Communicating effectively with any dental patient is essential. Communicating with patients with autism spectrum disorder (ASD) can pose some new and different challenges. With a little preparation, you can rise to the challenge of meeting these patients with positivity and understanding.
According to The National Autistic Society, autism "is a lifelong developmental disability that affects how people perceive the world and interact with others." ASD expresses itself in different ways and can be associated with other conditions or learning disabilities. Though every person experiences autism differently, it is commonly described as a triad of symptoms:
- Difficulties in socialization
- Difficulties in communication
- Repetitive and restrictive patterns of behavior and dislike of change
The "spectrum" element means that adults and children with autism have a wide range of capabilities. Some may be able to book and drive themselves to their own dental appointments, while others may rely on a caregiver for help brushing their teeth. Not all of the following tips will apply to every patient, so be sure to ask the individuals you meet how you can best help them during a dental visit.
For patients with ASD, regular and early contact is key! Starting with dental appointments in early childhood can help build their confidence and acclimatize them to the dental environment. It can also help you as a provider in instilling good home care habits and getting to know them as individuals.
Sending out a pre-appointment letter can be useful to let a patient with autism know what to expect at an appointment. You could also attach an ASD-specific questionnaire to get to know them a little. For example, I found out a 4-year-old patient with Asperger's syndrome (a condition that falls on the ASD spectrum) had anxiety about seeing people in uniform, so we decided to change into more casual scrubs to see him.
The Autistic Self Advocacy Network notes that individuals on the autistic spectrum often have a "need for consistency, routine, and order." This means that using timers and countdowns is preferable to abstract phrases like "this will only take a second." You can schedule your patients with ASD first thing in the morning or during non-peak hours when they will not be kept waiting.
Communicating clearly and directly about the treatment process is also critical. Even highly intelligent and verbal patients with ASD can often take what you say literally, so you may need to adapt your usual pediatric language (e.g., not talking about using a "vacuum" to suck up water in their mouth for a patient with ASD). Rather than open-ended questions, give them direct instructions: "First you need to sit in the chair, Christina, and then please open your mouth wide so I can see your teeth."
It is also helpful to follow a "tell, show, do" routine. First, clearly and simply explain to a patient with ASD what will happen, then show them and then do it.
The bright lights, loud noises and strong smells that you take for granted in a dental practice can all be overstimulating for a person with autism. Ask about what you can do to help a patient stay calm. This might include dimming the lights, turning off any background music or using an unflavored prophy paste.
Intense sensory reactions may interfere with oral hygiene. If a patient is having trouble brushing regularly, ask them to try brushing with water alone to find out if the texture or flavor of toothpaste is problematic. Some patients may respond better to a simple change, such as an electric brush or non-foaming toothpaste.
An important thing to remember is that an overwhelmed patient with ASD may have trouble telling you what is wrong. Some people with ASD are articulate, while others are nonverbal or only selectively verbal. Be prepared to use a hand signal or signing to communicate pain or the need for a break.
The most important point that I've learned so far in treating these patients is get to know them. Every person is different, with different habits and behaviors. Building in some of your patients' own preferences and habits into how you treat them can make for a more positive and productive relationship.