There is an important skill that every child with ASD needs to learn and practice – going to the doctor. I have several patients who have actually been expelled from their practitioner’s office for disruptive behavior, including the neurologist and pediatrician! That’s pretty extreme, considering that the medical specialist should be familiar with what happens when any child enters the terrifying atmosphere that promises fear, discomfort and pain.
So, when a patient who suffers from difficulty with receptive and expressive language is taken to a place of such foreboding, it isn’t difficult to imagine the anxiety and agitation that will inevitably accompany that fateful trip. Often, the child has been prodded and ‘stuck’ many previous times, then gets placed in rooms with strangers, too much light, unusual noises and odors that make even the most neuro-typical adult tremble in anticipation of the too familiar or the unknown.
Whether it is the ER, the pediatrician’s office, or another exam room, the child’s behavior will have a profound effect on what the practitioner decides is wrong and how to proceed. If the child is screaming and acting out from the onset, the doctor may not even have the opportunity to listen to the parents’ story, let alone perform an adequate physical exam. Patients who otherwise may not even have a fever or rash may develop symptoms just because of the unusual atmosphere. How can a doctor decide if the eardrums are inflamed when merely placing the speculum into the patient’s ear canal causes so much agitation that the procedure itself leads to irritation and redness? Listening to the heart and lungs becomes a futile effort in a sensory-heightened, fleeing individual.
To be sure, there are measures that professionals can take to mitigate the impending storm. The office environment should be designed to be more serene with soothing lighting and relative quiet when possible. The child should be provided with an area to play and get accustomed to the surroundings. It is desirable to schedule the most disruptive patients when there are more staff members to assist and fewer strangers in the waiting room.
The doctor needs to speak with the family first, and let the child get used to the situation. The clothes that professionals choose don’t have to be the white or blue uniforms that suggest bodily invasion. Forget about lab coats, and neckties are an unwelcome distraction (and, they become very uncomfortable when pulled or urinated upon). Because ASD children are often smarter than outsiders believe, it is very helpful to speak in a matter-of-fact manner, even to the youngest or least aware patients. Finally, I let my kids touch and play with the medical equipment before applying it to their body. This trick has resulted in the need to replace some equipment; but with the help of eBay, it’s not too expensive.
Parents can also do things that will assure a more effective visit. First, please purchase a toy doctor’s kit (no small parts, of course) and have the children practice. Second, ask the therapists to rehearse a physical examination. If the child can’t tolerate such a mock exam, it’s not going to improve when the real thing occurs. Next, the family’s ability to provide a calm and reassuring pre-trip experience is paramount. Statements such as “This is the nice doctor” or “This doctor isn’t going to hurt you” are rarely believed. Finally, the visit is really not the time to correct minor problems (“Sit up straight”) or show off behaviors (“Show the doctor how you…”). Such requests are confusing and only serve to increase anxiety.
A thorough interview with the family and effective physical examination will ultimately have a positive effect upon your child’s health. There is less likelihood that unnecessary antibiotics will be prescribed, just to get the patient out of the office. There is more opportunity to arrive at an accurate diagnosis. For autistic children who cannot speak, it is the best chance that the practitioner will see the child as a whole human being and think about what is going wrong to cause ill health.