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Avoiding Meltdowns at the Dentist: Tips for Parents of Kids on the Spectrum

"My  son would rather have a mouth full of cavities - and the pain that goes with it - than go to the dentist. Are there ways to help a child with high functioning autism to become less fearful of dental work?"

Young people with ASD level 1, or High-Functioning Autism, have the same rate of dental problems as the general population. As hard as it is for most kids to go to the dentist, it’s even harder to have a positive dental experience for kids on the autism spectrum. Even so, there are some things you can do to improve the dental experience for your child.

Below are some tips. Some will work - some won't. But everything here is worth a try:
  1. Visit the dentist’s office before an actual visit.
  2. Have the child touch the equipment.
  3. Explain to the child what will happen.
  4. Have the child bring a comfort item like a favorite toy or blanket.
  5. It is a good idea to have a gradual and slow exposure  to the environment of the dental office so your child doesn’t get frightened by the experience.
  6. Make sure you tell the dentist how best to handle your child.
  7. Tell the dentist what works and what doesn’t work when working with your child.
  8. Remind the dentist that children with ASD are more easily overwhelmed by an overload of the senses, which can over-stimulate the child.
  9. Ask that the dentist keep the chaos in the office to a minimum.
  10. Make the child’s first visit to the dentist positive and short; have the dentist count the teeth or something else innocuous.
  11. Ask that the dentist approach the child as quietly and as non-threatening as possible.
  12. Have the dentist explain everything to the child and show the child what’s going to happen before actually doing it.
  13. Praise the child for acceptable behavior and have the child sit in the dental chair for awhile so he/she can become accustomed to it.
  14. Kids with ASD want to know what’s coming next without having to be surprised, so have the dentist tell the child where and why he needs to touch the child, especially if you’re dealing with dental equipment.
  15. Ask that the dentist talk calmly and avoids words that have double meanings; these children take everything literally, so it’s important to say exactly what you mean.
  16. Ask the dentist to start the exam using only his/her fingers.
  17. Ask the dentist to avoid shining the light in the child's eyes.
  18. Using a toothbrush to examine the teeth is a good idea because it’s a safe, familiar item. The dentist can use a dental mirror after that.
  19. Ask if you can hold your child’s hand during the dental examination.
  20. Anything that is familiar will make for a good experience.
  21. Some autistic children respond well to being lightly wrapped in a small blanket during the examination. In other cases, the child will need sedation or will need to undergo general anaesthesia in order to accomplish any significant dental work. General anaesthesia is especially important in older children that don’t respond well, even to light sedation.
  22. Lastly, you may want to have your child view the social story in video format below and see if it might help alleviate some anxiety as it relates to dentist visits. This is a true story told by an autistic child himself.
Good luck!




PARENTS' COMMENTS:

•    Anonymous said... A pediatric dentist. An ultrasonic toothbrush to minimize need for dental work. Alpha-Stim for anxiety.
•    Anonymous said... find a hygenist and dentist that will take the time to work with your child not against them
•    Anonymous said... I agree find a dentist & hygenist that are willing to take the time that's needed with your son. We were referred to a pediatric dentist who specialized in special needs children...let's just say that this man shouldn't be allowed to work on ANY child. We had far better luck with a local dentist who was up for the challenge
•    Anonymous said... I found a dentist that specializes in special needs patients, and that was very helpful for my son. Hopefully you can find one in your area. good luck.
•    Anonymous said... I was terrified of the dentist when I was younger so was determined my son wouldn't be like me ( obviously didn't know until later he was an aspie ) I took him with me each time I went to the dentist from a baby and the dentist always looked at him at the same time so he doesn't have the fear. I do actually pay now though as he is no longer nhs but my son doesn't want another dentist xxx
•    Anonymous said... It will depend a lot on having a good dentist that will set him at ease. My daughter's dentist can do whatever he needs to do because he built up the trust with her first.
•    Anonymous said... My 6 year old son just had fillings done yesterday! I was really surprised how well he did!! He had the "conscious/twilight sedation" but he was pretty much awake the whole time. He drifted in & out, but did AWESOME!! See if you can find a dentist that does that type of sedation. Just be careful that he doesn't bite/chew on his lip when he is numb afterwards. My son has a very sore fat lip now.....but other than that he did great!! Best of luck!!
•    Anonymous said... My 6 yr old ASD son is so disturbed by having his face and mouth touched that every time we brush teeth it is a big struggle. He developed 3 cavities from it and when we tried to have his regular dentist feel them he had the biggest meltdown of his life. Eventually the dentist had to make a referral to the local children's hospital to have him put under, so that the cavities could be fixed. What an ordeal. Yet, he still fights me on brushing his teeth.
•    Anonymous said... My son does well with the laughing gas but we've found his issue is the noise of the tools. We also now let him listen to his MP3 or IPod while he's getting work done and life seems to be much easier.
•    Anonymous said... My son hates being touched by doctors and the dentist. Positive reinforcement, reassurance helps. My 9 year old goes to a pediatric dentist that is very good with him.
•    Anonymous said... When my Aspie son was 10 we finally got referred to the children's hospital dental clinic. We had a lot of major work done with the amazing skills of the staff there. My son found the "laughing gas" helped him relax. After many appointments the dentist kindly told my son that he now needed to learn to go back to a regular dentist, as many children were waiting to get into the children's hospital for dental work. We have been able to go to our family dentist for regular check-ups and cleanings for the last few years. It seems his positive experiences helped him change his outlook. Good luck finding the right dentist to help your son.

