Trips to the Doctor/Dentist

Going to the doctor can be a very stressful experience for people with autism spectrum disorder (ASD) and their caregivers. Below you will find; reasons why this experience may be difficult for a person on the spectrum, information to be aware of at the doctor and strategies that can be used to help improve the situation.

Possible reasons for disliking the experience

Fear of the unexpected


Although a visit to the GP can provide the structure that people with autism need, in that there is a definite routine involved, it can still cause anxiety. This can be due to the fact that in most cases it is unknown exactly what a doctor will do. The unstructured time in the waiting room and the other patients present can be difficult for a person with an ASD. The unfamiliarity of the consultation room and equipment used can seem quite daunting. Alternatively, negative experiences from the past and associations with pain can influence an individual’s future associations and fear of the experience.

Sensory difficulties


Sensory issues can be a large factor in a person with autism’s negative experience at the doctors.

Lights


Sensitivity to certain lighting can be a particular problem for people with an ASD. For instance strip fluorescent lighting can be experienced as painful and distracting.

Touch (tactile system)


If an individual is hypo-sensitive to touch they may have a high threshold to pain or temperature and not mind heavier pressure when touched. This could cause difficulty when being examined by the doctor as the person with autism may not appear to be in pain but could, for example, have broken a bone. They may be unable to decode the different body sensations to recognise it as pain.

They can display unusual responses to pain such as laughing, humming or stripping which may make it difficult for the doctor to recognise and identify the problem. It may be that change in behaviour is the only indicator that a person with an ASD is in pain.

On the other hand, a person with an ASD may be hyper-sensitive to touch. They may experience the slightest touch as uncomfortable or even painful. They will therefore withdraw from touch which can cause difficulties when a doctor is trying to conduct a physical examination. Materials used could also be a problem, for instance the paper sheet on the examination table, cotton wool or plasters may cause particular discomfort.

Noise


Some doctor’s offices use buzzers to indicate when it is a patient’s turn to see the doctor. They may also have music playing in a waiting room. Crying babies or children in the waiting room may also be quite noisy. For those with hyper-sensitive hearing, these types of noises can be magnified and become quite disturbing. Also with this heightened volume, surrounding sounds could become distorted. For the person with an ASD, this could cause difficulty in recognising sounds, such as a name being called for instance.

Personal space and body awareness


A crowded waiting room may be quite distressing for someone with an ASD who may need their personal space. Similarly close proximity to the doctor could be quite uncomfortable for the patient. Problems can also occur when trying to explain where pain is experienced. Those who have difficulty with body awareness may not be able to experience where different body parts are.

Communication


It can be a problem for patients with an ASD to indicate where pain is, due to communication difficulties. It may also be difficult for them to understand what a doctor is asking or to understand when the doctor is explaining what they are going to do to them.

Strategies

Preparation


It can help to prepare the individual as much as possible for their visit to the doctor’s. Marking the visit on a calendar using visual supports can help. Using flow charts to explain why they have to see the doctor may also be useful.
It may help to visit the doctor’s before the appointment to familiarise the person on the spectrum with the environment. Taking photos (for example, of staff or a building) can provide an object of reference when preparing at home. Using toy doctor’s sets at home can help to familiarise the individual with the equipment and its uses.

It may help to get the first or last appointment of the day to avoid waiting for too long and to book a double appointment as extra time may be needed. Afternoons tend to be a less busy time in doctor’s surgeries.

It may be worth checking if there is a quiet area that the person with an ASD can sit in if the waiting room is too much for them.

Prep the office for your visit


It may help to provide GPs or nurses at the office with information on patients with an ASD so that they are prepared for the visit:

It may also be worth letting the doctor know of possible triggers specific to the individual. This can include particular dislikes/likes they have, behaviour and communication strategies that work or interests they have. These may help the GP form a relationship with them. The GP may need to be informed of sensory issues so that the examination and equipment can be adapted accordingly (for example, replacing a paper sheet on the examination table with a cloth one). This information could be provided through a letter or phone call before the appointment.

Visual supports


It may help to provide visual supports explaining the process and what may be involved during the visit. This could include sequence cards, checklists or photos.

