Register now for ABA Group Therapy start dates in January and February 2025

Planning a Successful Medical Visit: Tips for Physicians

MAY 3, 2023

Children with autism sometimes have trouble accessing health care due to behaviour challenges. Without access to medical screenings, health problems and underlying conditions can go undetected. But with a few simple modifications, your medical practice can create a positive experience for patients with autism. These changes have little impact on your practice, but they make a big difference for families who need support. If your patient with autism has emerging challenging behaviours, you may also want to consider referring them to our Urgent Response Services.

By planning ahead, you can ensure your office and staff are prepared to support your patient with autism. Consider the following tips:

Prepare yourself and your staff

  • Ask questions. Before theday of the appointment, speak with the child’s parents to learn as much as you can about them and what has made medical appointments challenging in the past.
  • See them first. If a child has trouble waiting or being around strangers, make sure they’re booked for the first appointment of the day.
  • Be quick. When the child arrives, direct them straight to the exam room. Try to see the child quickly once they’re ready.
  • Be prepared. Sometimes behaviours are unavoidable. If challenging behaviours arise in the waiting room, be prepared to move the child to a different area. This could be a hallway, an exam room or an office. If this isn’t possible, remove other patients from the waiting area.

Prepare your schedule

  • Keep it short and sweet. Consider breaking up one long visit into two (or more) short visits. Keep in mind the ultimate goal is for the visit to be successful, which may be easier to achieve with multiple visits.
  • Chat with the family beforehand. For children who can’t tolerate a lot of time in the office, it can be helpful to have a call with the caregiver or family member before the appointment to gather as much information as possible (for example, the child’s history and any concerns). This helps limit the amount of time the child spends at the office.
  • Create opportunities for breaks. Consider whether a child could find breaks helpful and schedule the visit accordingly. (e.g., Take down the child’s medical history, medications and current concerns, let them leave for a break while you see another patient, then resume the appointment later for the physical exam.)
  • Ending early is okay. Be prepared to end the appointment early and schedule a follow-up visit if challenging behaviours arise. It’s more important to end an appointment prematurely than to push through, allowing challenging behaviours to escalate.

Prepare your office space

  • Think efficiency. Consider what you and your staff can do to make the appointment as fast as possible. Make sure equipment is ready to go, and interruptions are kept to a minimum.
  • Think triggers. Make sure and ensure any potential triggers (like needles) are kept out of sight.
  • Think accommodations. Speak to the child’s caregiver or family member about any modifications that can be made to the office environment. Perhaps turning down the lights will help if the child has sensory sensitivities. You may also consider removing objects from the waiting area that the child may throw if challenging behaviour occurs.

Things to consider before and during the visit

  • Suggest using pictures. Ask the parents whether showing the child visuals before the appointment would help prepare them. Sometimes looking at photos or illustrations of the waiting room, the medical building and the exam room (even pictures of medical devices like the blood pressure cuff) ahead of time can help ease anxiety about the medical visit. The pictures can also be part of a social story that the caregiver or family member shares with the child before the visit.
  • Have a plan b. Have a discussion with the parent or caregiver about things that might help their child calm down if challenging behaviours occur or start to escalate. Sometimes giving the child a device and letting them watch a video or giving them a favourite comfort toy can help.
  • Check-in with parents. Ask the parent about warning signs to look out for so that you can be prepared. It’s also a good idea to check in with the parent during the appointment to ask whether to proceed or end early.
  • Engage the patient. During the visit, communicate directly with older children, teens or young adults. You will learn a lot of information from the patient that their parent or caregiver may not be aware of. In an ideal scenario, a parent or caregiver will be present to help facilitate interactions and fill in the blanks. Keep in mind that giving control to the patient will help make the visit a positive experience for them.
  • Help ease caregiver stress. Consider writing down a summary of the visit and any next steps for the parent or caregiver. Medical appointments can be stressful for parents and caregivers of children with autism, especially if they’ve had negative experiences in the past. They may forget important information if their focus is on getting their child through the appointment. Write down information and any actions the caregiver needs to take. This will ensure nothing is missed.

Points to keep in mind

  • Some children with autism are reluctant to see a doctor due to past negative experiences.
  • Medical visits can be challenging for children with autism. There are a variety of reasons for this, including sensory sensitivities and the unpredictable nature of appointments.
  • Children and young people with autism can be a difficult population to reach. If you can help make medical appointments successful, this will help ensure children and youth with autism get the care they need to live healthy lives.

Patient with new or escalating urgent behaviours?

For physicians serving clients with autism in Toronto, you may be interested in Surrey Place’s Urgent Response Services. Urgent Response Services help children and teens with urgent behaviours that are new or have been escalating over the last 14 days. These behaviours can include aggression, violent thinking, suicidal ideation or behaviour, fire starting, harm to animals, risk of exploitation, self-injurious behaviour, inappropriate sexual behaviour, flight risk and property destruction. If you have a client who has suddenly started exhibiting a new behaviour and is at risk of harming themselves or others, consider referring them to Urgent Response Services.

