This document provides guidance for parents on helping their children with autism spectrum disorder (ASD) cope with blood draws. It discusses ASD and how individuals with ASD may struggle with communication, social interactions, and routines. The document offers tips parents can use before, during, and after medical visits involving blood draws to help make the experience less stressful for children with ASD. These tips include using visual supports, social stories, relaxation techniques, distraction strategies, and reinforcement. Appendices provide examples of relaxation exercises, visual supports, social stories and other resources parents can use to assist their child with ASD during blood draws.
Child development –redflags2015a foritl5633Engle1017
Training for Head Start center level staff to recognize potential developmental delays in order to refer the children to the appropriate early intervention agency
Child development –redflags2015a foritl5633Engle1017
Training for Head Start center level staff to recognize potential developmental delays in order to refer the children to the appropriate early intervention agency
Our services, which began with aptitude testing, career guidance and individual psychotherapy, today cover the entire spectrum of services in mental health, ranging from clinical assessments, in-depth vocational guidance, workshops for various target groups, individual and group psychotherapy, assessments for gifted, hyperactive and autistic children, corporate assessments, and many more programmes.
This is a great resource for parents of young children with autism spectrum disorders. It is intended to be completed by parents about their children and shared with the child’s teacher, babysitter, therapist, etc.
Are you feeling stressed about your child’s behavior? Educate yourself on mental health in young children and get your child the help they need from professionals if they have any of the behavioral symptoms.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
Dr. Alexa of Specific Chiropractic shares how upper cervical chiropractic can help improve your health. Dr. Alexa is a member of East Bay Business Exchange a referral networking group in San Ramon, CA.
Friendship Circle Parenting Our Special Children SeminarTzvi Schectman
Karen Wang, a Parent of a child with special needs and Dr. Sarah Baker a child Psychologist present about important topics relating to children with special needs Including:
Child Anxiety
Anxiety in childhood: What’s typical, and what’s not?
What to do (and not do) when children are anxious
Behavioral treatment for kids with anxiety
Handling tantrums and meltdowns
How to support siblings in special needs families
This is a great powerpoint presentation on dental care for infants and toddlers. For those of you with new babies, dental care often gets lost among the various checkups, vaccinations, etc., dental care can get lost in the picture. I hope this helps. Zafar Hasan
The presentation is about stress and anxiety.
As we know children are now fighting with so many stress and anxiety because of many reasons,
we have to take some big steps towards this matter.
Many of the calls we receive are about behaviour. Unfortunately, as parents, our ability to manage our child’s behaviour seems to be one of those things that identifies us as ‘good’ or ‘bad’ parents, which is why when things seem to be going wrong it is often distressing. The first thing to remember is that all parents have difficulties with their child’s behaviour sometimes and the second is that though we can’t control children’s behaviour, we can manage it.
Our services, which began with aptitude testing, career guidance and individual psychotherapy, today cover the entire spectrum of services in mental health, ranging from clinical assessments, in-depth vocational guidance, workshops for various target groups, individual and group psychotherapy, assessments for gifted, hyperactive and autistic children, corporate assessments, and many more programmes.
This is a great resource for parents of young children with autism spectrum disorders. It is intended to be completed by parents about their children and shared with the child’s teacher, babysitter, therapist, etc.
Are you feeling stressed about your child’s behavior? Educate yourself on mental health in young children and get your child the help they need from professionals if they have any of the behavioral symptoms.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
Dr. Alexa of Specific Chiropractic shares how upper cervical chiropractic can help improve your health. Dr. Alexa is a member of East Bay Business Exchange a referral networking group in San Ramon, CA.
Friendship Circle Parenting Our Special Children SeminarTzvi Schectman
Karen Wang, a Parent of a child with special needs and Dr. Sarah Baker a child Psychologist present about important topics relating to children with special needs Including:
Child Anxiety
Anxiety in childhood: What’s typical, and what’s not?
What to do (and not do) when children are anxious
Behavioral treatment for kids with anxiety
Handling tantrums and meltdowns
How to support siblings in special needs families
This is a great powerpoint presentation on dental care for infants and toddlers. For those of you with new babies, dental care often gets lost among the various checkups, vaccinations, etc., dental care can get lost in the picture. I hope this helps. Zafar Hasan
The presentation is about stress and anxiety.
As we know children are now fighting with so many stress and anxiety because of many reasons,
we have to take some big steps towards this matter.
