Dental tool kit: Dental professionals
Autism & accommodations
In this section for Dental professionals: Autism & accommodations | Welcoming autistic patients
What is autism?
Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 36 children and 1 in 45 adults in the United States today.
Autism looks different for everyone, and each person with autism has a distinct set of strengths and challenges. Some autistic people can speak, while others are nonverbal or minimally verbal and communicate in other ways. Some have intellectual disabilities, while some do not. Some require significant support in their daily lives, while others need less support and, in some cases, live entirely independently.
On average, autism is diagnosed around age 5 in the U.S., with signs appearing by age 2 or 3. Current diagnostic guidelines in the DSM-5-TR break down the ASD diagnosis into three levels based on the amount of support a person might need: level 1, level 2, and level 3. See more information about each level. Anybody can be autistic, regardless of sex, age, race or ethnicity. However, research from the CDC says that boys get diagnosed with autism four times more often than girls.
Many people with autism experience other medical, behavioral or mental health issues that affect their quality of life – and could affect their dental health and visits. Among the most common co-occurring conditions are:
- attention-deficit/hyperactivity disorder (ADHD)
- anxiety and depression
- gastrointestinal (GI) disorders
- seizures and sleep disorders
All people with autism may have difficulty in these areas:
Social interactions
- Starting and taking turns in conversations
- Sharing interests or emotions
- Understanding what others are thinking or feeling.
Communication
- Making eye contact
- Understanding other people’s body language, gestures and facial expressions
- Regulating tone of voice (e.g. they may speak too loudly, too quietly and/or with a monotone voice).
Developing, maintaining and understanding relationships
- Expressing feelings and seeking emotional comfort from others
- Making friends and playing with peers
- Understanding boundaries and personal space
- Feeling overwhelmed in social situations.
Repetitive movements, play or speech patterns
- Stimming, or making repetitive body movements to regulate emotions (e.g. rocking, hand flapping, spinning, running back and forth)
- Lining up toys in a row, spinning wheels, repeatedly flipping switches
- Imitating another person’s speech, repeating words or phrases (also known as echolalia).
Insistence on sameness and need for routine
- Extreme distress at even small changes in plans or routine
- Ritualistic behaviors (e.g. watching the same videos over and over, repeatedly touching objects in a set order)
- Need for routine (e.g. same daily schedule, meal menu, clothes, route to school).
Intense and highly focused interests
- Extreme interest or knowledge of specific, narrow topics
- Strong attachment to a certain object (e.g. a toy or figurine).
Under- or over-sensitivity to sensory stimulation
- Sensory differences, like unusual sensitivity to light, sound, touch or texture
- Lack of sensitivity to pain or temperature
- Sensory-seeking behaviors (e.g. smelling or touching objects, visual fascination with lights or movement).
Other characteristics of autism
- Using other kinds of communication besides spoken language (e.g. typing on a computer, pointing to pictures on a tablet, or communicating through behavior)
- Difficulty with executive functioning (e.g. planning how to complete a task, juggling multiple tasks, making decisions)
- Trouble with fine motor skills and coordination
- Needing help with daily living skills
- Difficulty regulating and/or communicating emotions, sometimes resulting in harmful or self-injurious behaviors, sensory overload, meltdowns or shutdowns.
Getting to know
your autistic patient
In addition to having each patient with autism or parent of an autistic child fill out a form like the Standard Dental Form, it is recommended that you offer a pre-visit consultation to allow time to get to know them and them to get to know you and your office, too. While every person with autism is unique, some basic tips that are generally helpful in welcoming and treating them are:
- Use a calm voice
- Explain dental terms to them; show them the tools you will use.
- Give them time to ask questions.
- Allow them to have sensory accommodations.
During appointments and procedures, it will be important to offer the autistic patient breaks to check-in with them, allow them a moment to regulate and/or ask additional questions.
“Appointments are child-led – the goal is for him to have a positive experience…We get done what can be done and whatever we can’t get done waits. If he starts to get stressed, we stop until he is ready to continue, or we end the appointment…if the x-rays aren’t perfect, we try again next appointment. Everyone uses tons of praise and positive affirmations to keep the appointment really positive.”
- Lindsay Austin, Autism Speaks Legal, Risk and Compliance Director
Accommodations to consider
Many people hate the dentist and have a hard time dealing with the dental environment. But the sights, sounds and smells of the dental office can be especially overwhelming to an autistic patient. The dental exam can trigger physical sensitivities and so can feel overly intrusive.
Providing accommodations can be a difference maker in these children having a successful visit and in turn, long-term positive dental health. Some simple and practical ones, that can benefit all patients, include:
- Dimming the lights if necessary, or offering sunglasses.
- Turning down loud noises and warning about loud tools.
- Turning on instruments so that the patient can see them before the instruments go in their mouths.
- Removing clutter, particularly unpleasant dental pictures, in the exam room or in sight of the dental chair that may distract the patient or make them anxious.
On top of that, you should be willing to explain to your autistic patient what you will be doing. If you have plastic displays of a mouth and teeth, you may want to use them to show how you will be doing things, like how you will be counting their teeth or brushing them.
It is also helpful to end each visit on a positive note, so that you and your patient can build upon your success.
Sometimes it may take several visits in order to complete a dental exam. If you work with the family on this process, you will build a relationship together that will result in a lifetime of good dental health.
