Visiting the Doctor and Dentist: Some intervention strategies to maximize success! Jamie D. Bleiweiss, M.A. Advanced Doctoral Candidate, SUNY Stony Brook Angela Mouzakitis, M.S.Ed., BCBA Advanced Doctoral Candidate Queens College

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 Environmental Factors: The Waiting Room...

Paper on the exam table Unfamiliar people poking & prodding Cold room (temperature) Lighting may be uncomfortable Antiseptic/bleach smell Environmental Factors: The Exam Room

– History Conditioned response from previous visits (associate doctor’s office with shots, pain/illness, blood drawn) – Pain/discomfort caused by the exam. – Intrusiveness of some of the procedures. Additional Factors Associated with Visits

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 homework  Advanced 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…”approach  Access 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!