A trip to a doctor has the potential to provoke anxiety in just about anyone. In kids and adults with developmental disabilities, these visits may be particularly stressful for them and for their caregivers. Further, getting the best medical care requires cooperation during the visit. In clinical treatment, we are often asked how to use ABA techniques to prepare for and successfully navigate these planned and unplanned visits to a doctor or dentist. Here a few tips from the Emerge ABA team:
- Priming before the visit
- Read books together about a typical trip to the doctor or dentist to expose to typical routines and ideas. Create your own “book” for unique procedures so they know what to expect
- If the individual has a sibling or adult present during their visit, have them model the expected behaviors first
- Role play at home with pretend, or even better, real tools. Label these actions so as better to prepare them (e.g “I’m going to check your blood pressure”). Give a favorite toy a “check up” as well.
- Program common stimuli. Try to set up a practice situation that most closely resembles the real thing. Often individuals with developmental disability have challenges with generalization of skills. Using common stimuli (objects and people) while teaching skills helps them perform practiced skills in the real setting
- Let them know what to expect and consider the best way to provide the information: with spoken words? text? pictures? all of the above together?
- Consider taking photos of the doctors or dentists office, waiting room, tools, and treatment rooms for discussion/practice
- Never lie! If you know there will be a shot or other painful procedure, do not lie. Do not say that it will not hurt (it does!). Instead, let them know the truth. You will feel a pinch and then it will be over.
- Teach prerequisite skills. Reflect on the typical instructions given by the doctor or dentist. “Open wide” “Can you step on the scale?” and so on. Practice these skills individually in a comfortable setting first. Use the common instruction, prompt the desired response and reinforce attempts and successes.
- Reinforce desired behavior by providing something pleasurable (praise, stickers/tokens, etc.) immediately following a desired behavior. The typical sticker at the end of a long visit may be insufficient to reinforce desired behavior.
- Look for opportunities to manage antecedents and setting events:
- Come prepared. In some cases it is difficult for a parent to discuss their concerns while also providing care. Further, some topics are best not discussed in front of a child. Consider bringing help or preparing a brief document outlining your concerns. Then, the doctor can review if your attention is needed elsewhere.
- Discuss individual needs with the medical team before you arrive. Ask for accommodations whenever possible:
- less wait time
- slowing down interactions with the patient
- requesting to avoid unnecessary procedures (skipping a gown, for instance if that is not necessary for good care).
It is important to find a patient doctor or dentist with whom you feel comfortable. Make sure they can accommodate your family’s individual needs. If the challenges your family are experiencing are too difficult to manage alone, consult with a professional. Emerge BCBAs are equipped to work with challenging behaviors and may be able to help.