Patients with Autism: Awareness, Communication & Legal

Strategies

Presented byKathy Johnson

Autism Society of Michigan

“Uniqueness”

“No two autistic children are alike. What may work successfully for one will not work for another. It is true there are specific principles of learning that run through all human endeavors. The goal is to observe and find the specific pattern of response each exhibits, then move from there.”

Temple Grandin

What Is Autism Spectrum Disorders?

ASD is a neurological disorder that impairs how a person interprets and navigates the environment

Communication and socialization are challenged with persons on the autism spectrum

Autism is a regulatory disorder that impairs the sensory system

Incidence/Prevalence

It is estimated that more than 1 out of every 91 children in U.S. are affected by Autism Spectrum Disorders

There are 3 million to 3.5 million children and adults with autism in the United States

Co-Existing Disorders ofAutism Spectrum Disorders

Attention Deficit Hyperactive Disorders

Attention Deficit Disorder Anxiety Disorder/Panic Disorder Seizure Disorder Obsessive Compulsive Disorders Sensory Disorder Depression

Autism versus Asperger Syndrome

Preference for concrete information weaknesses in language

Weakness in both higher and lower level pragmatics

More obvious sensory needs

Diagnosis more straight forward/earlier

Blinded by their weaknesses

Preference for factual information

Normal language on the surface

Weaknesses in higher level pragmatics

More subtle sensory needs

Diagnosis later Blinded by their

strengths

Classic Myths

Individuals with autism never speak Autism can be outgrown People with autism cannot show or

respond to physical affection Individuals with autism do not want

friends People with autism are manipulative Persons with autism do not relate to

peers or adults

Classic Myths

Individuals with autism are mentally impaired

Autism is curable People with autism do not have a

sense of humor Autism is caused by bad parenting

What Does Anxiety Look Like in a Person with ASD?

Anxiety increases sensory disturbances for persons with ASD.

Stereotypical behaviors such as: flapping, rocking, twirling, jumping, vocalizing, self injurious behaviors, aggression towards others, and finger flicking may be seen when person with ASD is anxious.

Anxiety in a Person with ASD

Many individuals with ASD grind their teeth as a calming strategy to ease their daily stress.

It is also seen in children with poor balance in an effort to stabilize themselves.

Sensory Issues

Auditory – The drill makes noise, the cleaning apparatus, the sound of suction, the hum of the x-ray machine, the sound of implements being arranged and rearranged, people talking back and forth behind their back or above their head

Sensory Issues Visual – Lights over the dental chair

can be too bright, blinding and overwhelming; agitation can occur in areas that are visually stimulating

Individuals with autism spectrum disorders are visual learners; they learn 90% visually, 10% auditorially.

It is better to speak less in a calm tone and show them models of what you are going to do.

Sensory Issues

Olfactory – Strong smells of medical supplies, toothpaste, mouthwash, dental assistant’s perfume, hand cream, loud music may be calming or overwhelming;

Many individuals have seasonal allergies so their sense of smell is impaired

Sensory Issues

Sense of Touch – difficulty tolerating light touch, dislikes teeth brushing, may complain of pain when brushing teeth, may appear irritated when the dentist or staff invades their space, discomfort when sitting in one place for any length of time

Sensory Issues

Vestibular (balance) – may be fearful of having feet off the ground and the head in a back position in the dental chair; they may become disoriented after a change in head position

Sensory Issues

Taste – May gag easily, have difficulty with strong medicinal tastes, cotton in mouth, x-rays may be difficult to place in mouth

Sensory Issues

Pain Tolerance vs. Pain Intolerance Inconsistent response for some; many

will feel no pain at all while others will feel pain at the slightest poke

Helpful Hints 1) Arrange for a tour of the office. Let the

patient sit in the chair with normal overhead lights. No drills running. Let them see the trays and touch and feel everything, including the X-ray machine. Let them meet all the staff.

2) Make the first official dental visit short and as uninvasive as possible.

3) Ensure that the dentist or hygienist explains what is going to happen, what is going to be touched, what instrument is going to be used, what that instrument is going to feel like, how long it’s going to take.

Social Story What is a Dentist? A Dentist is a Doctor for your teeth. Charlotte and Mommy are going to see the Dentist

soon. His name is Dr. Carroll A dental hygienist will clean Charlotte’s teeth with a

funny brush (which might make noise). She will get to wear sunglasses and watch a movie

too!! After her teeth are cleaned, then Dr.Carroll will come

in and look at Charlotte’s teeth. Charlotte will tell the Dentist, “Thank you very much.

See you next time!”

Picture Rehearsal

Legal Issues Use immobilization techniques only when

necessary for the safety of the person and the dental staff. This requires consent from the parent or guardian.

Some individuals with autism spectrum disorders are treated under general anesthesia; this is an area of concern as many people with ASD react negatively to medications. A medication history should be taken from the parent/guardian.

Tips for the Dentist/Dental Hygienist

Approach the child slowly and in a non-threatening manner.

Use a "tell-show-do" approach. Explain each procedure before it occurs and provide praise for acceptable behavior.

Always tell the child with autism where and why you will be touching them. This tends to decrease their hypersensitivity to touch.

Talk calmly in short, direct phrases. Avoid words or phrases with double meanings.

More Tips Use a toothbrush to gain access to the oral cavity.

It will be familiar to the patient and allow for improved cooperation.

Some children with autism are calmed by moderate pressure, whereas light pressure can be bothersome. Placing a lead apron on the child during treatment may be comforting and lead to positive behavior, but air from the dental air syringe may agitate them.

Allow the parent/guardian to watch procedures. Educate them about findings and oral hygiene practices.

Final Tips Find a manual toothbrush that the patient likes.

Some toothbrushes may have features or sizes that are bothersome to the patient. Most children with autism have motor skill deficiencies, so electric toothbrushes seem ideal; however, they can be over-stimulating to some patients.

Some days, a patient with autism may be over-stimulated by the time they get to the appointment. Make each visit a positive experience regardless of what or how much is accomplished. Provide the care you can, and reschedule if necessary.