CDA Essentials 2016 • Volume 3 • Issue 8

24 | Volume 3 Issue 7 I ssues and P eople Strategies for care of children with autism Ms. Coulter Jackson describes various approaches that they use at their practice. “We’ve taken pieces from all of these programs and combined them to create our own program. We choose from any of these strategies based on a child’s tolerance to it.” • D-Termined Program: This program helps a child with autism become familiar with the dental practice setting and learn cooperation skills by using repetitive tasking over a short interval. For example, I sit the child back in the chair, repeat “Legs out straight, hands on your tummy,” and see the child in short appointments over the course of a number of days. • Orofacial therapy: This method of desensitization was taught by Argentinian physician Dr. Castillo-Morales. It uses different approaches including stabilization of the jaw and deep pressure and vibration on the joints. It can help the child begin to accept touch and set up the duration of each procedure (i.e., counting to 5 while applying pressure). • Errorless learning: This technique reinforces good behaviours; it’s something we were doing innately, although we didn’t know there was a technical name for it. It’s continual positive reinforcement. Instead of saying “Put your hands back down,” we take their hands, put them back in their lap and then say “Good job, nice listening.” • Music therapy and counting: Martine Hennequin, a psychologist from France, lectures on her work with adults with Down Syndrome and use of music therapy. She attended our clinic in London, Ontario, where she helped us to learn about using music as a distraction tool. Some children tolerate scaling and polishing as long as I sing for them. Parents and support staff often join in too! • Social stories: Most children with autism have used some form of a social story, which involves using photographs in a story—it helps to teach a child about what to expect for their visit to the clinic. It would include a picture of me, Dr. Friedman, and the clinic. • Pivotal response therapy (PRT): Rather than target individual behaviours one at a time, PRT targets pivotal areas of a child’s development such as motivation, responsiveness to multiple cues, self-management, and social initiations. Part of the overall goal of each visit is to find a method of tolerance for overall care—not just for one particular procedure—and PRT helps with this. Watch the eyes The way I determine whether or not I’m going to continue what I’m doing is by looking at the patient’s eyes. So if the child is smiling and attentive I keep going. Some kids will make eye contact and others won’t. Children with autism often have difficulty making eye contact so I wait until a child tries to make eye contact—that’s one way I can tell whether what I’m doing makes them comfortable or not. Learn from experts Our biggest problem in pediatric dentistry is that when our patients grow up, they don’t have a practice to move to. If dentists in general practice could learn some of the methods we use with our patients, then these children could make the transition right into another practice as adults. a This interviewhasbeeneditedandcondensed. Theviewsexpressedarethoseoftheauthoranddonotnecessarilyreflecttheopinionsorofficialpolicies oftheCanadianDentalAssociation. Visit oasisdiscussions.ca/2016/ 06/23/cas for the full interview and to see how Heather works with children in the clinic. In one video, she uses deep pressure, orofacial massage, counting, singing and continual positive reinforcement with a young boy with autism. Another video shows Heather working successfully with a 12-year-old girl with Down Syndrome and autism who first visited the clinic at age two, when she was unable to tolerate even entering the clinic.