Many of the calls we receive are about behaviour. Unfortunately, as parents, our ability to manage our child’s behaviour seems to be one of those things that identifies us as ‘good’ or ‘bad’ parents, which is why when things seem to be going wrong it is often distressing. The first thing to remember is that all parents have difficulties with their child’s behaviour sometimes and the second is that though we can’t control children’s behaviour, we can manage it.
Global Medical Cures™ | Alzheimers Caregiver Guide
Caregivers guide to dealing with Alzheimers patients
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Parenting is a very hard task, and every parent wants to make their child a better person. Discipline plays a key role in it. It helps in the better development of your child. As parents, it is your responsibility to teach your baby discipline.
https://www.buenaparkmontessori.com/toddler-curriculum
This article by the Center for Autism Research at Children's Hospital of Philadelphia discusses the presentation of anxiety in children with ASD (autism spectrum diagnoses) and cognitive behavioral therapy as a treatment option.
Learn about aspergers and its treatment optionsASC HealthCare
Aspergers is a nervous disorder that can occur at any age. If you have come to know about your child having Aspergers then you may be wondering what to do as you want your child to be happy and healthy all the time.
Various diagnosis can be conducted to ensure that whether your child has Aspergers disorder or not.
It is common to get concerned over different things about Aspergers but this guide can help you understand what needs to be done in case your child is having Aspergers.
In our year-end issue, enjoy strategies for handling emotional holiday stress, learn how to challenge your implicit biases, set up your budget for the new year, and hear from our experts about their favorite New Year traditions.
Bridge The Gap- Publication of Helikx School Social Work and Research Departm...alen kalayil
Helikx School Social Work and Research Department Publication which talks on Learning Disability, School Social Work,Executive Skills in Children, Brain Gym, ADHD etc
Similar to Guía extracción de sangre para padres de niños con Autismo (20)
Las actividades escritas que acompañan elmaterial del Nivel I ofrecen práctica en el desempeño de lastécnicas visuales básicas (atención, ubicación, seguimiento),coordinación ojo-mano y el inicio de discriminación y pareoutilizando materiales concretos.
En caso de incendio (Tarjetas y cómic-Historia Social para personas con autismo)Pili Fernández
Tarjetas de "EN CASO DE INCENDIO" adaptadas con pictogramas Arasaac y cómic_Historia Social .
Recopilatorio de imagenes traducidas y adaptadas de la información obtenida en "Child Safety and Abuse Prevention Programs" http://www.keepyourchildsafe.org/fire-safety-kids-page.asp Para descargar tarjetas en https://picasaweb.google.com/105594468279657481379/ENCASODEINCENDIO#
Los zapatos de Marta es un cuento para conocer la espina bífida dirigido a niños entre 6 y 15 años y a sus familias. La autora de los textos es Meritxell Margarit y las ilustraciones de Marta Montañá. Ha sido publicado por la Federación Española de Asociaciones de Espina Bífida e Hidrocefalia. http://febhi.org/index.php
MATERIALES - Normas para la clase.
Conjunto de tarjetas para trabajar las normas básicas de comportamiento en el aula. http://arasaac.org/materiales.php?id_material=907 - ARASAAC
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Guía extracción de sangre para padres de niños con Autismo
1. A Parent’s Guide To Blood Draws for Children with Autism
Taking the Work Out of Blood Work:
Helping Your Child With ASD
A Parent’s Guide
These materials are the product of on-going activities of the Autism Speaks Autism
Treatment Network, a funded program of Autism Speaks. It is supported by cooperative
agreement UA3 MC 11054 through the U.S. Department of Health and Human Services,
Health Resources and Services Administration, Maternal and Child Health Research
Program to the Massachusetts General Hospital.