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The Silent Bullying of Children on the Autism Spectrum

"Josh, our 7-year-old son with [high-functioning] autism, has had 5 weeks of school so far. My husband and I have noticed a change (for the worse) in his behavior ever since he started. We suspect he is being bullied by a particular individual, but Josh has not come right out and told us if this is indeed going on. Any advice?"

Young people with ASD level 1, or High Functioning Autism, unfortunately, are at a higher risk of being bullied or teased than other children. This can happen on the playground, in the classroom - and even in your own home.

Because many of these kids have some social and communication difficulties, they often can’t tell grown-ups exactly what is happening. Thus, parents and teachers may have to consider bullying as a cause when certain behaviors occur or worsen in the child.

Here are a few examples:
  • One of the things you’ll notice is an increase in isolation and a decreased tolerance in being around peers. The ASD child may throw temper tantrums or flatly refuse to acknowledge other children, even those that he or she is normally comfortable around.
  • Enuresis or encopresis may be a side effect of being bullied.
  • A youngster who has been potty-trained completely may go back to soiling as a way of handling the stress of being bullied or teased elsewhere.

Very rarely will the autistic child tell parents or teachers directly about the bullying. Instead, the adults will find that the child has regressed with behaviors and skills that he or she has already accomplished. Instead of believing this to be an “off day” or an “off week,” parents and teachers need to consider that bullying or teasing is happening.

If bullying is happening in your own home, it requires that you remain aware of what is going on in your household and stopping the behavior before things get too serious.

If you suspect it is happening at school, then consider observing what is going on in the classroom or talk to the teacher about your suspicions. Hopefully, the teacher will be your son’s advocate in the classroom - and you can expect that the teacher will be able to intervene in any bullying that might be happening.

Bullying, unfortunately, is a risk that parents of children on the spectrum must always consider. Keeping a sharp eye out on changes in your son’s behavior and advocating for him when necessary should help him thrive in an otherwise complicated environment with peers who simply don’t understand his issues.





COMMENTS FROM PARENTS:

•    Anonymous said... Can you or another trusted adult spend any time observing? Some kids are being bullied and wouldn't know how to cope or even exactly how to describe what is happening in order to get help. There are so many steps - knowing what is happening, knowing how to talk about it, knowing how to ask for help, feeling safe from retaliation....

•    Anonymous said... Just keep a really close eye. This happened to my son and we saw no signs until he was at his breaking point. Needless to say there is no more public school for us. Kids are cruel and teachers often don't have the resources to be everywhere at once.

•    Anonymous said... My daughter has had this problem and I'm sure will continue. She would not tell us anything about it, she actually pretended to enjoy going to the place that this was happening. We only found out about it from another little girl and even then my daughter pretended that she was trying to help someone else that was being picked on and the boys turned it in her. Almost like she was herself two different people! She still does not tell us anything about what happens at school and I try to pull a another child to the side to ask how she is doing in school! My daughter, I believe, is embarrassed and ashamed by it. I would suggest making sure he knows its not him and he needs to tell, a nice call to the school and the bullying child's parents also!

•    Anonymous said... Whenever I would talk to teachers about my son coming home bruised, ketchup smeared or mere reluctant to go back to school the next day, there never was an explanation. Nobody ever saw him being bullied. Sometimes my son would say something out of the blue two weeks later. Public school is no longer an option for him, if I want to see him get through School. We have finally decided to homeschool him. Once he found out that he is not going back there, all that anxiety is gone. He stopped biting his nails and he is now a jolly happy 7 year old contently riding his bike or playing lego, humming and singing all the way! I do realize that he is still a target in the neighborhood. I try to keep a close eye on him and talk to him about behaviour that provokes kids to mistreat him. Hopefully it works.

