, age 43, was the mother of Delaney, age 7, who had mild autism. Amelia stated, "I need to start Delaney with a new doctor since our last one retired. I’m not sure how to select one, though, because we’re going to a bigger practice, and they don’t have a department for autism specifically.
"I’m really kind of nervous about Delaney, though, because when we introduced her to our last doctor for the first time, Delaney was nervous and restless, and she constantly wanted my attention. She started to bang her head against the wall and to throw the toys I had brought for her to play with. How can I choose a new doctor and help Delaney warm up to him or her without these issues?"
What might you have suggested to Amelia?
I stated, "As you have clearly experienced, interactions concerning someone with autism can become emotionally charged, and therefore stressful. To promote positive relations with your doctor and reduce stress, you might consider a few preventive measures."
3 Preventative Measures for Waiting
♦ #1 Flexibility
I stated, "First, let’s discuss flexibility. Autism may influence any area of development. Therefore, you will probably want a physician who is knowledgeable about the syndrome and its effects. You might also consider how comfortable this person might be with children and how adjustable he or she is to someone like Delaney who requires special care. You might ask a nurse if a specific doctor treats children with autism before committing to an appointment with him or her. Of course, you’ll want to establish the doctor’s credentials, fees, insurance considerations, and appointment policies.
It might be helpful to determine the size of the practice. A smaller practice might allow Delaney to become accustomed more easily to the people and surroundings. Familiarity can make Delaney less fearful. You may also want to interview prospective doctors without Delaney. Decide whether the physician is willing to work with you to make visits less traumatic for Delaney. Is the doctor uncomfortable with your questions? Are responses understandable? What approach does the doctor suggest for examining an anxious child?" Would you have suggested that Amelia find a flexible doctor?
♦ #2 Appointments
I found it helpful to also state to Amelia, "As I’m sure you know, most children dislike delays, but Delaney might find the slightest wait unbearable. I suggest that you schedule appointments for when Delaney is more adaptable, whether morning or afternoon or before or after a meal. Otherwise, you might want to request the first appointment of the day or after lunch to reduce waiting time from patient backlog. If the doctor is part of a clinic, you might ask at which time of the day there are the fewest patients.
You might try calling before leaving home to see if the doctor is on schedule or an emergency has arisen that would delay your appointment. Then, be sure to be on time yourself. Try to arrange the number and length of appointments your child can handle. Maybe Delaney will need several sessions with the doctor. You might experiment to decide whether Delaney performs better with a cluster of appointments on one day or scattered appointments. Which can both of you handle best, one long stressful day or several shorter sessions, possibly each with outbursts?"
I continued to state, "Prepare Delaney for what will happen. This will help to reduce anxiety. You might choose to incorporate the doctor’s visit into Delaney’s behavior modification routine. Try to identify the behaviors that must occur and Delaney’s rewards for these behaviors. Offer rewards that will satisfy Delaney. Praise Delaney continuously for good waiting behavior.
"Also, ask for a quiet examining room to wait in if Delaney becomes too excitable to stay in the waiting area. If you think she’s going to be particularly restless, you might want to plan ahead. Of course, even with the best preparations, you may still encounter delays. You might bring Delaney’s favorite toys. You can occupy waiting time with special activities together. Also, pack snacks for an extra long wait."
What might you have suggested to Amelia regarding scheduling appointments for Delaney?
♦ #3 During Sessions
I stated, "Third, in addition to flexibility and appointments, during sessions, you will want to help Delaney adjust to the doctor. Remind the physician to move slowly. Ask him or her if Delaney can handle instruments and just get to know the doctor for a while before an examination.
You might want to bring a prepared list of questions to save time and take notes. You might also ask the professional for printed information to explain further what is said. Don’t be afraid to request as much information as you need to understand and plan for your child. You have a right to explanations in understandable terms. You are the consumer.
Finally, as you have experienced, children rarely enjoy sitting through adult conversations. Delaney may be even more distracted. You might take someone with you to the appointment who can keep Delaney busy while you talk with the doctor, or ask if a nurse can supervise her out of the office. You may need to schedule another appointment or telephone call to talk without interruption."
Do you have an Amelia who has an autistic child who has difficulty adjusting to new doctors? What might you have said to her in a similar situation? Would playing this section during a session be beneficial?
In this section, we discussed doctors and long waits. This included flexibility, appointments, and during sessions.
In the next section, we will discuss Simple Play for Toddlers and Preschoolers. This will include playing with toys, toy match, borrowing and tackling spontaneous play.
Peer-Reviewed Journal Article References:
Blackman, A. L., Jimenez-Gomez, C., & Shvarts, S. (2020). Comparison of the efficacy of online versus in-vivo behavior analytic training for parents of children with autism spectrum disorder. Behavior Analysis: Research and Practice, 20(1), 13–23.
Cavalari, R. N. S., DuBard, M., Luiselli, J. K., & Birtwell, K. (2013). Teaching an adolescent with autism and intellectual disability to tolerate routine medical examination: Effects of a behavioral compliance training package. Clinical Practice in Pediatric Psychology, 1(2), 121–128.
Hassan, M., Thomson, K. M., Khan, M., Burnham Riosa, P., & Weiss, J. A. (2017). Behavioral skills training for graduate students providing cognitive behavior therapy to children with autism spectrum disorder. Behavior Analysis: Research and Practice, 17(2), 155–165.
What are three things to think about when considering doctors and long waits?
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