Page 1 of 21
2. A Parent’s Guide To Blood Draws for Children with Autism
Table of Contents
Introduction To Autism Spectrum Disorders ....................................................................................... 3
Tips To Help Your Child Have A Successful Blood Draw ....................................................................... 3
Relaxation And Distraction For Children With ASD ............................................................................. 4
Why Do Relaxation And Distraction Matter? ............................................................................ 4
Strategies For Relaxation And Distraction During Blood Draws ............................................... 4
Visual Supports For Children With ASD................................................................................................ 5
What Are Visual Supports?........................................................................................................ 5
First-Then Board ........................................................................................................................ 5
Visual Schedule.......................................................................................................................... 6
Social Stories™ For Children With ASD ................................................................................................ 7
What Is A Social Story™? ........................................................................................................... 7
When To Read The Social Story™ .............................................................................................. 7
Reinforcement For Children With ASD ................................................................................................ 7
Why Does Reinforcement Matter? ........................................................................................... 7
What If Challenging Behaviors Occur? ...................................................................................... 7
References And Resources ................................................................................................................... 8
Resources On Autism Spectrum Disorders .......................................................................................... 8
Acknowledgements .............................................................................................................................. 8
APPENDIX
Appendix A: Deep Breathing ................................................................................................................ 9
Appendix B: Make Your Own Pinwheel ............................................................................................. 10
Appendix C: Muscle Relaxing Training Script For Parents To Use With Their Children ..................... 11
Appendix D: Muscle Relaxing Picture Charts ..................................................................................... 13
Appendix E: Ideas For Distraction ...................................................................................................... 14
Appendix F: Visual Supports............................................................................................................... 15
Appendix G: Sample Social Story TM ................................................................................................... 20
Page 2 of 21
3. A Parent’s Guide To Blood Draws for Children with Autism
INTRODUCTION TO AUTISM SPECTRUM DISORDERS
The purpose of this pamphlet is to present ways for you and your child to cope with the stress and worry
that may come with blood draws. It provides strategies to make these appointments go more smoothly.
Although completing blood draws with children with ASD is the main focus, the information and techniques
presented here also apply to other aspects of a clinic visit.
These may be helpful for individuals of any age or with other conditions. For more detail, examples, and
printable tools, visit kc.vanderbilt.edu/asdbloodwork/
What Are Autism Spectrum Disorders (ASD)?
ASD are a group of developmental disabilities that affect the brain. They make communicating and
interacting with other people difficult. Because ASD affect people differently, they are referred to as
“spectrum disorders.” They can range from mild to severe. Not everybody with ASD has the exact same
symptoms or the same skills. All people with ASD are likely to experience challenges in three main areas:
Communication. Individuals with ASD may have absent or limited speech. If they have speech, they may
use it to recite or repeat words. They would have limited ability to use words to convey their wants or
needs and limited ability to use them in conversation and social interaction.
Social Interactions. People with ASD usually have trouble with social interactions. They may have
difficulty understanding social cues, such as tone of voice or facial expressions. They may also have a
difficult time maintaining eye contact.
Play and Routines. Individuals with ASD are likely to engage in repetitive behaviors. Routines are also
important and may play a role in daily activities. Another characteristic of ASD is what some describe as
“sensory overload.” For these individuals sounds seem louder, lights brighter, or smells stronger.
TIPS TO HELP YOUR CHILD HAVE A SUCCESSFUL BLOOD DRAW
Before the Visit During the Visit
• Discuss what will happen using • Share your suggestions with medical staff.
words and pictures that your • Remain calm and reassuring. Controlling your expressions and
child can understand. emotions will help your child do the same.
• Try to avoid focusing on the • Resist the “white lie.” If your child asks, say it may hurt. It is better
most unpleasant/painful to prepare your child than to say it will not hurt if it could hurt. You
aspects before the visit if it will could describe a needle for a blood draw as a “strong pinch.”
make your child more anxious.
• Explain what is happening in simple, direct language.
• Talk with your child’s providers
before the visit. Ask what they • Acknowledge feelings, but avoid long conversations and avoid using
can do to make the blood draw words like “scared” or “worried.”
go more smoothly, such as • Help your child see medical staff as helpers.
requesting a certain time of the
day, assuring no wait time, or • Prioritize what you need to accomplish during the visit. Focus on
scheduling with someone what is most important to complete.
familiar with ASD. • When possible, provide choices to help your child feel more in
• Plan to bring toys or visual control. For example, let your child pick where to sit, the color of a
supports that you use every day bandage, or a reward to follow the visit.
to help your child remain calm • Praise your child’s ability to complete the visit. Praise specific
and happy. compliant behaviors.
