Visits to the Doctor’s Office

Most of us don’t look forward to doctor’s appointments! Even the promise of a sticker or lollipop may not be enough to overcome our fears. Now, imagine you experience feelings of intense anxiety when confronted with new people and places, have sensory processing difficulties, and trouble communicating. These added hurdles can make a doctor’s visit especially daunting for kids with ASD and their parents.

Living in the time of COVID-19, it has become increasingly important to prepare ourselves and our children for interactions with health care providers. Below you will find a few strategies we use to prepare children and families for upcoming visits.

One example of a social story
  1. Social Stories

What are they? Social stories are a fun and creative way to teach kiddos new skills and prepare them for upcoming events. Basically, they are how-to manuals for children with ASD.

Tips for Success

The more you read the more you know. By going over the story on the days and weeks leading up to the visit, your child will have a better understanding of what to expect. This will help decrease anxiety and reduce the likelihood of tantrums and meltdown.

Bring the social stories or other helpful visuals with you to the doctor’s office! Many children with ASD benefit from visual explanations more than verbal. Plus, what better way to generalize what was learned then by reading the story again during the appointment. Following the story as the appointment progresses will help prepare the kiddo for whatever comes next.

There are many examples of social stories that can be used and here are some we recommend:

  1. Doctor Kit

The best way to prepare your child for the unexpected is to practice what is expected! One of our favorite ideas is to play with a toy doctor kit. Bonus, this is also a great way to work on those pretend play skills! The more you play, the better prepared they will be for the actual visit. Remember to make it fun!

Tips for Success

Act out likely scenarios, for example:

  • Put on the stethoscope and pretend you are listening to your child’s favorite stuffed animals’ heartbeat.
  • Use the blood pressure cuff on the family pet and show that even animals can be a part of the fun.
  • Practice using a tongue depressor. First, eat a piece of candy (keep the color a secret). Then, have the child use the tool to investigate and determine the color.

Take turns being the doctor and patient. Remember to be brave when they give you that shot!

If there are other children in the home, get them involved too. Children are more comfortable with people they know. Practicing with familiar people in familiar places will make this less scary in a real-world scenario.

  1. Reinforce, Reinforce, Reinforce

Going to the doctor’s office is scary for most children, but remember, practice makes progress… not perfect. Some appointments will be harder than others.

  • Break up the visit into smaller, reinforceable steps such as playing quietly in the waiting room or standing on the scale.
    • After each step, reinforce, whether that means providing praise such as Good Job! or rewarding them with a piece of candy.
    • Make the visit a positive experience. Sing songs or bring a game to play with them while waiting.
    • Remember that your child accomplished something just by walking into the door of that office!

We hope these suggestions take some of the stress out of upcoming doctor’s appointments! Be sure to grab an extra lollipop or sticker on the way out of the office. You deserve a pat on the back for being brave too.

Homework Completion for Kiddos with Autism Spectrum Disorder

This is one of those topics that really transcends Autism or special needs. The majority of clients who are in school have behavioral difficulties around homework: escape behaviors, noncompliance, aggression, tantrums, etc.

But guess what? So do neuro-typical kiddos!

It isn’t uncommon that we go into homes and clients need help completing homework successfully, and so do their older brother and younger sister. So definitely feel free to apply this information to any child you know of who has difficulty with independent and correct completion of age appropriate homework activities (that is the ultimate goal for homework).

Homework is such a common behavioral issue for families because it tends to combine multiple non-preferred tasks into one: completing academic tasks that may be very difficult, working on a task for an extended period of time, following multiple step instructions, working on a task independently, and working for delayed reinforcement. Add to that a situation that may be JUST as frustrating and non-preferred for the parent, and homework time tends to be bursting with problem behaviors.

So how can ABA therapy help with the bloody battle which is often homework time? ABA therapists approach the task of homework behaviorally. We focus on improving concrete behaviors that will allow the child to be more successful when completing homework, such as listening, attending, reading directions, sitting appropriately in the chair, tuning out noise or stimuli, writing, etc. We will work on homework by targeting problem behaviors the child is exhibiting to get out of, delay/avoid, or reduce homework expectations.

