On the Spectrum

Rick Johnson, for HealthLeaders Magazine , April 8, 2010
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Although patients with ASD are often complex and create challenges to proper diagnoses, there are some commonsense approaches to dealing with autistic individuals that are sometimes overlooked in the hectic healthcare environment.

Just by changing their routine and bringing them into a healthcare setting, autistic individuals will likely be stressed. Many have sensory processing issues that can increase their anxiety. On top of all this, a medical problem could cause the patient to act out in a way that might appear threatening or self-injurious. The last thing a patient with ASD needs in this supercharged situation is unwanted probing or medical professionals attempting to run through a battery of questions.

"You'd never put an otoscope in a blind child's ear without letting them feel it, so they know what's coming next," says Hyman. "The techniques require a little bit of thought but are not necessarily expensive."

Charlot provides training to physicians and ED workers in the UMass system. She recommends that providers spend extra time making sure to get an accurate medical and medication history. The patient might not have the language skills to give an accurate history, and caregivers should listen to family members about the patient's medical history. She also emphasizes the importance of trying to understand the patient's baseline behavior.

"People with ASD can have a minor life event that seems like a big cognitive behavioral meltdown," says Charlot. "You don't want to overreact to that medically."

The Autism Society of America recognizes National Autism Awareness Month in April, so it is a good time to remind healthcare professionals of the special needs and care that people with ASD require. People on the autism spectrum can often have greater medical needs than the general population, but without healthcare professionals who are able to interact effectively with ASD patients, access to care could be delayed or denied. Clearly that is an outcome that no healthcare professional wants.

Rick Johnson is editorial director for HealthLeaders Media. He may be contacted at rjohnson@healthleadersmedia.com.
Your Next Patient Has Autism

Here are some techniques to use with children who have disorders on the autism spectrum:

Choice: If possible, offer a choice; for example, "Would you like me to look in your right ear or your left ear first?"

Distractions: Questions: Ask questions about things they might logically be interested in, like pets or other family members. Toys or objects: Encourage the child to play with toys or objects he or she enjoys. Offer a safe object to explore. Counting and singing: If the child will count or sing, these are excellent distraction techniques.

Imitation and role modeling: Using a doll and other objects to represent the patient and medical apparatus, the child could be reassured about the procedure and given mastery over it. For instance, a pen could stand for a syringe and a vaccination could be modeled using the pen and the doll. Then the child could give a "vaccination" to the doll, and then the clinician could give the actual vaccination to the patient.

Rewards: Reward the child for complying with a request. Do not assume you know what is rewarding to the child. Ask the parent or caregiver what is rewarding to this particular patient. Reward any attempt at the behavior you are asking for from the child, and ignore any behavior that makes the target behavior impossible.

Easy requests, then difficult requests: Ask the child to do something you know he or she can do and is willing to do before you ask for more difficult behavior. For instance, say to the child, "Show me your ears," if you are sure the child can do that. Then follow with your request, "Open your mouth and stick out your tongue."

Visuals: Since some children with autism or disorders on the spectrum have language difficulties, procedures could be explained using pictures showing what will happen and what will be expected of them. This is effective if the child is already used to communicating through pictures.

Body hold techniques: Many parents or caregivers are already well trained in these techniques, and will know what techniques work well with their child. They can be enlisted for those procedures in which the child needs to be immobilized.

Pain management: Offer analgesia such as EMLA cream for venipuncture or injections; this requires 45 minutes for maximum effectiveness. Offer distraction—for example, cover with shirtsleeve to prevent child from removing.

Copyright: North Shore-LIJ Health System, www.northshorelij.com. Used with permission.

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