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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. Environmental Factors: The Waiting Room... .

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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


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Environmental Factors:

The Waiting Room...

  • 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

  • Unpredictability

    • Unfamiliar place & people

    • Unsure of routine

  • Toys present sharing

  • Unexpected/sudden noises  coughing, sneezing

  • Long wait


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Environmental Factors:

The Exam Room

  • Paper on the exam table

  • Unfamiliar people poking & prodding

  • Cold room (temperature)

  • Lighting may be uncomfortable

  • Antiseptic/bleach smell


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Additional Factors Associated with Visits

  • 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.


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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


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Preparing for the Visit

  • 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)


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Do your homeworkAdvanced preparation is an asset!

  • Call ahead of time to learn the routine

    • Typical wait time?

    • Can accommodations be made?

    • Let them know about your concerns ahead of time.

  • Familiarize yourself with the staff

    • How experienced /knowledgeable they are about ASDs

    • Are they open to education?

    • Tell them about your child.


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Things to consider prior to visit:

  • 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)


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Come Armed!!

  • Bring material/items to address sensory issues

    • Head phones; fidget items; weighted blankets

  • Keep bag o’ tricks as distracters


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Social Stories

  • 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!


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Power Cards

  • 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


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Priming

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

  • Go through what they might experience during the visit.


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Pretend Play

  • 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


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Read Some Books!!!

  • Read books about going to doctor/dentist

  • Watch videos that deal with doctor visits



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Schedules and Checklists

  • 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!


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Activity Schedules

  • 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


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  • Example: see the doctor play favorite computer game!


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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


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More Visual Supports!

  • 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


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

    • Use clear, concise, specific instructions

    • Ensure expectations are clearly understood

    • Reduce ambiguity/uncertainty


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    Coping Skills

    • Prior to the event, during teachable moments

      • Relaxation techniques

      • Access preferred/calming materials

      • Communication skills

      • Teach coping skills


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    Praise and Reinforcement:

    Let them know when they are on the right track!

    • 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!


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    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!


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