Page 3 of 21
4. A Parent’s Guide To Blood Draws for Children with Autism
RELAXATION AND DISTRACTION FOR CHILDREN WITH ASD
Why Do Relaxation And Distraction Matter? Tips for Using Relaxation and
When children with ASD think about going to the doctor, many Distraction
become worried about the visit. You can help by teaching your child Parents may find that typical
simple relaxation techniques. approaches to using relaxation are not
Distraction may help by taking your child’s mind off stressful events, always effective for children with ASD.
thoughts, or emotions and putting attention on positive thoughts or Certain changes can be made in order
activities. to effectively use these strategies with
your child:
Strategies For Relaxation And Distraction During Blood
Draws • Practice makes perfect. Try to
teach relaxation strategies at
• Deep Breathing.* Teach your child to take a deep breath, scheduled times in the day instead
hold the breath for a few seconds and then release it. For of when your child is already
young children, using a pinwheel or bubbles to practice can anxious. Reward your child
help them focus on their breathing and distract from their immediately after practicing
stress. relaxation. This encourages
• Muscle Tensing/Relaxing.* Have your child relax by focusing continued practice and adds
on different muscles of the body and alternately tensing and another positive connection with
relaxing them one at a time. relaxation. Later when you use
these strategies because your
• Visualization. Encourage your child to imagine something child is worried, he or she will
pleasant and to visualize that scene with eyes closed. connect it with something
Suggest thinking about smells, sounds, and touch of what is positive. Your child will trust that
imagined. Using pictures or objects to remind your child of some- thing good will follow, just
favorite places or activities can help this strategy be more as it has during practice sessions.
successful.
• Prevent instead of react. Try to
• Favorite Toys/Activities. Involve your child in distracting use these strategies before your
activities before the procedure begins and, if possible, before child becomes worried, instead of
your child begins to become upset. Use a favorite toy, a only using them to calm your child
particularly engaging topic of conversation, or a game that down after becoming upset. It is
does not require movement. best to use these beforehand (for
• Music. Play your child’s favorite music or sing a silly song. example, at home before going to
the doctor’s office, in the car
• Laughter. Find ways to make your child laugh.
before going in to the office, in the
waiting room) or when mild signs
of anxiety are noticed.
• Use visual supports or concrete
*If your child has lost consciousness during prior blood draws, tools. It is important to use visual
check with your physician before using deep breathing or muscle supports (for example, pictures) or
relaxation. other concrete cues while putting
relaxation strategies in place. Use
them as a quick reminder to your
child that it is time to use these
strategies. This will be more
helpful than trying to explain
through talking.
Page 4 of 21
5. A Parent’s Guide To Blood Draws for Children with Autism
VISUAL SUPPORTS FOR CHILDREN WITH ASD
What Are Visual Supports?
A visual support refers to using a photograph, drawing, object, or list to communicate with a child who has
difficulty understanding or using language. Visual supports
Why are visual supports important?
can be especially helpful when your child has to participate
The main features of ASD involve challenges in
in medical procedures such as blood draws.
interacting socially, in using language, and
Two kinds of visual supports that might help your child having limited interests or repetitive behaviors.
with ASD more successfully complete blood draws are Visual supports help in all three areas before,
First-Then Boards and visual schedules. during, and after blood draws or other medical
procedures.
First-Then Board
A First-Then board is a visual display of something preferred that will happen after completing something
that is not as preferred. During blood draws, a First-Then board can help motivate your child to take part in
an activity that is not enjoyable by clarifying a preferred activity that will occur after it is over.
1) Decide what task you want your child to complete first (what goes in the “First” box) and the
preferred item or activity (what goes in the “Then” box) that your child can have as soon as the
“First” task is done. Put a visual on the board for each “First” and “Then” activity. The board can
refer to the general overall procedure (“First go to the doctor, Then playground”).
2) The board can also refer to specific steps during the process that can each be paired with
reinforcement. For example, “First sit in waiting room, Then lollipop.” Next, change the board to
“First take temperature, Then sticker” and so forth through the blood draw.
3) Show the board to your child with a very brief statement (“First sit in waiting room, Then
lollipop”) before starting the “First” task. If needed, refer to the board while your child is doing the
task (“One more minute, Then lollipop”).
4) As soon as the “First” task is over, refer back to the board (“All done with the doctor, now the
playground!”) and immediately provide access to the “Then” activity.
First-Then Board
FIRST THEN FIRST THEN
Feel pinch Play with cars Doctor visit Playground
Page 5 of 21
6. A Parent’s Guide To Blood Draws for Children with Autism
Visual Schedule
A visual schedule is a display of what is going to happen throughout the day or during an activity. A visual
schedule is helpful during blood draws to decrease anxiety and difficulty with transitions by clearly letting
your child know when certain activities will occur.