•    Anonymous said... I would start talking about bullying in a neutral way. That might encourage him to open up.

•    Anonymous said... Then I would speak to the school....

•    Anonymous said... It is tricky to ask the right question since the HFA/Aspergers child has a tendency to be so literal.

•    Anonymous said... We had quite the "experiences" throughout my son's school years and we didn't see "eye to eye" with all the staff BUT there was never a time where I ever felt uncomfortable with expressing my concerns to the staff and asking them to keep an extra close eye out during our most difficult times (when we felt bulllying was taking place). Always utilize your resources. The staff is there to help be your eyes and ears when you aren't able to be around. All you have to do is ask for the help. Good luck!

•    Anonymous said... our son has this prob this year he graduated 5 grade & will be going to middle school he used to love school weve done all talking w/teacher/principle/case worker butt still i fear the worst is yet to come if u find a better way let me know ty

•    Anonymous said... I dont think all kids with Aspergers always know when they are being teased. My sons school is awesome. They even noted on his IEP that they need to be more aware of teasing and bullying against him. Because he may not always recognize it.

•    Jenny said... Our son had rocks thrown at him by a neighbor kid. Yet he still considered them his friend. I had to explain to him what true friends were and how they should treat you I'd they we're truly your friend. He was sad about it, but it did help him understand why they couldn't come over.

•    Anonymous said... Tricky maybe, example..'I read this article today about bullying in school, how does bullying make you feel Johnny?'. Depending, of course, on the child, you have to figure out what they can relate to. Everyone is different and beautiful! :)

•    Anonymous said... Many times they will not come out and tell you this is happening. It's like pulling sharks teeth just to get my son to tell us what he did at school that day. You're going to need to talk to his teacher.

•    Anonymous said... I heard so and so was doing mean things to someone, can you help me understand what is happening at school. what have you seen xyz do or say?

•    Anonymous said... My Son has major challenges at camps over Summer/Winter breaks with behavior. Alas, it's due to anxiety and lack of daily routine and structure. Consider those issues as well. Good luck.

•    Anonymous said... As long as the team there doesn't look after it, you shouldn't let a 7-year-old child stay there. (Regardsless of AS or not. Kids can be severly mean.) Your son cannot handle it alone and may be injured, either physical or psychical. 

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Coping with Birthday Parties: Tips for Parents of Kids on the Autism Spectrum

"My autistic son (high functioning) will be turning 6 next week. We are considering having a birthday party for him and inviting a few of his neighborhood friends over. However, in times past, he has not done well with all the hustle and bustle that comes with 'partying'. Do you have any ideas about how we can have a better experience this time so that things don't result in a meltdown?"

Exciting times like Christmas, Thanksgiving, and birthdays are all a time to share our joy and happiness with our families and friends. We all have fond memories of our own childhood when we looked forward to putting up the decorations, eating mouth watering meals, and receiving all those longed for presents.

As moms and dads, we naturally want our kids to enjoy it all  and have as much fun as we did. So we talk, anticipate, and prepare with mounting excitement as the child's birthday draws nearer. 
 
However, for those parents who are raising a youngster with ASD or High-Functioning Autism, it often adds up to an almighty headache! Why? Because these "special needs" kids can have a real hard time coping with all of excitement and anticipation.

Anticipation for a child on the autism spectrum leads to increased levels of anxiety, which he can't control. He becomes overloaded, and then you have a massive meltdown at the time when you are all supposed to be enjoying and celebrating his birthday! The party is often ruined and everybody upset, especially your son who is trying so hard to fit in and be like everybody else.

==> How to Prevent Meltdowns and Tantrums in Children with ASD

So how can you achieve the impossible and enjoy the occasion while at the same time keeping your son calm and behaving appropriately?
  1. The first simple step to take is to simply reduce the time talking about the joyous occasion. Remember, your son can't easily control his emotions, and to chatter constantly about the event will simply lead to stress and anxiety. It is also useful to enlist the help of others in your home in this and keep any conversations to a minimum while your son is around.
  2. Another great strategy to help is to keep any physical changes to your home to the minimum. So by all means decorate, put up balloons, and have cake, but just don’t make a big fuss about it all.
  3. Also, don't put out any presents until the day they are to be opened, because your son will have a hard time keeping his hands off and will became anxious and potentially defiant.
  4. Although it’s important not to overload your son, it is equally important to explain any changes to his routines. So prepare him for any changes by calmly telling him the day before what will be happening. Visual supports always work well, so use photos or simple pictures to explain what will be happening.
  5. It is also important to explain to your son what is expected of him (e.g., to say 'hello, how are you' to guests and sit at the table to share the birthday cake).
  6. Your son will also need to be given permission to leave the festivities if he starts to get out-of-control, and you can rehearse this together with some simple role play. This is really important as it gives him an exit strategy and also allows him to get through the party without going into meltdown. Additionally, if you see that your son is becoming distressed, you can activate an "exit cue" so he gets out before the situation deteriorates.




