Planning a Dental Visit for Autistic child



                                                       



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Taking the child to a dentist can be a very stressful experience for both parents and child. Children with ASD or other developmental disabilities often have difficulties with sensory stimuli, and communication and increased levels of anxiety.

Long waiting queue, lack of communication, background sounds, the smell of different medicines and chemical solutions, being touched by dentists, and finally having a dental equipment within the mouth are some of the challenges an Autistic child face during his visit to a dentist. All this makes him anxious and impulsive during and after the check-up leading to uncooperative behaviours and negative experiences. 

Anxiety may be caused by various reasons such as fear of unknown, sensory sensitivities and communication difficulties. Children usually display noncompliant, impulsive and restless behaviour when they are unable to communicate their feelings of anxiety while meeting new people, going to public places, sensitivity issues such as tactile defensiveness and auditory sensitiveness.


Concerns for the parents:
  • Will visit be will a  successful or an embarrassment?
  • Number of aspects contributing to uncooperative behaviour and alleviated anxiety:
  • Child's sensory sensitivities (Noise, tactile defensiveness, different odours)
  • Lack of communication
  • Increased levels of anxiety

Here are some supportive strategies which can ease child and parent’s concerns and develop the better understanding regarding oral hygiene care.

Prepare child as early as possible:

It will be best for the parent, the child and the dentist to meet and
develop a plan ahead of the visit. Inform the child about dental visits as early as possible. Telling him at last minute can lead to extreme anxiety resulting in a distressful situation. Although behavioural changes are expected, but knowing about check-up much before the visit will ease the anxiety. Communicate and educate him about the purpose of visit to release or reduce his anxiety levels. Use visual support such as a calendar to explain date of visit or days remaining for the check-up.

Talk to the Dentist:

  • Tell the dentist as much as you can about the child’s sensory sensitivities and behavioural strategies’ that are successful. If this is child’s first visit to dental surgery, it is always better to ask for help from staff and communicating to the dentist about your child’s condition.
  • Let dentist know about child’s sensory issues such as:
  • The doctor may not approach or touch the child without informing him or taking permission to touch.
  • The dentist may avoid if not essential  or be cautious while entering into child’s intrapersonal space as it can be uncomfortable and stressing for him.
  • The dentist may speak slowly as information processing takes time. He must ensure to use simple and short sentences while communicating.
  • He may give answers to all questions asked by the child as not getting answers can quantify anxiety and mental tension.
  • Lastly, the doctor should tell the child what he will be doing. Showing equipment to be used during check-up can help the child calm down and stay relaxed.

Sensory Strategies’:

  • Use headphones to block the background sounds.
  • Use music for distraction and as calming strategy. I-pods, music
    player or headphones can he used.
  • The dentist can be requested to turn down the loud noises in the room.
  • A child can wear a weighted vest, hat or carry a weighted bag pack to get heavy work activities done to get needed proprioceptive input.
  • Carrying a weighted blanket, lap weight in the car can be used as an effective strategy after check up to calm down the anxious or agitated child.
  • Use Theraband or resistive tubes to stretch the body after a check-up.
  • Wobble cushion or wobble wedge can be added to a dental chair with dentist’s support if the child feels comfortable having it.
  • Stress Balls: Always help’s child to reduce stress, anxiety in different settings.
  • Massage hands and feet of child before going for an appointment.Carry Massage Rollers or massage sticks along with you. 
  • Hug more often.
  • Vibrators can be very calming for oral cavity however should be used under Occupational Therapist's guidance. 
  • Doing heavy work activities for deep firm pressure will relax the child.

  1. Wall Pushes
  2. Chair Pushes
  3. Rolling Therapy ball over the whole body with firm pressure
  4. Star Jumps
  5. Specific Yoga poses
  6. Animal Walks (Frog walk, Crab walking)


Fidgets:

They are the best source to source to keep the child focused on the task. It helps to reduce anxiety levels, and keeps the child calm and mind diverted. 

Different fidgets can be used according to developmental age groups such as key chains, finger squeezers, giant nut and bolt, Bluetac can be used by teens or adolescents for challenging in-hand-manipulation skills, and fine motor control whereas fleece bags, Chewy bangle Bracelets, Playdoh can be provided to young ones for play and engagement purpose.


Visual Reminders:

The pictorial presentation is always helpful for an individual to understand the sequence of events and know what will come next. Visual Reminders reduce stress, anxiety and ambiguity. It helps the child to stay organised and well informed. Visual schedules may be used to depict the steps involved in brushing one’s teeth and what steps are involved in completing a dental procedure. You may find picture cards for scheduling at www.do2learn.com


Sand timers:                                                 

They are a visual resource of teaching a child about the duration of brushing. They encourage the child to brush regularly and develop early dental hygiene habits. The child understands that for how long he needs to continue brushing. Resource


Tooth-brushing: 
A child should brush their teeth two minutes twice a day. It is essential to supervise child until he is seven or eight years old. It is important to choose toothpaste and mouthwashes with the correct amount of fluoride to help protect teeth decay. The toothbrush should have the small head to ensure brushing around the back easily.

