Autism Awareness Week 2020

This week it's autism awareness week... so let's learn about the condition...

You may have read some of my previous posts about Autism, but let's have a recap...

What is Autism?

Autism or Autistic Spectrum Disorder (ASD) is a lifelong developmental disability that affects the way a person communicates and relates to the world around them. It has differing degrees of severity (hence the spectrum). 

Incidence is around 1 in 100 people with males being more diagnosed than females (4:1 ratio), although this is thought to be due to social masking of symptoms in females. 

70% have a learning disability. Although a triad of symptoms was traditionally described as what defines a diagnosis, more up to date thinking is a dyad of impairment:

  1. Fixed interests, repetitive, unusual and sensory behaviours 
  2. Impairment in social communication and impaired interaction
Plus additional difficulties can be described. 

There are some co-morbidities that are associated with ASD including:
  • Development e.g. hypotonia, cognitive disabilities
  • Psychiatric e.g. Anxiety, OCD
  • Behavioural e.g. self-harm, aggressive behaviour
  • Sensory e.g. hypersensitivities/hyposensitivities
  • Neurological e.g. seizures/epilepsy
  • Gastrointestinal e.g. food sensitivity, GORD
  • Sleep disruption
The cause of ASD is unknown (possibly genetic and environmental), and there is no 'cure'. Management focuses on gaining independence in daily activities such as behavioural strategies, special educational needs, and possibly medication to manage specific behaviour challenges or co-morbidities. 

Communication Tips

Patients with ASD may be verbal or non-verbal. Many may take what you say very literally, so here are some tips when communicating with these patients:
  • Use their name 
  • Use a special interest to engage them 
  • Say less and speak slower
  • Limit questions
  • Use less non verbal communication
  • Use visual supports
  • Be aware of background noise, it can distract the patient from what you are saying
  • Establish a 'stop' signal 
  • Patients will probably avoid eye contact - this doesn't mean they are not listening 
  • Give patients space and time to digest what you are saying
  • Some patients use Makaton signs to help communicate

Sensory Tips

As I've already mentioned, some patients with ASD have hyper/hyposensitivities. This can be very apparent in a dental setting, so here are some tips:

  • Patients might be sensitive to the dental light. Dark glasses can be used 
  • With patients who are sensitive to touch, minimise any contact with the patient, including how long you are using instruments inside the mouth
  • Patients can be sensitive to noise - some may have ear defenders. Noises like the suction or high speed drill can be almost painful for these patients. Avoid them or play music the patient likes 
  • Patients can also be sensitive to smells/tastes including mouthrinses, filling materials. This might decide what materials you can use for a patient to materials they tolerate

Oral Health Tips 

Although there are no specific oral health issues that feature in patients with ASD, there are some common patterns that arise:
  • Poor oral hygiene can be because of lack of compliance, dislike of taste/texture of toothpaste. Behavioural management from their carers, realistic expectations and the use of flavourless, non-foaming toothpaste can help
  • If they have a limited diet, this can impact of their oral health, for example if there is high sugar intake
  • Patients may be bruxists and have tooth surface loss, or chew things for sensory feedback. This is known as stimming. Safe chew toys can be advised which are kind on teeth
  • Self-injurious behaviour can present in the mouth, as ulceration, lip biting or gingival clefts
  • Due to possible high risk of caries/perio, prevention is key! Fluoride varnish/toothpaste and follow ups should be advised

Dental Appointment Tips

Seeing some patients with ASD in the dental surgery can be a challenge, here are my tips:
  • Preparation is key. If their carer/parent can come beforehand to take pictures of the environment/team this can prepare the patient, help construct a social story or use simple leaflets/questionnaires about the patient so the patient, their carer and the dental team are prepared e.g. if the patient doesn't like seeing people in uniform, the team can remove prior to appointment 
  • Minimise waiting time in the waiting room 
  • Plan the visit so there is no surprises
  • Consider domiciliary visits
  • The same team and surgery should be used to establish routine
  • See the patient at the time of day that least disturbs their routine 
  • Plan a sugar-free reward after the visit e.g. favourite take-away or activity, or even just a sticker!
  • Keep background noise to minimum
  • Use a time indicator 
  • The patient may require several acclimatisation visits 
  • Sedation or general anaesthesia is an option

What are your tips when managing patients with autism? Let me know in the comments below. 

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