Welcome to the October edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to theautismblog@seattlechildrens.org.

Q: I had to bring my 10 year-old autistic son twice to the doctor’s office for a flu shot. First time they couldn’t do it. Second time they gave him some medicine to calm him down which didn’t help. We ended up holding him down and doing it. It took 4 adults this time. I have no idea what we are going to do next time. My son is growing and I don’t think holding him down will work much longer. What can I do?

A: This is a great question and one that comes up every year around this time. There is a lot of work that can be done to prepare for events like these. These kinds of procedures can be scary for any child, but may be especially anxiety-provoking for children with limited language, cognitive, and/or emotion regulation skills. First, it is important that we are honest with kids about what to expect with shots; rather than telling kids that “shots don’t hurt,” we want to message that shots pinch at first, but that the pain is finite and only lasts a few seconds.

In preparation for the procedure, the use of social stories can help children understand what is going to happen and how. Additionally, frequent rehearsal at home using pictures and other visuals (like a toy doctor’s kit) can also help kids understand what to expect and can work to desensitize kids to the procedure and tools used.

You will also want to teach basic coping strategies within those social stories and rehearsals. For example, teaching deep breathing strategies (“smell the flower, blow out the candles”), positive scripts (like “I’m going to be okay. It only hurts for a second.”), or self-distraction strategies (like counting or singing out loud while getting the shot or procedure).