Individuals with Autism are likely to become avoidant, non-compliant, and may protest with negative emotions when it comes to events such as: medical or dental procedures, haircuts, and eye exams (Buckley et al., 2020; Cavalari et al., 2013; Conyers & Miltenberger, 2004). Behavioral techniques called desensitization, graduated exposure, positive reinforcement, stimulus shaping, and modeling are used to help increase the levels of tolerance related to the fields and others similar listed above (Cavalari et al., 2013). These techniques do not always yield immediate results, which can be frustrating for our clients because they are required to be repeatedly exposed to non-preferred tasks. It can also be nerve racking for their caregivers at times because they want to see the child succeed and attend appointments with ease.
- Little successes along the way are just as important as reaching the end.
- Remember to praise every accomplishment along the way whether big or small. Positive reinforcement plays a key role in encouraging the client to keep working at building their tolerance.
- Try not to jump the gun!
- Sometimes we can get a bit too excited about the increase in progress that we are seeing and are tempted to move at a faster pace or skip steps. It is critical to not fall in this trap! A negative outcome can result in an extreme regression of progress and put the child back to square one. Remember slow and steady wins the race!
- Encourage the client to express their concerns.
- We can observe that our clients have negative emotions pertaining to the procedure, but are they able to tell us what about it they do not like? Also, do they understand why the procedure needs to occur in the first place? Making space for dialogue is important in increasing tolerance as well. If we understand that our client is primarily afraid of the squeeze of the blood pressure cuff, then we can adjust our focus to that specific area. Explaining that the squeeze only lasts a couple seconds and not forever (with a model most likely) can provide a peace of mind.
- Let them take the lead.
- A possible reason for engaging in avoidance or noncompliance with these kinds of procedures is due to the feeling of having no control. Try having your child or client take the lead with roles reversed, meaning have them be the doctor and you be the patient! This can help increase confidence levels and give them that sense of control back.
References
Buckley, J., Luiselli, J. K., Harper, J. M., & Shlesinger, A. (2020). Teaching students with autism spectrum disorder to tolerate haircutting. Journal of Applied Behavior Analysis, 53(4), 2081–2089. https://doi.org/10.1002/jaba.713
Cavalari, R. N. S., DuBard, M., Luiselli, J. K., & Birtwell, K. (2013). Teaching an Adolescent With Autism and Intellectual Disability to Tolerate Routine Medical Examination: Effects of a Behavioral Compliance Training Package. Clinical Practice in Pediatric Psychology, 1(2), 121–128. https://doi.org/10.1037/cpp0000013
Conyers, C., Miltenberger, R. G., Peterson, B., Gubin, A., Jurgens, M., Selders, A., Dickinson, J., & Barenz, R. (2004). AN EVALUATION OF IN VIVO DESENSITIZATION AND VIDEO MODELING TO INCREASE COMPLIANCE WITH DENTAL PROCEDURES IN PERSONS WITH MENTAL RETARDATION. Journal of Applied Behavior Analysis, 37(2), 233–238. https://doi.org/10.1901/jaba.2004.37-233