Tooth brushing timers: They are the great source for showing a child visual representation of time required to brush teeth.

Mirrors: They help child and parent to examine the teeth well. They enable the child to check areas that are missed while and after brushing.

Types of Toothbrushes: 

The Oral-B Stages 1 toothbrush can be used for young children aged from 4-24 months.

Oral-B Stages 2 toothbrush can be used for children aged 2-4 years. It has a narrow head and easy-grip handle to hold properly. Different 
characters are designed to encourage brushing.

Oral-B Stages 3 toothbrush can be used for children aged 5-7 years. The bristles target to hard-to-reach back teeth. It has  grip handle for the hands still learning to brush.

Oral-B Stages 4 toothbrush are meant for children aged 8 years and above.

Electric Toothbrushes: They are much easier to manipulate around the teeth and encourages the child to brush their teeth. It should be used for children having oral hyposensitivity for awakening the oral sensory receptors. These toothbrushes help to control drooling, and provides massage and sweeping within the oral cavity.
Play Brush: Play brush is a manual toothbrush add-on that makes tooth brushing interesting and fun for kids of all ranges. It works via Bluetooth and teaches the child to brush properly. It improves oral hygiene, grip control while holding a toothbrush, and encourages the child  to brush more often since mobile games engage  him to perform brushing precisely and effectively. The smart device toothbrush can be used as an effective plan for children who likes to play games and works better with technology.


Books & Apps:

References:

National Autistic Society, UK
Autism Speaks Family Services Community Connections
Sensory Integration Network, UK
Oral Healthcare for the Dyspraxic Child (Anna Vaguhan)




                                                                     









Sensory Strategies for Handwriting Skills



                                                 
                                                          


              (The following blog contains affiliate links. Thank you for your support)

Lewis is a 5-year old child who has recently joined pre-school. According to his parents he is very active, energetic and friendly boy who likes running in ground, spinning, jumping, watching Doctor Who and talking to everyone. After working with Lewis for a week, his class teacher discovered some unique habits, characteristics and behaviours of him which were as follows:
  • While sitting in his chair or writing he slouches without him knowing about it. Likes wandering in the classroom and “always on a go”. He cannot sit for more than 10-12 minutes in his place.
  • Doesn’t like playing with Lego or construction toys.
  • Easily distracted by background sounds or outside noise (e.g., bird chirping or vehicle passing by)
  • Gets confused with letters and numbers while reading and writing
  • He is right handed but often uses left hand to write.
  • While writing he goes out of space without realising it.

When these observations were discussed with school OT, she strongly recommended him for Sensory Integration assessment as all above stated features were part of sensory difficulties which were interfering in his handwriting, self-care, fine motor skills and day to day activities.

Handwriting is an important functional task for school aged children and primary way to express thoughts, ideas and knowledge, and emotions. Composing stories, expressing own emotions, copying numbers, from the blackboard, completing school assignments, writing formal letters, or applications all needs precise handwriting skill. 

According to Case-smith (1992), children began to draw and scribble on paper as soon as they are able to grasp a writing tool. The development of writing process in early years includes scribbling, drawing lines and circles.

During 7-8 years they learn to use the different functional tool such as
knife and fork, scissors, pencils, zippers, buttons, brooms. They learn to plan and sequence actions which are the important part of motor planning. 
Developing ideas, for building blocks, construction toys, Legos, sand castles, are taken enthusiastically. All these experiences of childhood enable a developing brain to work efficiently and organise incoming sensory information received from different sense organs.

However, for an atypically growing child these opportunities and playful scenarios are sensory challenges. They may experience stress in the case in the course of the day to day tasks related to fine motor, gross motor and handwriting skills.

These children are reluctant to write, easily tired, seen slouching in their chair, their desk is often disorganised, may drop things in hand and may display behavioural issues due to frustration, the anger of not being able to accomplish tasks in hand and other sensory difficulties.


DIY Sensory Feel & Find Me Box



                               
                                         


                               (Developmental Age: 5 years onwards)

We all are very much in love with different sensory activities as they are engaging, fascinating and nurturing,keeping us calm, alert and organised in our day to day accomplishments. Besides activating (alerting sensory activities) or relaxing (calming sensory activities) different sense organs, these tasks improve self-regulation, fine motor coordination, eye-hand coordination, laterality and dexterity.

At the same time, sensory fun can rescue our ASD, ADHD and SPD children from meltdowns, anxieties or sensory overloads due to their nature and character.