January 10, 2014

Having a Conversation with a Child with Autism

Many people feel awkward around someone who is different — in color, gender, nationality or physical/mental ability. It’s part of the human condition, but so is compassion and understanding. Kathleeen O’Grady, a research associate at Concordia University in Montreal and the mother of a son with autism, helps to expand our humanity with advice on how to communicate with a youngster who has autism.

Writing on KevinMd.com, O’Grady notes that an estimated 1 in 88 children is diagnosed with autism, a neurological disorder often characterized by difficulty with social interaction. That can make holding a conversation challenging, but it doesn’t mean you should leave kids with autism out of one.

“Contrary to popular belief,” O’Grady writes, “most kids with autism are not anti-social. Yet, many “neurotypicals” still struggle when it comes to including a child with autism in the conversation. Those that do try, often fail because they don’t know a few essential rules that can help make the interaction possible.”

Here are O’Grady’s three rules for communicating with a kid who has autism.

1. Don’t start the conversation with a question.

Even a simple question like, “How are you?” or “What’s your favorite color?” can seem like a test to some children with autism. And if they fail the first question, the conversation is over before it starts.

These kids generally know what you are saying or how to answer, but sometimes their answer sometimes gets “trapped” between the thought and the expression of it. Any environmental change or interference — background noise, pace of speech, accent or their own anxiety when exposed to new places and people — can make the answer to even a simple question enormously difficult.

So start a conversation with a statement they can build on: “I love your shirt;” or “Cool dinosaurs” are observations that invite a child to comment in kind if he or she wants to. Then you can build on it, conversationally.

2. Be patient.

Usually, kids with autism don’t need you to speak slowly, but they do need time to form a response. “Too often,” O’Grady writes, “I’ve seen adults wait for a child’s response to a question, and when the response doesn’t come, immediately throw another question out there in hopes that the child will respond to the second attempt.

“If they’d simply waited another 20 or so seconds, they may have had a response to their first query.” But throw out another, and the child might get confused and freeze up trying to figure out if they should respond to the first or second query.

Just wait. And just when you think you’ve waited long enough, count out five more seconds in your head, and wait again. Each child has his or her own response time, so it may take a few tries to figure out how long they need.

3. Don’t take it personally, and try again later.

Some adults try and fail to engage children with autism. They presume that the child doesn’t like them or is anti-social generally. Neither is likely to be the case.

Kids on the autism spectrum sometimes just don’t respond to social communication — even when they are fully able, and even when they understand what’s going on.

Maybe the child is imagining something terrific in his or her head — a video game, a piece of music — that is so powerful that he or she can’t be pulled out of the imaginary world and into yours at that moment. In other words, you can’t compete.

Sometimes the environment is overwhelming, and makes the child too anxious or overloaded with sensory stimuli to respond. Sometimes, a kid just doesn’t feel like talking.

It’s not personal. Try again to convince him or her that joining your conversation is worth the effort. If there’s still no response, the mood will pass. Try again later.

The bottom line, O’Grady says, is that you should never leave a child with autism out of the conversation. “Chances are,” she says, “they want to engage, but they need to do so on their terms and within their abilities. Make the effort, and not only will you make a child happy, it’ll make your day too.”

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November 8, 2013

Emailing Health Concerns—Parents Like the Idea, Docs Worry About the Reality

Everyone—patients, providers, insurers—wants to have the most efficient system possible for the delivery of health care. The proliferation of electronic communication can enhance efficiency, and, of course, can thwart it—see: HealthCare.gov.

The results of a poll released by the University of Michigan C.S. Mott Children’s Hospital contributes to the push-me/pull-me nature of electronic communications and health care. For a minor illness, it said, most parents prefer to get an email response from their kids’ doctor instead of making an office visit.

Providers raise issues they say parents might not have considered.

The polled parents reported that co-pays for office visits ranged from nothing to $30. About half said that such online consultation should be free. Those who said email consultations should carry a cost said it should be less than an office visit.

Many health-care providers haven’t established co-pays for email services. Many say that parents don’t understand that email consultations require medical history and chart review, just like an office visit. And all such communications must be documented in the child’s medical record.

“Providers also worry about creating an expectation that they are on call to answer emails at all hours of the day. No one wants a child’s care delayed if an email can’t be answered right away,” Sarah J. Clark said in a University of Michigan news release. Clark is associate director of the National Poll on Children’s Health, and an associate research scientist in the department of Pediatrics.

Other provider concerns include ensuring that online systems are secure, and protect the privacy of the email exchanges. (See our blog, “Medical Identity Theft Is a Health Risk.”)

More than 3 in 4 parents said they probably would seek email advice for their children’s minor illness if that service were available. Only 6 in 100 said they were able to get such email advice now.

Some practices offer email consultation in a package of online/electronic services that might include family conferences, texting and Web chats. Often, that involves a monthly or annual fee instead of a fee for service.

The poll surveyed 1,420 parents with children as old as 17.

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