It may also help to use pain scales or a picture of the human body to help the person with autism communicate their pain.

Time indicators


Time indicators may also be useful whilst waiting for the appointment and during examination. Sand timers and clocks can be used as a distracter during things such as injections so that the person with autism can see a definite end.

Rewards


A reward system may help the individual with autism during their experience at the doctor’s. It can provide them with something to look forward to and enable them to see an end to the experience.

Comforters/distractors and relaxation techniques


Comforters/distractors can help the individual with an ASD with sensory issues, fear or boredom in the waiting room. These could include personal devices for listening to music, earplugs, glasses, books or favourite toys.

Demonstrating on others or toys to show what will happen during a physical examination can help to reassure an individual with an ASD.

Using objects such as stress balls can help during experiences of pain or discomfort.

Relaxation techniques such as deep breathing, counting, singing favourite songs, talking about a favourite interest or looking at favourite books/toys could also help during physical examination or treatments.

Reproduced by kind permission of The National Autistic Society “ www.autism.org.uk.

 

Dentist Visits

Going to the dentist can be a very stressful experience for those on the autism spectrum and their caregivers. Here are some strategies that can help to make the experience better.

Possible reasons for disliking the experience

Lack of understanding


Some people do not understand the purpose of going to see someone who looks into their mouth and uses strange equipment, whilst they are expected to lie on a chair with a large light shining on their face. They may not have understood the importance of having healthy teeth and gums and the consequences of not having regular appointments.

Sensory issues


One of the main anxiety triggers relates to sensory experiences. Mouths are extremely sensitive, and for a person on the autism spectrum, the sensation of a cold instrument entering their mouth could be very painful. In addition, the noise of the drills and cleaning instruments could also be a problem. Sometimes the taste of the mouth wash or the paste being used will also have an adverse impact. There may be other sensory factors that could cause distress, such as the dentists perfume, moustache, or the colour of their clothing.

Invasion of space


Dentists are one of the few professionals who we permit to enter our personal space. Most people find this uncomfortable but understand that the dentist needs to be so close in order to examine teeth. For people on the autism spectrum, this close proximity may be extremely distressing.

Strategies to help

The following strategies are dependent on the person’s level of understanding and their individual needs and should be adapted accordingly.

Preparation


As a result of past negative experiences, many caregivers understandably avoid telling the person with autism about their dental visit until the last minute or on the day of the appointment. But even though it may initially cause a behaviour pattern change, it is better in most situations to try and inform the person as early as possible. This can be difficult if their concept of time is poor. The use of visual supports (eg a calendar) can help.

If it is the person’s first visit to the dentist, you may like to take them to visit the building, to meet the dentist and meet other staff prior to any treatment. You may also like to show them the equipment which the dentist will use and how it works.

It is also important to prepare the dentist and their team by giving them as much information as possible about the person’s needs so they can make adjustments to the procedure.

Try to ensure that the appointment is the first of the day – maybe even book a double time slot. This reduces the chance of the dentist running late and provides enough time not to feel rushed.

Social stories


Social stories are an effective way of providing information about an activity and the reason for doing it, eg what happens at the dentist and why we need to go for a check-up.

Story books


There are lots of basic story books about visiting the dentist which may help you, eg
I know why I brush my teeth
Topsy and Tim go to the dentist
Sensitive Sam visits the dentist.

Breaking down the visit


You could use visual supports such as a sequence of pictures or photos that show the different steps involved in the dentist visit. This could help the person to know which is coming next and when each step is finished. You could also include a reward picture at the end of the sequence so they have something to look forward to.

Time indicators


Use visual or auditory timers (eg sand timers, buzzers, a mobile phone alarm) to help the person to understand that this experience has a time limit.

Comforters/distractors


Letting the person take comforters into the dentist’s surgery could help to occupy or distract them. For some people, listening the music on headphones, or having music in the background, can act as a good blocker.

Sedation


For some people, the experience of visiting the dentist is so distressing that it may be necessary to consider sedating them. If you feel this is the case, you will need to talk to your dentist and a medical professional to discuss the options.

Reproduced by kind permission of The National Autistic Society “ www.autism.org.uk.