Providing a better doctor’s visit for children on the autism spectrum

An estimated 1% of the population has autism spectrum disorder (ASD). With such a large increase of potential patients on the spectrum, there is an increased chance of pediatric practices needing to provide care to them. In fact, 1 in every 36 children is believed to have ASD. 

However, many medical staff report a lack of confidence in their ability to serve individuals with ASD effectively. This lack of confidence is due to multiple factors: the wide variety of ways that autism can manifest, lack of prior training, and general lack of knowledge about autism. 

However, there are ways that medical practices and healthcare practitioners can provide safe and successful accommodations so that children on the spectrum can receive strong medical care. We'll start by giving an overview of what autism spectrum disorder is, and then cover what healthcare professionals can do to provide them with the best experience. 

Autism spectrum disorder, otherwise known as ASD or autism, is a developmental disorder that affects an individual's communication and social interaction skills. Repetitive or restricted interests, behaviors, and activities can characterize ASD. 

While the cause of autism is unknown, factors that increase its likelihood include having:

Because autism can manifest very differently from person to person and with varying levels of severity, it is known as a spectrum disorder.

Some of the common signs of autism include, but are not limited to: 

Individuals who are autistic may develop signs within the first 5 years of life, commonly evidenced by missing developmental milestones. Perhaps surprisingly, social media is playing a role in ASD self-diagnosis as individuals notice these signs and then seek out help from a professional.

However, because of the wide range of symptoms and severity from person to person, autism is often challenging to diagnose. A healthcare professional must assess one's developmental history, behavior, and progress. It is not possible to diagnose ASD through a medical test, such as a blood test. 

While regular healthcare is essential for everyone, many individuals with autism have comorbidities, such as digestive problems, other psychiatric disorders, or epilepsy, which require additional care. However, children with ASD often experience barriers to care because doctors may be unsure how to accommodate their needs. In addition, going to the doctor can be more anxiety-inducing than it would be for the general population. 

Doctor's appointments can be very challenging for people with autism because the sensory environment or experiences associated with doctor's visits, such as a change in routine, receiving a vaccine, getting care for a wound, or even having their blood pressure taken, can be overwhelming. 

Many children with ASD may struggle to communicate their symptoms or feel their doctor does not understand them. These concerns, compounded with the lack of education about autism, how it presents, and how to make children with autism feel comfortable in a doctor's office, can lead to breakdowns in the patient-provider relationship. 

Providing a more positive environment is essential to maintain the integrity of the patient experience, from how a patient and their caregiver perceive their doctor's visit to their overall satisfaction with their care to the likelihood of returning for additional care, should they need it. Luckily, there are steps that both parents and healthcare practitioners can take to make a doctor's visit more comfortable for children with autism. 

Creating a best-in-class experience for children with ASD begins from the ground up. Increasing one's knowledge about autism through continued learning can go a long way toward serving these patient groups effectively. When starting your medical practice or bringing on additional staff, hiring individuals with experience working with people with autism can help your practice connect better with patients. 

On a day-to-day operations level, a successful appointment with a child with ASD starts with the patient scheduling process. Offering an online scheduling portal for parents, complete with detailed intake forms, can help minimize the time in the waiting room. In addition, having a medically accessible website can signal to parents and caregivers that your practice is willing to go above and beyond to provide a comfortable experience for their child with ASD or any other disability.

One of the main ways to create a welcoming medical practice for children with ASD is to learn about and train all staff in communication strategies that can accommodate their unique needs.

Remember that, as a spectrum disorder, the communication skills of patients with ASD may vary wildly, and some children may be non-verbal. If possible, speak with parents ahead of time to determine the level of communication skills their child has and if they will need an interpreter.

It is also vital to keep a child with ASD in the conversation. Communicate with an autistic child with the same level of age-appropriate information and care that you would any other patient. 

While every child with ASD is different, there are some communication traits that many people with autism have. These are general approaches that may allow you to communicate with your patient more successfully. 

Many individuals with autism have difficulty interpreting figurative language, choose to respond to questions in a very literal way, or have trouble focusing. Being literal and concise can help overcome some of these challenges and narrow the focus so the patient can respond more effectively. 

Children with ASD may have difficulty determining what information an individual already has in a conversation and may have trouble with the larger picture. Questions like, "What are your symptoms?" may be unhelpful. Instead, ask specific questions to narrow down the situation and provide tools such as diagrams of the body, visual storyboards, or other devices. 

Children with ASD may have non-verbal cues that make them seem more closed off, inattentive, or upset. While it is essential to recognize the signs of an autistic individual under stress, there are familiar non-verbal cues that some individuals with autism may exhibit in their everyday lives.

Given the individuality of each child with autism, gaining a deeper understanding of the condition and fostering inclusive environments is exceptionally valuable. Therefore, the following resources can prove immensely beneficial.

Parents are an essential liaison between a healthcare provider and their child with ASD. Parents and caregivers can ensure that a doctor's office visit goes as smoothly as possible by taking these steps ahead of time, beginning with setting expectations.

It's important to recognize that a doctor's office visit is a break in an autistic child's routine. Setting expectations — such as when the appointment is, what the purpose is, and what will happen — can go a long way towards mitigating anxiety. Parents should ensure that their child has the skills needed for the appointment. For example, if their blood pressure needs to be taken, parents should ensure their child can extend their arm appropriately.

Role play is a great way to teach a child with ASD social skills and can help reduce anxiety surrounding the visit. Many autistic children also benefit from being shown, as opposed to being told, what is and is not appropriate to do in certain situations. By role-playing the doctor's visit, parents can give their children the confidence to speak up during the appointment and also provide them with a road map for what the appointment will be like. 

Waiting rooms can overwhelm children with ASD due to new sensory experiences. Arriving at the appointment as close to the start time as possible and minimizing time in the waiting room is essential. 

Finally, parents need to ask questions ahead of time about what the appointment will be like including: 

Incorporate this information into role-play scenarios and help to orient the child. Ideally, parents will act as liaisons for their child and their needs. 

Medical practices can assist with this process by providing information about and asking relevant questions regarding accommodations and services at their clinic during the patient intake process. This assistance is one way healthcare professionals can provide the best experience possible for children with ASD. 

In addition to the above resources, healthcare providers will most likely benefit from these websites.