Relaxation
When children with ASD think about going to the doctor, many become worried about the visit. Blood draws can cause a child with ASD to become even more anxious since they are not always part of his or her routine doctor’s visits. You can help by teaching your patient simple relaxation techniques.
Research shows that stress leads to increased tension, which contributes to higher levels of pain.
Relaxation can significantly reduce children’s stress and pain. To help keep your patient calm during a procedure or visit, you can use, or coach the parent to use, simple relaxation and distraction techniques.
Deep Breathing*
Breathing techniques are very important for inducing relaxation and preventing anxiety or irritability. Diaphragmatic breathing, or “belly breathing,” is a wonderful way to help patients relax by slowing their breathing and heart rates and normalizing their blood pressure. The ultimate goal is for patients to be able to relax quickly when faced with stressful situations. However, the best way to achieve this is through practicing breathing techniques on a daily basis. Encourage parents to practice deep breathing with their child regularly leading up to stressful visits.
Teach your patient to take a deep breath, hold the breath for a few seconds and then release it. For young children, blowing a pinwheel or bubbles can help them focus on their breathing and distract from their stress.
Deep Breathing Script: for older children or children with more highly developed verbal skills
Using Bubbles or Pinwheels to assist with Deep Breathing: for younger children or children with less developed verbal skills
Visualization
Encourage your patient to imagine something nice and visualize that scene with eyes closed. Tell the child to think about the smells, sounds, and touch of what is imagined. Parents may use picture or objects to remind their child of favorite places or activities to help this strategy be more successful.
Music
Encourage parents to bring and play their child’s favorite music or a sing a silly song to distract them.
Muscle Tensing*
This is a method of having your patient relax by focusing on different muscles of the body and alternatively tensing and relaxing them one at a time.
Picture board to use with muscle tensing (pdf)
*If your patient has lost consciousness during prior blood draws, deep breathing or muscle relaxation may be contraindicated.
Tips for Using Relaxation with Patients with ASD
Professionals may find that typical approaches to applying relaxation techniques are not always effective in working with children with ASD. The difficulties related to each of the three main components of autism spectrum disorders – social impairments, communication deficits, and restricted interests/repetitive behaviors – may make conventional approaches more difficult.
Socialization
Individuals with ASD may misinterpret social cues during their daily interactions and may be less responsive to abstract social expectations. This may decrease the awareness of the need to implement relaxation techniques, the social motivation to apply these strategies, or the likelihood that they may spontaneously imitate the calm behaviors modeled by others.
Communication
Persons with ASD often have difficulty understanding and following verbal directions and may have limited communication skills to express their wants and needs to others effectively. This may decrease their ability to express their emotional state and to comprehend others’ suggestions that they may need to calm down.
Behaviors/Interests
People with ASD have difficulty interpreting their internal state, quantifying abstract emotions, or effectively using self-regulation strategies, and may have very intense or unexpected reactions to certain stimuli. Because of this, it may be hard for individuals with ASD to recognize the internal cues necessary to initiate the use of relaxation strategies independently and it may be difficult for other people to effectively implement these strategies after the individual with ASD has become emotionally aroused.
Certain changes can be made in order to effectively use these strategies with your patient.
Practice Makes Perfect.
Try to teach relaxation strategies at scheduled times in the day instead of when your child is already anxious. Reward your child immediately after practicing relaxation. This encourages continued practice and adds another positive connection with relaxation. Later when you use these strategies when your child is worried, he or she will connect it with something positive. Your child will trust that something good will follow, just as it has during practice sessions.
Prevent instead of react.
Try to use these strategies before your child becomes worried, instead of only using them to calm your child down after becoming upset. It is best to use these beforehand (for example, at home before going to the doctor’s office, in the car before going in to the office, in the waiting room), even if your child does not seem worried at that point. It is also helpful to use these strategies when mild signs of anxiety are noticed (for example, your child becoming fidgety or begins making anxious comments).
Using visuals or concrete tools.
It is important to use visual supports (link to visual supports section) (for example, pictures) or other concrete cues while putting relaxation strategies in place. Use them as a quick reminder to your child that it is time to use these strategies. Visual supports can also be used to explain in more direct ways what you want your child to do and to help your child rate how anxious he or she may be. This will be more helpful than trying to explain this through talking.