1) Decide the activities that you will put on the 3) When it is time for an activity on the
schedule. Try to mix in preferred activities schedule to occur, let your child know with a
with non-preferred ones. brief verbal instruction before the next
activity begins. When that task is completed,
tell your child to check the schedule again
2) Put the visuals that stand for the activities and transition to the next activity. Some
that you have identified on a portable children may respond best when each task
schedule (on a binder or clipboard) and bring during the procedure is broken down in a
it to the visit. The schedule should be detailed way. If this makes your child more
available to your child from the beginning of anxious, a more general schedule might be
the first activity. It should continue to be better.
visible through all of the activities.
4) Provide praise and/or other rewards for
following the schedule and completing the
activities. Put a preferred activity at the end
of the schedule to give your child something
positive to look forward to after completing
all the items on the schedule.
VISUAL SCHEDULE
Page 6 of 21
7. A Parent’s Guide To Blood Draws for Children with Autism
SOCIAL STORIES™ FOR CHILDREN WITH ASD
What Is A Social Story™? Tips For Writing A Social StoryTM
Many people with ASD benefit from having a written guide for situations that • Accurately describe the situation
may be new, scary, or confusing. A Social Story™ is a helpful way to provide this in detail. Focus on aspects of the
guide for blood draws. A Social Story™ helps your child understand the situation situation your child may find
and decreases anxiety that comes from entering an unknown situation. difficult (for example, meeting
new people, waiting, lights,
When To Read The Social Story™ smells).
If your child needs to know the details about the blood draw ahead of time to • Focus on important social cues,
relieve anxiety, then have your child read the story a few days prior to the visit. events that might occur, reactions
Use this as a time to briefly answer your child’s questions about the visit. that might be expected, and why
the event is occurring.
If reading the story ahead of time will make your child more anxious, wait until
just before the visit (for example, in the car on the way) or when you are at the • Write from your child’s
appointment (for example, in the waiting room) to share the story. Have your perspective (“I will go to the
child read the parts of the story that explain what is happening at each particular doctor. I will…”) or third person
step during the visit. (“Kevin is going to the doctor. He
will…”).
Social Stories™ were created by Carol Gray. • Use positive, concrete language.
For more information visit www.thegraycenter.org.
• Do not write in absolutes. For
example, instead of “The doctor
REINFORCEMENT FOR CHILDREN WITH ASD will use cold spray on my arm,”
Why Does Reinforcement Matter? write “The doctor may put
something on my arm to make it
Because of the difficulties many people with ASD have with communication and feel better”.
social interactions, typical ways of using reinforcement may not work well.
• Write the story specifically for
It is important to use specific reinforcers when asking your child with ASD to your child and his or her
participate in blood draws, and before the visit to practice strategies, such as experience with blood draws.
relaxation, that will help. Doing this will help your child with ASD connect these • Some children may respond best
activities with other enjoyable things. This may make the process less stressful to breaking down each task that
for your child and will let your child know that his or her hard work will be will occur during the procedure
rewarded. in a detailed way. This may make
What If Challenging Behaviors Occur? other children more anxious and,
for that child, a more general
Continue to focus on the task and praise the parts of the procedure your child is story might be better.
completing. Instead of shifting attention to the challenging behavior, provide
brief statements or a visual that tell your child what you would like for them to do (for example, “Hold your arm
out”).
If you think challenging behaviors may occur, introduce your child to the strategies in this pamphlet before the
visit and practice them during daily activities he or she enjoys.
Tips for Using Reinforcement During Blood Draws
• Choose a reward that your child does not always have available and is different enough to be motivating during something
like a blood draw.
• If your child is undergoing several medical procedures, have a few different rewards so that your child remains motivated
throughout the entire visit.
• Give reinforcement as soon as you can. If this is not possible, provide some type of visual way to let your child know that the
reward is coming soon (for example, a picture of the activity, a7 of 21
Page token).
• Be clear about what the reward is and exactly what your child did to earn it (for example, sat still, walked in without help).
• Always follow-through with providing the reward you promised.
