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Interacting with Patients who have ASD

Doctor talking with patient. He is showing him something on the tablet.

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FAQ Sheet

Overview

Autism spectrum disorder (ASD) describes a neurological disorder that affects social interactions, communication, and other behaviors. Patients with autism may require accommodations during appointments. They may also react differently to treatment than patients without an autism diagnosis. The following tips will help you effectively serve patients with ASD.

Accommodations for waiting rooms and appointments

  • Allow your patients with ASD to complete registration paperwork in advance to reduce wait time.
  • Consider giving patients with ASD the first or last appointment of the day. Long wait times can be stressful.
  • Give the individual with autism, their family members, or their support staff the option of waiting for their appointment in a small side room to avoid the over stimulation that can result from a busy wait room.
  • Give the patient with ASD the option of leaving and coming back at a determined time if the wait is expected to be long.
  • The individual may also prefer to wait outside or in the car instead of the waiting room. Texting or calling the patient when the doctor is ready may be a great option in this case.

During the appointment

  • Always explain what you are going to do before starting any procedure or examination. Be prepared to repeat the information more than once or provide a more detailed explanation if needed.
  • If possible, show a picture of what is going to happen or use a doll (if appropriate) to explain what you are going to do.
  • Use concrete language free from irony, metaphors and words with double meanings.
  • If requested, allow patients with ASD to wear headphones, hats, or sunglasses during the appointment as much as possible.
  • Give direct requests. For example, “Please stand up.” If you say, “Can you stand up?” this may result in the person staying seated or giving the answer, “yes.”
  • Avoid using gestures or body language without accompanying verbal instructions.

Medication Management

The initial diagnosis and assessment of patients with autism spectrum disorder (ASD) should include a thorough behavioral assessment, developmental (prenatal, early childhood, and later childhood) history, and often genetic testing.

No currently available medications have been demonstrated to specifically improve social and communication functioning, the core features of ASD. Development of social and communication skills generally requires behavioral treatments, and an optimal treatment plan will include behavioral treatments and supports.

There is evidence that medications can be helpful in addressing some symptoms that are common in individuals with ASD, including anxiety symptoms (for example panic attacks); major depression; irritability, tantrums, self-injurious behaviors; inattention and hyperactivity; interfering repetitive behaviors; and seizures. For many of these symptoms, there are both pharmacologic and non-pharmacologic (behavioral) treatment options that can be considered.

Pairing Psychopharmacology with Behavioral Treatment

Behavioral treatments that have the largest evidence base in ASD are based on applied behavior analysis (ABA). Clinicians trained in ABA are called behavior analysts or board-certified behavior analysts (BCBAs). These clinicians can carry out a functional behavior assessment to determine the antecedent events (events preceding a behavior) and consequent events (events that occur after a behavior) that tend to shape the occurrence of the behavior. They often collect data on the frequency, severity, and timing of behaviors, as well as antecedent and consequent events. They can design behavioral interventions that can reduce the occurrence or severity of interfering behaviors, and promote learning of adaptive behaviors. Psychopharmacologic treatment is best conducted in collaboration with behavioral specialists, so that a coordinated treatment plan can be implemented, and so that the effect of both pharmacologic and behavioral interventions can be tracked by data collection.

Other components of an overall treatment plan for individuals with ASD may include speech therapy, occupational therapy, supports in the context of school or work, and vocational rehabilitation.

Help individuals & family members prepare for med check appointments

Because med checks are typically brief, it can be very helpful to ask individuals and family members to prepare some information ahead of time and bring written notes on the following:

  • A few main issues or concerns that the individual and/or family want to address.
  • Questions for the clinician, including any about the effects of current medications.
  • Any changes that have been noted in symptoms since the last appointment.
  • Any new, troublesome symptoms experienced by the patient or noticed by the family or support personnel; these symptoms may potentially be adverse effects of the medication.
  • The time of day and amount of medication that the patient has been taking; bring notes on any difficulties in administering the medication (patient refusing it, not swallowing it, etc.).
  • If the patient is using a new pharmacy to fill prescriptions, bring the name, address and phone number of the pharmacy.
  • Information about the patient’s medical conditions or allergies to medications that the clinician hasn’t heard previously.

Resources for More Information

  • Pennsylvania Psychopharmacology Guidelines Work group Report, developed by the Autism Services Education, Resources & Training Collaborative (ASERT)
  • Kaplan G and McCracken JT (2012) Psychopharmacology of Autism Spectrum Disorders, Pediatric Clinics of North America 59:175-187.
  • Doyle CA and McDougle CJ (2012) Pharmacotherapy to control behavioral symptoms in children with autism, Expert Opinion in Pharmacotherapy 13:1615-1629.

Sources: The National Autistic Society Patients with autism spectrum disorders: guidance for health professionals-www.autism.org.uk.

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This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.