Visiting the Doctor and Dentist: Some intervention strategies to maximize success!

1. 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

2. 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

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

4. 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.

5. 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

6. 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)

7. 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.

8. 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)

9. Come Armed!! • Bring material/items to address sensory issues • Head phones; fidget items; weighted blankets • Keep bag o’ tricks as distracters

10. 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!

11. 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

12. Priming • Practice with your child-in a relaxed setting (no demands) • Go through what they might experience during the visit.

13. 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

14. Read Some Books!!! • Read books about going to doctor/dentist • Watch videos that deal with doctor visits

15. An Array of Visual Supports

16. 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!

17. 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

18. 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!

19. 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

20. 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

21. Tell them what to do vs. what not to do! • Use clear, concise, specific instructions • Ensure expectations are clearly understood • Reduce ambiguity/uncertainty

22. Coping Skills • Prior to the event, during teachable moments • Relaxation techniques • Access preferred/calming materials • Communication skills • Teach coping skills

23. 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!

24. 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!