Why appointments are hard for children with autism spectrum disorder
Each child with autism spectrum disorder (ASD) is different. But many children with ASD have social and communication difficulties, a preference for set routines, and sensory sensitivities. This means that appointments in unfamiliar places with unfamiliar people are often difficult for them.
Children with ASD tend to have trouble understanding and expressing their feelings. So when your child goes to an appointment, she might be upset by not understanding why she's there. She might not understand the questions she's being asked. She might show her confusion or anxiety through her behaviour - for example, by stimming, refusing to cooperate or being aggressive.
Changes in routine can be very difficult for children with ASD. For example, if you take your child to an appointment at a time he knows he should be at school, he might feel upset. You might notice that he's asking lots of repetitive questions or behaving restlessly.
And children with ASD often have sensory sensitivities to light, loud noises or touch. Going to a busy, stimulating place like a clinic or the hairdresser can be very challenging for them. Your child might respond to the sensory overload by covering her ears, crying or trying to leave the room.
Strategies for before appointments
The strategies below can help your child feel more comfortable about visiting the GP, dentist or hairdresser. You can use them to prepare your child for an experience that's unfamiliar or confusing. You can also use some of the strategies during the appointment itself.
Talk to the professional
Talking to your GP, dentist or hairdresser about your child's needs before you go can help the professional be better prepared and able to provide a good service for your child. If the professional doesn't want to talk to you beforehand, it's OK to choose someone different. It can help to ask for a professional who's had experience with children with additional needs.
Explain any sensory sensitivities that your child has. If your child has trouble understanding what people say, you can mention this too. For example, you might say, 'It often helps if only one person speaks at a time, slowly and clearly, using simple language in a soft, calm voice'.
Visit before the appointment
Ask the professional if you can visit briefly beforehand so your child can meet the professional and see where he's going. You could also drive past a couple of times in the lead-up to the appointment to remind your child. You could say, 'There's the hairdresser. You're going there on Wednesday'.
Choose an appointment time
If your child finds waiting or busy spaces difficult, try to book the first appointment of the day. If your child needs time to settle before she can be examined, you could ask for a longer appointment. You could also ask for an appointment on a quiet day of the week.
Use Social Stories™
A Social Story™ can help your child understand what's going to happen. If you have an appointment with a professional who specialises in ASD, the professional might be able to send you a Social Story™.
For example, a Social Story™ for going to the hairdresser might look like this:
- Everyone's hair grows and needs cutting every few weeks. Usually, they go to a hairdresser to get their hair cut.
- Lots of people I know get their hair cut, like Sam. She goes every month to the hairdresser and gets her hair cut safely.
- At the hairdresser's, people get their hair washed while sitting in a special chair, not in the bath like at home. Then the hairdresser asks them to sit in another chair and starts cutting their hair with scissors.
- Sometimes the hairdresser uses clippers to cut people's hair. These make a funny buzzing sound and can tickle you. This is OK. The clippers don't hurt.
- The hairdresser will talk to me while she's cutting my hair, and I can look at my reflection in the mirror while she's cutting my hair.
- When my haircut is finished, I will look fantastic!
Try to build in possible changes in plans - for example, 'I might have to wait for a while before I see the doctor'. This also gives your child an idea of what to expect.
You could read the story with your child every day for a few days before the appointment and again immediately before.
Use pictures or other visual supports
You might use photos, videos, symbols, pictures, words or other visual supports to show your child what's going to happen at the appointment.
For example, you could make a visual schedule with photos to show your child what will happen at the dentist. You might take photos of the dentist's front door, waiting area, treatment room and someone having teeth examined. Before you go, you can show this visual schedule to your child.
You can also use this strategy during the appointment to show your child what will happen next. Ask the professional to put a sticker on the schedule at the end of each step and praise your child.
Video-modelling can also help. You could try looking on YouTube for videos of going to the dentist or hairdresser. Just remember to watch them yourself first to check they're suitable for your child.
You could also use a picture symbol on a calendar, so your child knows what day he's going to the appointment.
There are lots of storybooks and DVDs that can help you talk about going to the GP, dentist and other places. Some include characters like Dora the Explorer or Elmo. You should be able to find some at your local library.
Watch someone else
You can help your child understand what's going to happen by letting her watch someone else first. For example, she could watch her brother, sister or friend have a haircut. You might need to do this several times before your child feels comfortable to stay in the room or get into the hairdresser's chair.
Arrange a home visit
A mobile hairdresser who comes to your home might be a good idea. Your child can get his hair cut in a familiar place, without the sensory overload of a salon.
Use a sedative
For some children who get very distressed during appointments, dentists can prescribe a mild sedative to help them cope with the treatment. Some children who might get very distressed (and hurt themselves or others accidentally) might have work done under a general anaesthetic.
Get professional help
Some children might need a more structured approach to help them feel comfortable about going to an appointment. This will involve breaking the appointment down into several small steps and working on one step at a time.
For example, steps for a visit to the hairdresser might include sitting in a chair for five minutes, having hair washed, tolerating one snip of scissors and so on. There might be rewards each time your child completes a step. Finally, the steps can be put together so that your child successfully manages the whole process.
This type of approach should be done in consultation with a psychologist, an experienced Applied Behaviour Analysis (ABA) practitioner, a Board Certified Behaviour Analyst®, or another professional who's skilled in using behaviour interventions.
Strategies for while you're waiting
Waiting to see a doctor, dentist, hairdresser or other professional can be boring and frustrating. The strategies below might help.
Use a visual timer
Visual timers can help some children understand how long they'll be waiting. These timers show how much time has passed. You can buy timers or even use a smartphone app. But waiting times at GPs or dentists can be unpredictable, so be careful with this strategy.
Take things to do
Take an appointment 'survival kit' with you. This could include one or two favourite small toys, a book or audio book, some favourite music or a favourite program on a handheld device, snacks and a drink.
You can also use this strategy during the appointment to distract your child and help her feel more comfortable.
Strategies for during appointments
If you notice that your child is becoming overwhelmed, take a step back and think about the environment. Are there any specific sensory triggers? Is there too much talking? Let your child have a break while you think of a strategy with the professional.
These other strategies can also help you get through an appointment. They're described in more detail above:
- Use pictures or other visual supports.
- Take things to do.
- Get professional help.