Tips On Improving Your interactions When Seeing Children With Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is one of the more common conditions you may encounter when treating children. Children with ASD can be a pleasure to treat, but commonly require variations to your behaviour management techniques. This post will provide some information to help you successfully care for children on the spectrum.

Children with ASD can display several distinctive behavioural patterns including; impaired social interactions and repetitive behaviour

Other patterns/conditions that may be present include; Self-injurious behaviour, ADHD, depression, anxiety, poor sleep, intellectual disability and epilepsy

Some children with ASD may be severely affected and have great difficulty in communicating with you. Conversely, some children may be mildly affected to the point you would be unaware they had ASD, but still require additional care. Generally, as with all children, taking your time to discuss with the parents their child’s medical history and previous dental interactions can be invaluable when providing care. We will run through what we do in our practice when we are notified we will be seeing a child with ASD.

1.     Generally the parents will mention that their child is on the spectrum. Our reception staff will ask if there are better times to be seen, if they are better with males or females and ask if there are any specific characteristics or behaviours we should be aware of. For example, they may hate minty tastes or being touched on the face, or they may have an obsession with specific objects like clocks.

2.     Our staff will also offer to the parents that they and the child can come to our facility during a quiet time to have a look through and familiarize themselves with the facility

Our waiting room so children can play in a non-threatening dental environment.

3.     We will send the parents a social story along with a welcome email explaining what we will do at the first visit. If you would like the social story, please enter your email details below so we can send it to you. Social stories are brilliant for children with ASD and for that matter any child who is a bit anxious

The Social Story we created. We are happy to send it to you if you enter your details below.

4.    Unless there is an emergency, try to avoid providing any treatment at the first visit, other than an examination and perhaps a clean and fluoride varnish

5. This prior preparation will greatly improve your ability to examine and treat the child. When they enter the surgery, try and avoid going straight for the chair. Let the child do a different activity, whilst you are talking to the parent. This will help them become more familiar to the environment and you.

Try and do something else with the child first so they get more familiar with the surgery.

When you are ready to examine the child, try and talk to them and gently touch their hands or arms. This way you are not invading a very private space (the mouth) as your first physical contact. You can ask them to brush their teeth and then see if they will let you have a go. Explain that they need to sit in the chair so you don’t get a sore back when it is your turn to look! Sometimes it can help to have the chair already reclined when they enter the room, so they just need to hop into the ‘bed’.

When trying to examine their teeth, or in fact perform any procedure, Tell-Show-Do will work in most cases. For example, when performing a prophy:

1.    Tell them you will use an electric toothbrush

2.    Show them the slow speed and prophy cup and gently spin it

3. “Do” it on your thumb first and then theirs. After, ask them to point to which tooth they would like you to clean first (Don’t ask a child IF you can clean their teeth… Ask which tooth you WILL be cleaning first or which toothpaste you WILL use!)

From here, if the child handles this all well, you can progress up into more complex procedures, but stick to the same principles. Keep in mind prior to performing any dental procedure in a child, such as a restoration, you will need radiographs to ensure that you are treating appropriately. This can sometimes be more challenging to achieve than the procedure itself and we will cover tips for taking radiographs in another post.

Counting also helps children tolerate treatment better, this way they know it will stop at 5 or 10 for instance (however you can cheat and make it longer, for example: 1…2…oh like the number of eyes you have..3…4…5…just like how old you are….etc)

Celebrate on a High

Once you have completed treatment, ensure you reward the child. Generally, toothbrushes are boring gifts. If you have something a bit more fun, that always helps to improve compliance. You can also show them the ‘prize’ prior to performing the procedure and explain that they will only receive it if they do really well. Irrespective, if they do well or not for the procedure you wanted to complete, try and finish each appointment on a high note for something they are able to achieve. This will help to build confidence and continue the process of desensitisation. Parents will also appreciate leaving the appointment on a high note.

If the child is not compliant for an examination, please contact one of your paediatric dental colleagues. Children with special needs, including ASD, have a significantly increased number of untreated oral diseases compared to the unaffected population. This means they are much more likely to be living in pain, or with poorer longer-term oral health outcomes. You can be a great portal to introduce them to the dental word and ensure they get the support they need to have the mouth that they deserve.

A final note is that parents with children on the spectrum commonly have numerous appointments with multiple health and allied-health professionals. Daily life can be a massive challenge for them as even simple tasks like getting ready for school can be very tedious and challenging. When you are talking to them, try to empathise with their situation and ensure that they know that you are there to help make their life easier. The child may only drink juice and eat chocolate biscuits. Your job is to explain how this elevates their risk category, but you are here to help reduce their risk factors wherever able. This may include applying 3-to-4 monthly fluoride varnishes or helping them with tips to establish a routine at home to improve their oral hygiene.

We hope this all helps

Sarah and Tim