Responding During the Visit
Accommodations That Can Be Made
Children with ASD may need additional accommodations during clinic visits in order to ensure success. Although parents may implement strategies as well, having clinic staff facilitate the use of these will be beneficial. Ideas include:
- Minimizing the waiting time in environments that can be over-stimulating or anxiety provoking (e.g., busy waiting rooms, phlebotomy labs).
- Ensuring that adequate resources are available. Recruit additional staff to participate with complex patients.
- Using visual supports or Social Stories™. Discuss with parents the potential use of these in advance of visit.
- Providing appropriate distraction toys that match the sensory needs of a particular patient.
- Having appropriate rewards available.
- Considering any additional accommodations based on parent input or the clinical team’s experience with a particular patient.
- See the Environment section for more details on specific modifications that can be made at each step in the appointment.
When to Change the Pace of the Procedure
In general, procedures should move quickly and efficiently to avoid escalation of anxiety or irritability. The clinical team will have to use judgment to determine if taking extra time to explain, distract, or comfort would be beneficial. Concerns about safety or comfort should prompt careful consideration. Taking a short break or slowing the pace of a routine procedure may be necessary. This may allow more time for the use of relaxation or distraction strategies. The team should discuss ahead of time the types of scenarios that would change the course of the procedure. For example, a child with increasing agitation may benefit from the implementation of guided relaxation techniques before proceeding.
When to Stop or Reschedule the Procedure
Although the information that results from the phlebotomy and laboratory analyses may be clinically important, the clinical staff must constantly evaluate the benefits and risks of continuing a procedure. The clinic staff must use their clinical judgment to determine if a procedure should be stopped or postponed. For children with ASD, there are many reasons to consider discontinuing a routine procedure.
- The results are not clinically important. Before ordering a test, a practitioner should consider how they will use the information for clinical decision making. The practitioner and the clinic team should be clear about the priority of the situation: routine, urgent, critical.
- Insufficient staffing or equipment. The clinic staff should consider discontinuing a procedure if there is not enough staff to safely execute a procedure or readily respond if additional help is needed. Staff training and level of experience with patients with ASD is an important factor in deciding the composition of the team. The child's parent is a critical part of the team, but it should not be assumed that the parent is physically able to help with the process.
- Increasing agitation or aggression. Increasing agitation or aggression may put the patient or staff members at serious risk for physical injury. If the risk cannot be alleviated, the procedure should be stopped. Additional equipment, additional staff, or additional planning may be necessary before re-attempting the procedure.
- Creating a negative association for future procedures. Completing a procedure despite the patient showing signs of severe anxiety or agitation may cause the patient to have a negative association with these types of procedures in the future. These feelings may extend to other procedures conducted at your practice and other medical settings and may make future medical visits difficult to complete and anxiety provoking for the patient.
