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Read more#AuthenticAction: Profound Autism at the Dentist
How ABA enabled my son to transform into a cooperative patient and partner in his own health
(Stock image)
By Eric Jager
As the parent of a profoundly disabled autistic young adult, I’ve heard lots of perspectives on the challenges and health risks associated with autism. This has meant learning about multiple therapies and determining how and when to use them to reduce the trauma caused by his autism and to increase his ability to function independently. My son is not unique in that the dentist’s office was a tremendous source of his trauma.
But thanks to a program developed and implemented by his ABA therapist and a dental hygienist who utilized methods grounded ABA, he is now able to calmly tolerate a professional cleaning, an outcome which I previously thought was not possible when we began the process years ago.
“Thanks to a program developed and implemented by his ABA therapist and a dental hygienist, he is now able to calmly tolerate a professional cleaning, an outcome which I previously thought was not possible.”
MJ, who is non-verbal and intellectually disabled, has had exposure to ABA (as well as speech and occupational therapy) in some form for 17 years and I have been reading about both practical uses and critiques of the therapy for almost as long. Over the years, I have seen a shift in the goals suggested by some ABA therapists and insurance companies. For example, extinguishing harmless “socially stigmatizing behaviors” like hand flapping has been less of a focus. Our therapists, with our active input, have had a more intense focus on increasing self-help skills, functioning more independently in the community, and tolerating unpleasant but necessary experiences including a visit to the dentist’s office.
MJ’s trips to the dentist were horrible when he was younger. He didn’t understand why he was there and he resisted opening his mouth. We found it very difficult to communicate the necessity of the experience which he clearly found to be a horrific sensory assault. He would frequently kick and scream and refuse to sit at all. His original dentist wanted to use something called a papoose to keep him still. This is a board that the child is placed on forcibly, if necessary, which binds his hands and legs in place. It reminded me of a straitjacket and we wouldn’t let him use it. As a parent, it was agonizing to watch a dentist use force to keep his mouth open. I can’t begin to imagine how traumatic this must have been for MJ.
This is when we asked our home-based ABA therapists to help. They used a common ABA procedure called task analysis which involves breaking down the process of acquiring a new skill or habit by dividing it into smaller, manageable tasks. The plan involved exposing MJ to various dental tools including the mirror, probe and toothbrush in the comfort of his own home. They worked with him to open his mouth for increasing lengths of time and simulated cleaning his teeth. He was rewarded with verbal praise (“Great job, MJ!”) each time he met one of the established sub-goals.
Next, the BCBA and team leader accompanied us to the dentist’s office and again used verbal praise to reinforce his success in sitting in the chair and opening his mouth, even for a very short time. He made some progress but ultimately, as MJ became bigger and stronger and remained generally uncooperative, this dentist said that the only way that he would be able to effectively clean his teeth would be in a hospital under anesthesia.
“It’s very rewarding to see him now, at 20 years old, finally sitting calmly in the chair for an entire 30-minute appointment. It was crucial for the team to remain patient and focused on the goal of reducing our son’s trauma.”
We found another pediatric dentist with a hygienist who was using the same methodology (explaining every step of the process to him, requesting that he open mouth for just a few seconds at a time and then rewarding him with a drink of water). Although, he is non-verbal it is clear that he likes this hygienist and is much less stressed by the dental visits. Over the course of several years at this practice he has shown slow but significant progress in tolerating the visits.
It’s very rewarding to see him now, at 20 years old, finally sitting calmly in the chair for an entire 30-minute appointment. It was crucial for the team to remain patient and focused on the goal of reducing our son’s trauma. The approach, while not quick or easy, has helped him to maintain his physical health and well-being.
Eric Jager is the parent of a young adult with autism. He writes about autism parenting and develops workshops for parents, educators, employers and individuals with disabilities.
Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors. Inclusion of any product or service in a blogpost is not an advertisement, is not made for any compensation, and does not represent an official endorsement.
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