The right approach to treating patients with Autism
Autism diagnosis is increasing at an alarming rate, as it is in the rest of the country. Today an estimated 1 out of 150 children nationally receives the diagnosis, up from 1 in 1,000 a couple of decades ago. That is more than that of Down syndrome, juvenile diabetes, and cancer combined according to the CDC.
We understand that most parents of children with autism are overwhelmed with the care they are required to provide for their own children. Dr. Osafi and his team are here to help make the dental visit as uneventful and relaxing as possible.
At Hello Kids Dentistry, we utilize the Applied Behavioral Analysis (ABA) technique to guide the dental visit and to allow the child to slowly become accustomed to the dental environment. Breaking down each desired behavior into smaller tasks and gradually teaching each small task, one at a time, using a reward system. A phone interview with the caregiver will be completed prior to the dental visit detailing specific information regarding the child’s medical history and to gain specific personality cues to allow for a smoother visit. This is a very time intensive approach and parental involvement before and after each visit is key.
The 5 steps to reaching these goals are as follows:
- Create a calm and comfortable dental setting
- Divide each skill into smaller tasks, using visual prompts.
- Demonstrate each skill to the child.
- Repeat the skills provided at home.
- Excite the learner with a reward system.
At the dentist, a patient with autism may experience:
- Fear of close contact with the dentist and dental staff
- Fear of dental instruments and equipment
- Sensitivity to sounds, touches, and tastes
- Confusion and uncertainty about the environment
- A heightened reaction to dental lights or changes in lighting
- Fear of being trapped or crowded room
These experiences often cause emotional reactions by the child, often expressed by:
- Crying or fretting
- Kicking, hitting, biting, and attempting to leave
- Refusal to open the mouth for the dentist and staff
- Tuning out and thus not registering what is being asked
The following techniques are utilized throughout the dental visit:
- Eye contact: If the dentist can get your child 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 helps establish a relationship between your child and the dentist.
- Educational Modeling: This is a way our dental staff will train your child to assume certain safe positions. The dentist may give instructions such as “feet out straight, hands on your tummy” repeatedly. This is done until your child automatically assumes these 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 a technique that encourages good behavior and doesn’t call attention to negative behavior.
- 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 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 will sit long enough for routine dental treatment to be safely delivered.
Things to remember:
These techniques do not work for everyone. Some children have not responded fully to our program. Often, these are children with more involved disorders or lower cognitive abilities. The key is not to presuppose an individual’s capabilities: patients will often surprise even those closest to them. It is amazing what a child with autism can accomplish when someone takes the time to work with him at his pace.
Parent/caregiver involvement is the key. It is critical that you are involved and committed to this process. You need to help reinforce the skills at home and help guide the dental team as to 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. This is especially important for most children with autism are at high-risk for getting cavities.
Don’t delay dental visits. Waiting will only let smaller problems become larger ones, including pain and infection. Waiting greatly reduces the probability of successfully treating your child in a normal dental office environment.
Bring your child to the Autism Dental Clinic at Hello Kids Dentistry for an initial assessment with Dr. Javid Osafi.
Call 425.659.1200 to schedule an appointment now.