Physicians who have patients with autism or intellectual or developmental disabilities may also find tools developed by the Developmental Disabilities Primary Care Program useful to support communication, transparency and accountability in your medical practice.

About Urgent Response Services

This resource was written with support from staff in Urgent Response Services. Urgent Response Services are part of the Ontario Autism Program. They were created to support children or youth with an emerging urgent need. Surrey Place leads Urgent Response Services for Toronto Region in partnership with 2-Spirited People of the 1st Nations, Community Living Toronto, Family Service Toronto, Geneva Centre, Holland Bloorview, Kerry’s Place, Lumenus, SAAAC, SMILE Canada and Strides Toronto.

YOU MAY ALSO BE INTERESTED IN:

Using the Mediator Model

Learn more about a method you will be expected to use at home with your child while participating in the Urgent Response Services

READ MORE

General Proactive Behaviour Strategies to Use at Home

Manage behaviour at home with proactive strategies like recognizing warning signs, maintaining routines and using positive reinforcement

READ MORE

How to Create a Behaviour Contract for Autism

Follow these steps to create a behaviour contract to encourage positive behaviours by outlining expected behaviour and rewards

READ MORE

By 2 months

Has your baby had their hearing screened? YES NO

By 6 months

Does the child?

Startle in response to loud noises? YES NO
Turn to where a sound is coming from? YES NO
Make different cries for different needs (hungry, tired)? YES NO
Watch your face as you talk? YES NO
Smile/laugh in response to your smiles and laughs? YES NO
Imitate coughs or other sounds such as ah, eh, buh YES NO

By 9 months

Does the child?

Respond to their name? YES NO
Respond to the telephone ringing or a knock at the door? YES NO
Understand being told no? YES NO
Get what they want through using gestures (reaching to be picked up)? YES NO
Play social games with you (Peek-a-Boo)? YES NO
Enjoy being around people? YES NO
Babble and repeat sounds such as babababa or duhduhduh? YES NO

By 12 months

Does the child?

Follow simple one-step directions (sit down)? YES NO
Look across the room to a toy when adult points at it? YES NO
Consistently use three to five words? YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)? YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes? YES NO
Bring you toys to show you? YES NO
Perform for social attention and praise? YES NO
Combine lots of sounds together as though talking (abada baduh abee)? YES NO
Show an interest in simple picture books? YES NO

By 18 months

Does the child?

Understand the meaning of in and out, off and on? YES NO
Point to more than 2 body parts when asked? YES NO
Use at least 20 words consistently? YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)? YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)? YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)? YES NO
Enjoy being read to and sharing simple books with you? YES NO
Point to pictures using one finger? YES NO

By 2 years

Does the child?

Follow two-step directions (Go find your teddy bear and show it to Grandma.)? YES NO
Use 100 to 150 words? YES NO
Use at least two pronouns (you, me, mine)? YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)? YES NO
Enjoy being around other children? YES NO
Begin to offer toys to other children and imitate other children's actions and words? YES NO
Use words that are understood by others 50 to 60 per cent of the time? YES NO
Form words or sounds easily and without effort? YES NO
Hold books the right way up and turn the pages? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 30 months

Does the child?

Understand the concepts of size (big/little) and quantity (a little/a lot, more)? YES NO
Use some adult grammar (two cookies, bird flying, I jumped)? YES NO
Use over 350 words? YES NO
Use action words such as run, spill, fall? YES NO
Participate in some turn-taking activities with peers, using both words and toys? YES NO
Demonstrate concern when another child is hurt or sad? YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)? YES NO
Put sounds at the beginning of most words? YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)? YES NO
Recognize familiar logos and signs involving print (Stop sign)? YES NO
Remember and understand familiar stories? YES NO

By 3 years

Does the child?

Understand who, what, where and why questions? YES NO
Create long sentences using five to eight words? YES NO
Talk about past events (trip to grandparents house, day at child care)? YES NO
Tell simple stories? YES NO
Show affection for favourite playmates? YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)? YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time? YES NO
Have an understanding of the function of print (menus, lists, signs)? YES NO
Show interest in, and awareness of, rhyming words? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 4 years

Does the child?

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)? YES NO
Use adult type grammar? YES NO
Tell stories with a beginning, middle and end? YES NO
Talk to try and solve problems with adults and with other children? YES NO
Show increasingly complex imaginary play? YES NO
Talk in a way that is understood by strangers almost all the time? YES NO
Generate simple rhymes (cat-bat)? YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)? YES NO