ABA therapists typically do not approach the task of homework academically. That means that the ABA therapist isn’t trying to teach the child how to do long division, their multiplication tables, or history lessons. ABA therapists are not tutors. If the child is an insurance client (the therapy is paid for via insurance) then it actually could be considered insurance fraud for the ABA therapist to spend hours teaching the child what a noun is. Insurance is paying for behavioral interventions, not academic tutoring. This may mean that the ABA therapist helps your child with homework, and all the questions don’t get answered. Or all the problems aren’t done correctly.

ABA therapists can help the child complete the homework for a specified amount of time, and direct the child to give the homework to mom or dad to check while the child and ABA therapist finish the session.

Common Homework Mistakes

Here are some of the most common mistakes parents can commit when trying to get a child with ASD to complete homework. This isn’t about shaming parents; it is about learning more effective strategies and better ways to tackle the problem of homework completion.

  • Arguing/Pleading with the child: Example- “Is that supposed to be a 3? Erase that and do it again that looks like an 8… yes it does… yes it does… yes it does…” Endless power struggles and arguments with the child are really just intended to distract the parent and delay the completion of homework. Arguing with a child is never necessary because as the adult, you are the final word. If your child is trying to pull you into an argument, don’t respond. Restate the demand and use prompting to help the child respond correctly.
  • Lack of transitions and priming: Example- Parent abruptly walks up to child “Okay, time to do your homework, come on.” Priming means you are stating expectations of behavior before the task. This could look like reminding the child to stay on task, that they can ask for help, and what reinforcement they can earn. Successful transitions would include telling the child at specific intervals that it is almost time to do homework, such as “it will be homework time in 5 minutes.” Successful transitions could also include making a visual schedule where homework is set for a specific time of day and the child knows that after a specific activity that it is always time for them to do homework.
  • NO REINFORCEMENT: Example- parents has child working on academic tasks for 40-60 minutes with no reinforcement given or praise. Reinforcement can be tangible, edible, short breaks, etc. With children who are very noncompliant or struggle with completing homework correctly it might be hard to praise or reinforce the child. If you can’t praise the child’s successful completion of the homework, you can praise their effort, or behaviors, such as “You are sitting so nicely!” or “I love how you are trying even though this is hard.”
  • Making Endless/Empty Threats: Example: “We will sit at this table all day until you complete your homework!” This sends a clear message to your child that you are tired and do not mean what you say. Stick to your original demand and avoid using unnecessary exaggerations or threats.
  • Doing Way Too Much Homework at Once: Instead of piling on a seemingly endless and daunting amount of work, break the homework down into sections, with easy tasks interspersed with difficult tasks.
  • “Helicopter” Mom or Dad: Example: when the parent hovers over the child, telling him where to sit, what to erase on his paper, and reading directions for the child. The goal for homework is that the child will complete it independently. In order to achieve that, it is important to not use excessive prompting. Offer the child choices so they feel more control. “What do you want to do first? Math or Writing?”
  • Using Time Out During Homework (PLEASE AVOID): If the child is doing homework (which is highly non-preferred), then sending them to time out is like sending them to Disneyland for a reprieve from their homework. You will likely then find it difficult for the child to come back and complete homework successfully, and problem behaviors will get worse. Instead, set a time limit on homework and set a powerful reinforcer. Tell the child if he or she finishes the homework before the timer, they receive the reinforcer.

We hope you find these helpful in your home and with your child! Feel free to comment with any additional questions!

An Autumn Outing with Spectrum

This past weekend, we enjoyed some Spectrum Family fun at Snead’s Asparagus Farm! What a great time to connect with our staff outside of work and have us grow as a team!

Autumn outings to animal farms, hayrides, and pumpkin patches have been a wonderful experience for Spectrum families and employees alike. They provide excellent opportunities for our kiddos to engage with peers and nature.