Marvin is sixteen and has Asperger syndrome. He attends the setting complaining of swollen glands and a throbbing headache. He is wearing a jacket covered in badges. His father accompanies him. Marvin is keen to establish what is going to happen in the consultation and asks questions like “Will it hurt?”; “Do you want me to take off my jumper?”; “Have I got to lie on the couch ?” He tries to divert your attention by asking you where you do your weekly shopping and volunteering the information that his family shops at Sainsbury’s every Friday night. Marvin appears to be stressed by the circumstances, but you also need to do a thorough examination.

Strategies

• Ask Marvin about his badge collection to help him relax.
• Ask Marvin to point to the areas that are causing pain.
• Ask Marvin questions about his symptoms in simple language.
• Give Marvin the opportunity to reply fully, but if he cannot, ask if you can ask his father some questions.
• Tell him exactly what you are going to do during the examination.
• Show him the equipment and let him feel and hold it.
• Encourage him to ask questions.
• If Marvin still seems stressed, demonstrate the examination on his father.
• Check that Marvin has understood what is required.
• Continue to talk to him about what you are doing and also ask questions about his badge collection to distract him.
• Give him praise for his co-operation.