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Autism Dental - Our Approach to a Special Challenge

Our philosophy is that if the parents and dentist are determined to help a child with autism learn the necessary skills to accept dental services in a normal environment, the child will eventually succeed. Our approach is an adaptation of the Applied Behavioral Analysis (ABA) technique: breaking down each desired behavior into even smaller   tasks and gradually teaching each small   task one at a time, using rewards in very specific ways. Because this is a very time intensive approach, parental involvement before and after each visit is key. The 5 steps to reaching these goals are as follows:

1. Divide each skill into smaller tasks, using visual prompts if necessary.
2. Demonstrate each skill to the child with autism.
3. Repeat the skill at home and at our dental office: children with autism need a lot of repetition.
4. Excite the learner with a reward system: rewards work well for children with autism.
5. Delegate the repetition to the parent, caregiver or therapist. Practice at home for the dental visit.

An Autistic Child’s Perspective of the Dentist

At the dentist, a patient with an autism may experience:

•Fear of contact – or the dentist being too close
•Fear of objects / dental instruments
•Hyper- or hypo-sensitivity to sounds, touches and tastes
•Confusion and uncertainty about what to do
•A heightened reaction to dental lights or changes in lighting

These experiences often cause emotional reactions on the part of the Child with Autism:

•Crying or fretting
•Kicking, hitting, attempting to leave the dentist office
•Refusal to open the mouth for the dentist
•"Tuning out" and thus not registering what is being said

It is important for everyone to realize that these responses have a meaning: they are the way a child with autism communicates. "Can’t" is an unpopular word in this "can do" world. During the dental visit, some children with autism simply can’t do certain things in the usual way.

Three Techniques Are Used Throughout Dental Treatment of the Child with Autism:

•Eye Contact: If the dentist can get your child with autism to respond to the request, "Look at me.", it is a good indication that your child will eventually succeed. "Look at me" commands help your child pay attention, and it helps to establish a relationship between your child and the dentist.

•Educational Modeling: This is a way our dental staff train your child to assume certain safe positions. The dentist may give instructions such as "feet out straight, hands on your tummy" repetitively until the patient automatically assumes those positions when he or she is seated in the chair. No other position is acceptable. This is called "educational modeling". The patient "models" the behavior, and then adopts that as a habit on future visits. Children with autism usually need a lot of repetition.

•Modulated Praise: This is technique that encourages good behaviour and does not call attention to poor behaviour of a child with autism.

•Counting Framework: Once the patient with autism has learned a particular request, for example to allow a mirror to be placed in the mouth, then your child’s dentist will ask him/her to hold that position to a count of ten. Your child is thus trained to hold still for successively longer periods of time, so that eventually he/she will sit long enough for dental treatment to be safely delivered.

Some Things to Remember

•These Techniques Do Not Work For Everyone. Some children with autism have not responded to our program. Often, these are children with more involved autism spectrum disorders and sometimes with lower cognitive abilities. The key is not to pre-suppose an individual’s capabilities, as patients will often surprise even those closest to them with what they can do when someone takes the time to work with them at their own pace.

•Parent/Caregiver Involvement Is Key. It is critical that you are involved and committed to this process. You need to help reinforce the skills at home in between dental visits and guide the dental team regarding what is working and not working.

•Start Young. Don’t avoid dental visits for your child. It is never too early. The first dental visit is recommended for all children by their first birthday.

•Don’t Delay Dental Visits. If you are like most parents of children with autism, you are probably overwhelmed. Waiting will only let smaller problems become larger ones. Waiting greatly reduces the probability of successfully treating your child in a normal dental office environment.

See you at our dental office. Call Autism Dental Center for Children, at (702) 233-3338 to make an initial appointment with our dentist. Ask to be scheduled with Dr. Jeff Kinner.

- - Treating Children with Autism from Birth to Age 18 -