8. A Parent’s Guide To Blood Draws for Children with Autism
REFERENCES AND RESOURCES RESOURCES ON AUTISM SPECTRUM DISORDERS
Want more tips for helping prepare your child with www.autismspeaks.org
ASD for doctor’s visits? Below are some links and www.autism-society.org
resources that might be helpful. Also, remember to kc.vanderbilt.edu
visit our website at kc.vanderbilt.edu/asd
bloodwork/ for more detail, examples, and printable
tools! ACKNOWLEDGEMENTS
Allen, J., & Klein, R. (1996). This publication was developed by Leadership Education
Ready…Set…R.E.L.A.X.: A Research-Based in Neurodevelopmental Disabilities (LEND) long-term
Program of Relaxation, Learning, and Self- trainees Whitney Loring, Psy.D., Kristen Reeslund, Ph.D.,
Dwayne Dove, M.D., Ph.D., Michelle Reising, M.S, and
Esteem for Children. Watertown, WI: Inner
Melanie McDaniel, B.A., and LEND faculty members Evon
Coaching. Batey Lee, Ph.D., Associate Professor of Pediatrics,
Culbert, T., & Kajander, R. (2007). Be the Boss of Psychology, & Psychiatry at Vanderbilt University and
Your Pain: Self-Care for Kids. Minneapolis, MN: Psychological Assessment Coordinator, Vanderbilt
Kennedy Center, and Cassandra Newsom, Psy.D.,
Free Spirit.
Assistant Professor of Pediatrics & Psychiatry at
Davis, M., Eshelman, E. R., McKay, M., & Vanderbilt University and Director of Psychology
Fanning, P. (2008).The Relaxation & Stress Education, Vanderbilt Kennedy Center, The Treatment
Reduction Workbook. Oakland, CA: New and Research Institute for Autism Spectrum Disorders.
Harbiner. It was edited, designed, and produced by Autism Speaks
Autism Treatment Network / Autism Intervention
Gray, C. (2010). The New Social Stories Book
Research Network on Physical Health and the
(10th ed.). Arlington, TX: Future Horizons. Dissemination and Graphics staff of the Vanderbilt
Gillis, J. M., Natof, T. H., Locksin, S. B., & Kennedy Center for Excellence in Developmental
Romanczyk, R. G. (2009). Fear of routine physical Disabilities. We are grateful for review and suggestions by
many, including by families associated with the Autism
exams in children with Autism Spectrum
Speaks Autism Treatment Network site at Children’s
Disorders. Focus on Autism and Other
Hospital Los Angeles. This publication may be distributed
Developmental Disabilities, 24, 156-168. as is or, at no cost, may be individualized as an electronic
Huebner, D., & Matthews, B. (2005). What to Do file for your production and dissemination, so that it
When You Worry Too Much: A Kid’s Guide to includes your organization and its most frequent referrals.
For revision information, please contact
Overcoming Anxiety (What to do Guides for
atn@autismspeaks.org.
Kids). Washington, DC: Magination Press.
These materials are the product of on-going activities of
Thorne, A. (2007). Are you ready to give care to a the Autism Speaks Autism Treatment Network, a funded
child with autism? Nursing, 37, 59-61. program of Autism Speaks. It is supported by cooperative
agreement UA3 MC 11054 through the U.S. Department
www.helpautismnow.com/going_to_the_docto
of Health and Human Services, Health Resources and
r.html Services Administration, Maternal and Child Health
www.helpautismnow.com/blood_draw.html Research Program to the Massachusetts General Hospital.
Its contents are solely the responsibility of the authors
and do not necessarily represent the official views of the
MCHB, HRSA, HHS. Printed June 2011.
Page 8 of 21
9. A Parent’s Guide To Blood Draws for Children with Autism
Appendix
APPENDIX A: DEEP BREATHING
Instructions for Belly Breathing:
1. Get comfortable. Lie on the floor or sit up straight.
2. Put one hand on your chest and the other hand over your belly.
3. Breathe in through your nose, 1…2…3...4. When you breathe in, feel your belly rise like a
balloon blowing up. Watch your hand on your belly rise, while the hand on your chest stays
still.
4. Breathe out slowly through your nose 1…2...3…4. Feel your belly go back in, like a balloon
deflating.
5. Keep breathing like this a few more times.
6. The more you practice…the easier it will become!
Giving your child a visual—like a picture to go along with belly breathing, blowing bubbles, or
blowing a pinwheel—will help make practicing deep breathing more enjoyable and easier for your
child to follow. This can also provide a distraction during stressful doctor’s visits.
Note: If your child has lost consciousness during prior blood draws, check with your physician
Blowing Bubbles Pinwheel
This technique is simple, yet soothing. Have your child take a deep breath and blow
Have your child get comfortable (for out slowly on the pinwheel. See how long your
example, lean back in a chair). Have child can make the pinwheel move – the longer
your child first try blowing bubbles he or she exhales, the longer the pinwheel will
using quick, shallow breaths. Watch spin! Make your own pinwheel using the
how the bubbles pop immediately. instructions on the following page.
