Developing Strategies for Autism Friendly Dentistry

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Developing Strategies for Autism Friendly
Dentistry

• Selina Master
• Director of Community and Personal Dental
  Services
• East Elmbridge and Mid-Surrey PCT

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CONTENT

• Correct terminology !
• Characteristics of Autism Spectrum Conditions
• Approaches and interventions
• Strategies for success

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ASC - CHARACTERISTICS

• Communication difficulties
• Literal interpretation
• Problems with social interaction
• Rigid learning styles
• Repetitive activities and obsessive interests
• Unusual sensory responses/processing

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ASC - SPECIFIC DENTAL ISSUES

• First visit
• Inability to predict situation
• Dietary limitations/fixations
• Sweets/Chocolate used as rewards
• Difficulties with tooth brushing
• Sensory sensitivity/defensiveness

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SENSORY SENSITIVITY

• Auditory
• Tactile
• Taste Texture
• Visual
• Smell
• Pain Temperature
• Synaesthesia

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APPROACHES and INTERVENTIONS 1

• ABA ( LOVAAS)
• TEACCH
• Music Therapy
• CBT SIT
• Specific Pharmacological and Biomedical
  interventions

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APPROACHES and INTERVENTIONS 2

• Systematic structured behavioural approaches
• CBT and SIT
• Communication based interventions
• Social effectiveness
• Predictability and consistency
• Modification of environmental setting
• Engagement of parents/care givers

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RESEARCH 1

• Structured teaching
• Structured ecological and behavioural approaches
  e.g. TEACCH
• Communication based approaches e.g. PECS
• Structured Cognitive approaches e.g. Social
  Stories

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RESEARCH 2

• Level of research in UK is strong
• Research into causes and interventions are a
  priority
• Poor co-ordination and evaluation
• Intensive, early structured behavioural
  intervention is associated with better outcomes
• A combination of approaches may be required
• Variable response to intervention

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INTER-PROFESSIONAL WORKING

• Specialist Speech Language Therapists
• Paediatricians Health Visitors
• TEACCH Programme

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TEACCH PHILOSOPHY

• Meaningful independent system
• Strategies
• Eliminate/decrease negative behaviour
• Develop expressive communication
• Structured predictable environment
• Individualised flexible systems

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STRATEGIES FOR SUCCESS

• Knowledge of child
• Capitalise on strengths
• Provide a clear structure
• Modify communication
• Strategies for sensory sensitivity
• Specific dental issues

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ASD - KNOWLEDGE OF CHILDUseful Questions

• What distracts the childs attention?
• What absorbs the childs attention?
• How much language can they understand and use?
• What kind of games do they like playing?
• What are their strengths?

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ASD - CAPITALISE ON STRENGTHS

• Memory for and ability to follow routines
• Visual memory
• Motivation to communicate about favourite objects
• Technical equipment
• Savant skills

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ASD - PROVIDE A CLEAR STRUCTURE

• Helps understanding
• Has a calming effect
• Improves learning
• Aids independence
• Increases self-esteem
• Teaches appropriate behaviours

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SETTING BOUNDARIES

• Make clear physical boundaries
• Stop instead of No
• Avoid moral reasoning
• Permit exploration

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ASD - MODIFY COMMUNICATION

• Use visual methods
• Use symbols/photographs
• Use only the words required
• Teach one concept at a time
• Keep everything positive!

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STRATEGIES FOR SENSORY SENSITIVITY

• Auditory
• avoidance/elimination
• music as camouflage
• auditory integration training
• minimise background noise and distractions
• only one person speaking
• ear plugs!

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STRATEGIES FOR SENSORY SENSITIVITY

• Tactile
• Sensory Integration Therapy
• Desensitisation
• Taste Texture
• lick and taste
• try when distracted
• try when relaxed

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STRATEGIES FOR SENSORY SENSITIVITY

• Visual
• avoid bright/intense light
• sunglasses
• minimise visual distractions
• Smell
• Hypnosis

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STRATEGIES FOR SENSORY SENSITIVITY

• Pain Temperature
• look for behavioural indicators
• encourage reporting of pain
• explain importance
• Synaesthesia

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STRATEGIES FOR SPECIFIC DENTAL ISSUES

• Pre-appointment preparation
• Start in waiting room/car park/home!
• Give helpful, appropriate and realistic dietary
  advice
• Support with tooth-brushing

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MELTDOWN !

• Stay calm and in control
• Never raise your voice
• Avoid eye contact
• Defuse or distract by changing the subject
• Use a favourite toy or special interest to
  restore a sense of calm!

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ASD - SUMMARY

• Communication systems must be individualised -
  prepare for each child
• Utilise their strengths - visual communication
• Review structure and environment
• Develop appropriate strategies
• Praise anything and everything!