Following these simple steps should lead to a much more positive experience for everyone and will provide your child with the love, support, reassurance - and above all confidence - to participate fully in his birthday celebration.

Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD

 
Comments from Parents:

•    Anonymous said... My 12 yr old Aspie son HATES parties. He doesn't even like for us to sing Happy Birthday to him, he starts crying - yet he loves music class at school. Go figure. We've had his birthday parties at his favorite places - bowling, mini-golf, Chuck E. Cheese, etc. He hated it. So we tried to have one at home and invited over only his best friend and his family. Can we say meltdown?!? He turns 13 this coming November and I really wanted to celebrate it, but he says PLEASE, no party. Soooooooooooo.... no party. I really feel that it's because most Aspies crave/require structure, and parties, by nature, are anything but structured.

•    Anonymous said... i completely sympathize here! we try to have parties for our now 9 year old and this year we decided against if finally because of how worked up he gets and he never enjoys it :(

•    Anonymous said... Our son loves museums so when he turned 10 we gave him the choice of a big party, or taking his cousins and going to the museum with just the 3 of them. He chose the museum and they all had a great time. It was a wonderful alternative to a stressful party.

•    Anonymous said... My son used to cry when we sang Happy Birthday. We've tried big birthday parties where we have gotten maybe three kids there from an entire class. This year we are doing a party but a very small one and will just invite the people he is closest to.

•    Anonymous said... Who says a party has to be big? Invite 2 or 3 friends. Plan an activity they will all enjoy. Could be a board game or a craft or even a video game. The point is to have fun. Maybe try cupcakes instead of a cake and not too many decorations. Sometimes less is more !

•    Anonymous said... Ask him what he wants. Maybe a day with mom and dad that he can plan with you would be awesome. Dad could cook his favorite breakfast (or go out if it's possible), then mom could do an activity with him. Then for dinner have his fave people there. My aspie thinks so different than I do, sometimes he has an idea of fun that I would never think of.

•    Anonymous said... We keep Julian's parties simple.. Not a lot of other kids because all the noise can cause a meltdown.. We keep it to one activity, cake and presents. Also we talk to him about it in advance.

•    Anonymous said... We did my boys film parties (luckily we have a projector in the house) so set up a few chairs, invited a few friends and did cinema food, got the boys to pick the film and they sat and watched. That way they had friends round, it was their party, but in familiar surroundings and without lots of noise and excitement :-)

•    Anonymous said... Holidays are especially stressful and equal more meltdowns... thanks for the tips!

•    Anonymous said... We've learned to change our opinion on what makes a b-day special. Why freak a kid out on their own b-day?? Ask what THEY want to do, and do that. The day is about joy and love, not balloons, clowns, crowds and cake. Follow their lead and let them determine what will make them happy.

•    Anonymous said... My son is five and we are in line for him to be evaluated for aspergers. We saw 1 woman who didn't even talk to him and just asked us a few questions and was ready to diagnose him based on a few things we said. Anyway, he has always been very afraid of people singing happy birthday, not only at his parties but at anyone's birthday. If we are going to a bday party he asks us in advance if they will be singing happy birthday and to tell them to whisper. Other than that though, he loves birthday parties as long as their isn't a lot of loud noise.

•    Anonymous said... I agree with other posters. We have split up celebrations thruout the week. She wants cupcakes @ school-early dinner (avoid crowds) @ her choice place. We have same 2 friends over for a fun day with same activities for last 2 yrs. It bores me but they have fun! So be it!

•    Anonymous said... Let him decide what he would like to do. There are so many fun things to do to celebrate his birthday without adding in needless stress for him.

•    Anonymous said... We just had DS's 7th birthday and it went really well. We kept it short and structured, at home and only a few friends that he picked. Each boy got a Lego race car to build, then they all went outside with their cars and chalk to draw roads and play with them, then we had cupcakes and opened presents. Quick, predictable and manageable :)

•    Anonymous said... Pick a place or a theme that your child likes. For my son's ninth birthday, we knew there was a robotics learning store that he loves going to. They offer birthday party packages that included most of food, supplies and entertainment. Our son loved it because it was a place he was familiar with and knew the staff. It was an activity that he loved doing....so he felt comfortable. The other kids and their parents all loved it because they had never heard or it, thought the robots were cool, and it was easy. Most of the dads that came seemed to have as much fun as their sons. It worked well.

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