Now have your child practice blowing
the bubbles using slow, deep breaths.
The slower your child breathes out, the
more bubbles he or she will make. Have
your child focus on watching all the
bubbles fall and repeat the process.
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10. A Parent’s Guide To Blood Draws for Children with Autism
APPENDIX B: MAKE YOUR OWN PINWHEEL
Step 1. To get started making your own pinwheel, cut a
4-inch x 4-inch square out of a piece of paper.
Step 2. Draw diagonal lines across your square to join up
the corners. Then, mark the center of the square with
a dot and draw an additional dot at each of the corners.
Step 3. Use a pair of scissors to cut along the diagonal lines.
Then, use a hole punch or punch a hole through each
of the dots.
Step 4. Line the dots on the outer edge of your pinwheel up
with the dot in the center. Push a tack through the dots
to hold everything together. Then, push the tack into the
side of a pencil eraser or straw.
Your pinwheel is now ready to use!
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11. A Parent’s Guide To Blood Draws for Children with Autism
APPENDIX C: MUSCLE RELAXING TRAINING SCRIPT FOR PARENTS TO USE WITH THEIR CHILDREN
When you feel tense, upset, or nervous, muscles in your body tighten. By practicing tensing certain
muscles in your body, you will learn to relax them. Now get comfortable!
Hands and Arms: Squeeze a Lemon
Pretend you have a whole lemon in each hand. Now squeeze it hard. Try
to squeeze all the juice out! Feel the tightness in your hand and arm as
you squeeze. Squeeze hard! Don’t leave a single drop. (Hold for 10
seconds.) Now relax and let the lemon drop from your hand. See how
much better your hand and arm feel when they are relaxed.
Arms and Shoulders: Stretch Like a Cat
Pretend you are a furry, lazy cat and you just woke up from a nap.
Stretch your arms out in front of you. Now raise them way up high over
your head. Feel the pull in your shoulders. Stretch higher and try to touch
the ceiling. (Hold for 10 seconds.) Great! Let them drop very quickly and
feel how good it is to be relaxed. It feels good and warm and lazy.
Shoulders and Neck: Hide in Your Shell
Now pretend you are a turtle. Try to pull your head into your shell. Try to
pull your shoulders up to your ears and push your head down into your
shoulders. Hold it tight! (Hold for 10 seconds.) Okay, you can come out
now. Feel your shoulders relax.
Back: Swing up High
Pretend you are on a swing at the park. Swing your upper body back and
forth, back and forth. To get really high, use your arms to help you swing!
Keep swinging! (Hold for 10 seconds.) Great. You’re all done on the
swing. Sit back and relax.
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12. A Parent’s Guide To Blood Draws for Children with Autism
Stomach: Squeeze through a Fence
Now pretend that you want to squeeze through a narrow fence. You’ll
have to make yourself very skinny if you’re going to make it through.
Suck your stomach in, try to squeeze it against your back bone. Get it real
small and tight. Hold it as tight as you can! (Hold for 10 seconds.) Okay,
you’ve made it! You got through the fence. Settle back and let your
stomach come back out where it belongs.
Jaw: Chew that Carrot
Now, pretend that you are trying to eat a giant, hard carrot. It is very
hard to chew. Bite down on it. As hard as you can. We want to turn that
carrot into mush! Keep biting. (Hold for 10 seconds.) Good. Now relax.
You’ve eaten the carrot. Let yourself go as loose as you can.
Face and Nose: Get That Fly off Your Nose
Here comes a pesky old fly and he has landed on your nose! Try to get him
off without using your hands. Wrinkle up your nose. Make as many wrinkles
in your nose as you can. Scrunch up your nose real hard and hold it just as
tight as you can. Notice that when you scrunch up your nose, your cheeks
and your mouth and your forehead and your eyes all help you and they get
tight too. (Hold for 10 seconds.) Good. You’ve chased him away. Now you
can just relax and let your whole face go smooth.
Legs and Feet: Squish your Toes in the Mud
Now pretend that you are standing barefoot in a big, fat mud puddle.
