Taking the Work Out of Blood Work: A Provider's Guide

Distraction

What is distraction?

"Distraction" means taking your patient's mind off stressful events, thoughts, or emotions and putting attention on other positive thoughts or activities. In other words, distraction means to "change the channel" of your patient's attention. When a patient comes in for a medical appointment, he or she may be on the "thinking about that needle" or "I wonder how badly this procedure is going to hurt" channel. As providers, we want to help patients to "change the channel" to something more like "one of my favorite toys" or "what are we going to eat for dinner after this appointment?" channel. Using a concrete example like "changing the channel" may be easier for your patient with ASD to understand rather than discussing the concept of distraction in general.

How to Use Distraction with Patients with ASD

• Get to know the patient. Ask the family about what the patient is interested in or what holds his or her attention (e.g. a favorite toy, a particularly engaging topic of conversation, a game that does not require movement).
• Encourage parents to practice distraction activities before the appointment so that your patient is comfortable using them.
• Encourage parents to bring items that will help distract your patient.
• Use visual supports to help cue your patient to start using the distraction strategies and to keep his or her attention on the distraction activities.
• Have toys or distracting objects (e.g. particularly anything with strong sensory properties) available and/or ask families about topics that are especially engaging to the patient.
• Play their favorite music or video or sing a silly song.
• Encourage parents to engage their child in distracting activities before the procedure begins.
• In addition to encouraging the parents, encourage your staff to engage the patient in distracting activities, toys, or topics of conversation before the procedure begins, and if possible, before the patient becomes upset.
• Praise your patient's effort in paying attention to and complying with distraction techniques.

Ideas for Distraction

The following are useful tools, toys, or ideas to have available in the clinic for use by patients and families during medical appointments:

Characteristics of Good Distraction Supplies

• Familiar and liked by patient
• Stimulating and novel
• Portable
• Allowed in hospital or clinic rooms
• Can be used with minimal movement by patient (and with one hand, if possible)
• Stimulating
• Able to sustain patient's attention

Examples of Good Distraction Supplies

• Portable device to play videos or music that the patient likes
• Games that require little or no movement that the patient likes (e.g. Rock, Paper, Scissors)
• Laughter (e.g. a game where you think of different types of laughter and imitate what they might sound like)
• Favorite toys or stuffed animals that can sustain attention
• Toys that are visually stimulating (e.g., toys that light up, spin, or have interesting colors or designs)
• Tactile toys or objects (e.g., toys with interesting textures, stress squeeze balls, toys that vibrate)
• Novel toys that are visually interesting, make innocuous noise, or are tactile (e.g. rain sticks, glow sticks, relaxation toys, pinwheels, bubbles)
• Relaxation techniques (e.g., deep breathing or progressive muscle relaxation)
• Topics of interest to the patient. Often patients with ASD will have a restricted interest. Engaging the patient in conversation about this topic can be very distracting for them (e.g., trains, elevators, a particular television show or movie).

Distraction Tools to Use During Blood Draws

• Sensory objects to put on the site of the blood draw (e.g. cold pack, vibrating toy)
• EMLA cream or sprays, if available
• Other additional, specific tools for blood draws (e.g. "Buzzy" buzzy4shots.com is used at some hospitals)

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These materials are the product of on-going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks. It is supported by cooperative agreement UA3 MC 11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. Website hosting, design, and maintenance provided by the Vanderbilt Kennedy Center.