Therapy

Armed for a
blood test
Teaching a child to tolerate blood tests
may seem like an impossible task.
But Risca Solomon explains how
ABA therapy can make it
achievable and presents
a step-by-step guide

Children with autism often have

to be sedated in order to have a
blood test. This means that blood
tests are seldom performed on
them unless its considered
essential. However, there is
another way: children and adults
with autism can be taught how to
cope with blood tests and remain
calm throughout, using the
principles of Applied Behaviour
Analysis (ABA).
Systematic desensitization
involves gradually, and in an
organized way, exposing the
individual to the item/activity that
may frighten them. This involves
breaking down the activity that you
want to achieve, in this case a
blood test, into each of its
component parts. The process is
called a task analysis.

Initially, you
should expose
the child to the step
for a very short time
and may be at a
distance away from
their body
An example task analysis for a
blood test is shown on the right,
along with techniques that can be
used to help teach that step. You
should consult an appropriate
medical professional when
working through the process.

Procedures
When working on any of the steps
above, the following procedures
can be helpful:
Reinforcement: you should
identify a highly preferred item/
activity for the child. Initially, this
should be given to the child when
he or she co-operates with each
step, eventually working towards
the item/activity being delivered
only at the end if the process.
Increasing periods of time:
initially, you should expose the
child to the step for a very short
time and may stand at a distance
away from their body. Gradually,
you should increase the proximity
of the item until it is able to reach
16 Au t i s m | e y e I s s u e 1 9 2 0 1 5

www.autismeye.com

www.autismeye.com

Step

Ideas to teach the step

1. Allow the arm to be held in

the correct position.

The arm often needs to be held throughout the entire

procedure. Often, it can be helpful to have one person
allocated just to holding the arm. Choosing the position for
the person with autism also needs careful consideration.
We have found that it works well if the person lies down on
the floor so the arm can be laid flat against the floor.

2. Adjust clothing to expose

site.

You need to select appropriate clothing. For an individual

who does not like pulling long sleeves up it may be best to
ensure they are wearing a short-sleeve t-shirt.

3. Allow numbing cream to

be applied to the area (such
as Emla or Ametop).

Ensure you have identified the best site for the blood test
with an appropriate medical professional. To teach this
step, you can begin with a white moisturizer cream squirted
out of a tube. The cream needs to be placed on the area
and not rubbed in. It can help to begin counting while you
are applying the cream and to continue the count for the
next few steps.

4. Allow a covering to be
applied on top of the cream.

As above, it can help to keep counting. Some children

dont like seeing the clear plastic dressing with cream
applied, so we put a bandage over the top of the plaster.

5. Keep cream in place for

the required time.

The cream often needs to remain in place for 30-45

minutes. During this time it can be useful to provide a
highly preferred activity.

6. Allow the covering to be

This stage can be practiced using baby wipes or handremoved and cream wiped off. sanitizing wipes.
7. Tolerate the numbing
spray (if required).

A spray bottle with cold water from the fridge can be used
to practice this step.

8. Application of a tourniquet
(if required).

The tourniquet can be practiced but should not be applied

with pressure without medical supervision.

9. Allow the needle to be

inserted.
10. Keep the needle in place
for the required time.
11. Allow syringes to be
changed if more than one
syringe of blood is required.

These steps can be practiced by holding a pointy silver

item up to the skin. It should be blunt enough to ensure
that it will not puncture the skin.

12. Allow a cotton wool ball/

swab to be placed at the site
(to stop bleeding after the
blood test).

You can practice this step at home.

13. Tolerate a plaster at site

after procedure if required.

Not all children will tolerate a plaster and some may be

allergic to it, so please ensure you check.

Risca Solomon is
a Board Certified
Behaviour Analyst
at Skybound Autism
Therapies, www.
skyboundtherapies.
co.uk

the desired place, and at the

same time increase the amount of
time it is placed there. To increase
the time intervals, its a good idea
to count out loud.
Recruit specialist help: many
hospitals offer specialist clinics for
children with phobias of blood
tests. These clinics are often run
by experienced nurses and may
include a play therapist.
After the blood test: once the
blood test has been completed,
try to keep the child continuing the

procedure calmly so that, if

possible, they are not left with the
last memory being the extraction
of the blood.
At Skybound Therapies we
have used these procedures to
assist in desensitising a variety of
individuals with autism and related
conditions to tolerate blood tests.
We have helped children from
across the spectrum, as well as
older children and teenagers who
have previously had bad
experiences with blood tests.
Au t i s m | e y e I s s u e 1 9 2 0 1 5 17