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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

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

slide2
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
slide3
Environmental Factors:

The Exam Room

  • Paper on the exam table
  • Unfamiliar people poking & prodding
  • Cold room (temperature)
  • Lighting may be uncomfortable
  • Antiseptic/bleach smell
slide4
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.
what can you do
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
slide6
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)
do your homework advanced preparation is an asset
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.
things to consider prior to visit
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)

slide9
Come Armed!!
  • Bring material/items to address sensory issues
    • Head phones; fidget items; weighted blankets
  • Keep bag o’ tricks as distracters
slide10
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!
slide11
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
slide12
Priming
  • Practice with your child-in a relaxed setting (no demands)
  • Go through what they might experience during the visit.
slide13
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
slide14
Read Some Books!!!
  • Read books about going to doctor/dentist
  • Watch videos that deal with doctor visits
slide16
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!
slide17
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
slide18
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
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
more visual supports
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
tell them what to do vs what not to do
Tell them what to do vs. what not to do!
  • Use clear, concise, specific instructions
  • Ensure expectations are clearly understood
  • Reduce ambiguity/uncertainty
slide22
Coping Skills
  • Prior to the event, during teachable moments
    • Relaxation techniques
    • Access preferred/calming materials
    • Communication skills
    • Teach coping skills
slide23
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!
monitor your small and large successes
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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