Squish your toes down deep into the mud. Try to get your feet down to
the bottom of the mud puddle. You’ll probably need your legs to help
you push. Squish your toes down. Push your feet, hard! (Hold for 10
seconds.) Okay, come back out now. Relax your feet, relax your legs, and
relax your toes. It feels so good to be relaxed. No tenseness anywhere.
You feel warm and tingly.
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13. A Parent’s Guide To Blood Draws for Children with Autism
APPENDIX D: MUSCLE RELAXING PICTURE CHARTS
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14. A Parent’s Guide To Blood Draws for Children with Autism
APPENDIX E: IDEAS FOR DISTRACTION
Characteristics of Good Distraction Supplies: Tips:
Familiar to child or something you know that they For medical appointments involving
like blood draws, the following distraction
Something stimulating and novel tools may be helpful:
Portable Sensory objects to put near the
site of the blood draw (for
Allowed in hospital or clinic rooms example, cold pack, vibrating toy)
Can be used with minimal movement by child (and Ask your doctor about availability
with one hand, if possible) of EMLA cream or sprays (which
Able to sustain child’s attention numb pain)
Some hospitals or doctors’ offices
will have additional, specific tools
for blood draws, for example,
“Buzzy” (buzzy4shots.com)
Examples of Good Distraction Supplies:
Portable device to play videos or music that the child likes
Games that require little or no movement that the child likes (for example, Paper, Rock,
Scissors)
Laughter (for example, a game where you think of different types of laughter and imitate
what they might sound like)
Favorite toys or stuffed animals that can sustain their attention
Toys that are visually stimulating (for example, toys that light up, pin wheels, colorful toys)
Tactile toys or objects (for example, toys with interesting textures, stress squeeze balls, toys
that vibrate)
Novel toys that are visually interesting, make innocuous noise, or are tactile (for example,
rain sticks, glow sticks, relaxation toys, bubbles)
Relaxation techniques (for example, deep breathing or progressive muscle relaxation) also
can be distracting. Just be sure to check with the health care provider that these techniques
are safe and appropriate to use during your child’s medical procedure.
Topics of interest to your child. Often children with ASD will have a restricted interest.
Engaging the child in conversation about this topic can be distracting (for example, trains,
elevators, or a particular television show or movie).
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15. A Parent’s Guide To Blood Draws for Children with Autism
APPENDIX F: VISUAL SUPPORTS
Here are some pictures you might find helpful to use with your child before and during a blood draw as
part of their visual schedule or first-then board.
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APPENDIX G: SAMPLE SOCIAL STORY TM
For children with lower reading levels, consider using short, descriptive sentences when creating a
Social Story™.
An example of a Social Story™: Going to the Doctor
I am going to the doctor. The doctor keeps me
safe and helps me when I am sick.
I may have to wait with my _______ (mom, dad,
etc). I can play with my ________.
When I am with the doctor, I will try to listen
and sit in my chair.
My mom will be happy if I listen and have nice
words and hands.
When the doctor is all done, I get my reward.
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21. A Parent’s Guide To Blood Draws for Children with Autism
An example of a Social Story™ for older children: Getting My Blood Taken
I am going to the doctor. People go to the doctor for lots of reasons. Sometimes, people go to the
doctor when they are not sick. When I get to the doctor’s office, I may have to wait my turn. While I
am waiting, I can __________ (talk to my mom, watch TV, read a book, or think about something
else, etc.). When it is my turn, a nurse may call my name. A nurse is someone who helps the doctor.
I will go with the nurse into another room. This is a safe thing to do and my _________ (mom, dad,
etc.) can come in with me. The nurse may ask me to answer a question and follow her directions.
The nurse will like it if I listen. I will try to follow her directions and stay calm. My __________
(mom, dad, etc.) will be very proud if I listen to the nurse and do what the nurse says.
Sometimes the nurse needs to take some of my blood to make sure I am healthy. I can give some
blood away because I have lots of blood in my body. The nurse may ask me to push up my sleeve
and may put a band around my arm. The nurse may also spray something on my arm or use other
things to make it feel better. The nurse will use a needle to take blood from my arm. The needle
may feel like a pinch. I will try to stay very still while the needle is in my arm. This is the safe thing to
do. While the nurse is doing this, I can _____________ (talk to my mom, look at my book, or think
about something else, etc.). The needle will come out of my arm when the nurse is finished. After
that, the nurse may put a cotton ball and bandage on my arm. When the nurse is finished, I can
have _____________ (reward). My mom and dad will be very proud of me for sitting still and
staying calm!
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