Increasing Blood Draw Compliance in Children with ASD

Background: An increasing number of studies are commencing to understand the genetic underpinnings of autism spectrum disorders (ASD).  In order to obtain the necessary data, most require a blood draw from the affected proband.  In our current sample of 245 children who have completed the genetics appointment, 35 children were unable to complete the blood draw due to behavioral difficulty (15%). In order to address this significant issue, we have developed a protocol designed to increase comfort and compliance with blood draws.   Social stories, picture schedules, and positive reinforcement have been shown to reduce anxiety and increase compliance to health care procedures among children with ASD (Ghuman et al., 2004). We decided to utilize all of these modes in our intervention.

Objectives:

1. Develop a novel intervention to increase compliance with venipuncture for children with ASD.
2. Evaluate the success rate of the intervention once entered into the training.
3. Describe children’s and parents reaction to the intervention.
4. Describe which factors in the intervention were most helpful for achieving a successful blood draw.

Methods:

Since initiating our intervention program, 34 families have been screened for study participation.  Of these families, 13 have requested to participate (38%).  We have completed the intervention thus far with 2 of these families. We anticipate completing the intervention and data collection by the IMFAR meeting.

We followed the guidelines established by Gray and Garand (1993) to create individualized social stories for each child.  The stories detail the multi-step process of having ones blood drawn, broken down into five distinct practice sessions.  Each completed practice session ends with a positive reinforcement (reward) for the child.  The reward is chosen for its salience for each individual child.

Additionally, each child receives an individualized Boardmaker picture schedule outlining the venipuncture procedure.  This includes a side-by-side comparison of how compliance during the procedure leads to a reward, while negative behaviors will not end in reward

Accompanying the social stories and picture schedule is a kit of venipuncture materials for the children to use as part of the practice session, including rubber gloves, alcohol swabs, band-aids, an elastic tourniquet, and a 5ml plastic syringe.  Each session begins with the child gradually experiencing a new venipuncture-related material (i.e. putting on gloves, tying the tourniquet) culminating with administration of a pretend shot. The parents are encouraged to practice for 1-2 weeks before the blood draw. 

After the blood draw session, families receive an internet-based or hard copy general satisfaction survey.  We inquire about the length and duration which they practiced, as well as which aspects were most useful.

Results:

In our first 2 children with ASD, both were able to complete the blood draw successfully. Researcher report has described probands repeating the language learned through the social story, to reaffirm the actual venipuncture is just as practiced. 

Conclusions:

Our preliminary findings have shown a high interest and two successes to date.  Positive response to our intervention has important implications for venipuncture for children with ASD in both clinical and research settings.