Teaching children to brush their teeth and managing a trip to the dentist can be a bit challenging, especially when your child has autism.
Some autistic children are hypersensitive, like my son. They feel things differently than a typically developing child. There's no escaping this. So if you're a parent of a child with autism just embrace this fact and work with it or around it.
When i'm trying to get my son to brush his teeth I have to always remember how overwhelming it is for him and the need to be patient. The sensory overload from the taste and smell of toothpaste, and the texture of the toothbrush is probably a bit too much for him. Worse when he has to go to the dentist. The strange smells, the loud noises, the sharp looking tools and that strange masked person hovering over him with those sharp looking tools. When you really think about the whole thing, you have to acknowledge how scary the process must seem to children, even more so for those on the spectrum. They don't know what's going to happen or how long it will take and all of this contributes to making the experience difficult for you and your child...but especially your child.
My son no longer has an issue with brushing his teeth and will brush his teeth when told to do so. He will also allow me to assist when his teeth need a bit more attention.
Going to the dentist however is a completely different story. With never-ending negotiations and me exercising the patience of Job and then at the end of the session only accomplishing him saying hi to the dentist and going up and down in the chair. It used to be extremely frustrating, but not anymore!
My son's last visit was a success. While he did not allow the hygienist to use the ultrasonic tool that removes tarter, he actually gave her the green light to use the mirror, count his teeth, use her polishing tool on a few of his teeth and use gauze to clean the rest of his teeth. I call this a HUGE win. Of course there were negotiations, isn't there always?? Sonic the Hedgehog (his favourite toy) had to be present and I had to promise he'd get my phone right after to play with, but at the end of the session we were all happy to note the amazing progress he made.
So what did we do? How did we make such progress? BLOOD, SWEAT AND TEARS! Ha ha, I'm just kidding, there was no blood. There were a few tears though, and lots of sweat!
With guidance from therapists and tips online we made a plan and stuck with it.
Here are a few tips and guidelines we found helpful:
- Introduce/encourage teeth brushing from early;
- Make sure to start with a soft bristle toothbrush;
- Use visual supports or schedules, for example take photographs of the tooth brushing steps, print the photos and then laminate them in a table format. You can then use a dry erase marker to check off each step;
- Establish a routine - for example, 1/2 hour before bedtime, dress for bed, brush teeth, read a book then it is bed time;
- Sing a song every time your child has to brush his teeth. We always started with this song: "Brush your teeth, brush your teeth make them clean. Brush your teeth brush your teeth make them clean. Brush your teeth, brush your teeth, brush your teeth, brush your teeth, brush your teeth brush your teeth, make them clean." (Sang to the tune of that sunday school song "Oh be careful little eyes what you see".);
- Use visual timers. There are tons of apps online to help with this. We also invested in the Philips Sonic Care Toothbrush for children - it has a really cool sparkly kids toothbrush app which helped turn brushing time into fun time!;
- Try to take turns brushing teeth. Allow your child to brush your teeth and then you brush his teeth etc
- Try Hand over hand brushing. It works especially in the beginning stages.
- Choose a dentist who has some experience with children with autism. Ask around for recommendations. Bonus if they have a fantastic hygienist working with them.
- Plan ahead, talk to your child's therapist ask them for assistance as they can help with establishing a step-by-step plan or a social story with rewards.
- Leading up to the visit you, your child and the therapist should go through the steps i.e. check in, wait in waiting room for name to be called, meet the hygienist and dentist, sit in the chair etc etc
- Reinforce or reward for EVERYTHING, even if your child was only able to say hi to the dentist -the point is to make going to the dentist FUN!
There are many more tips and guidelines online to help parents and caregivers encourage teeth brushing and successfully manage a trip to the dentist. My suggestions above are only that...suggestions. They worked for my child but may not work for yours. Remember each child is different, so do your research and try everything until you find the right formula for you and your child.
It may take a couple of visits to get to the point of the dentist counting teeth, even longer for an actual cleaning, but it will come. So, DON'T GIVE UP and always always always remember to be patient.
”I know of nobody who is purely autistic or purely neurotypical. Even God has some autistic moments, which is why the planets spin.”-
I recently visited someone and noticed him watching a video on his phone. I asked what he was doing and he said he was just watching a video of a moving train. I was puzzled and asked why. He answered, "it helps take my mind off of things...when I have a lot of stressful things going on I do this and it relaxes me..."
Ahh I said in my mind...It's his coping mechanism. This person is not autistic but the conversation got me thinking about autism, how autistics cope, how neuro-typicals cope and how similar they both are.
Do you know what stimming is? Have you heard that word before? The word stim is short for self-stimulatory behavior and is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as part of the diagnostic criteria for autism spectrum disorders - “Stereotyped or repetitive speech, motor movements, or use of objects…"which "...limit and impair everyday functioning.”
What Does Stimming Look Like? Here are a few examples:
Everyone stims in one way or another. Maybe not in the ways described above but we do have our various coping mechanisms- our own way of stimming. What’s your stim? You know you have one!
I twirl my curls when I'm thinking about something or when I’m anxious, some people bite their nails, or crack their knuckles.
When stimming interferes with everyday activities and prevents learning however, this is when it becomes a symptom of autism.
Autistic persons usually stim when nervous, excited or when feeling over or under stimulated.
Temple Grandin, animal behaviourist and autism spokesperson says most people stim simply because it feels good. She said dribbling sand through her fingers was a feeling that used to calm her. She has also said that stimming "may counteract an overwhelming sensory environment, or alleviate the high levels of internal anxiety...". For instance, when my son covers his ears. I now know it's because there are certain sounds that hurt his ears, like the sound of a rooster crowing. My son will not only cover his ears but refuse to exit a car if he knows there are roosters are around.
Sometimes my son will just start singing around people or while his teacher is teaching. He'll also recite lines from his favourite movies or TV shows or line up all of his toys in some sort of formation.
When my son was about two years old he'd go up to random strangers (usually a female) give them a hug and press his chin or forehead into their chest or just sit on their lap. At that age it’s kinda cute, then again not really because hello stranger danger, but can you imagine him doing that at an older age? Exactly, not cute at all!
Lately he’s been squeezing my neck - thankfully it seems this is just a mommy thing! Sometimes he’ll come over to me and squeeze my tummy and say “squishy....squishy mommy”. I don’t quite know what to make of that, but again thankfully he only does that with me.
As you can see, there are some stims that you can use, some that you can work with or work around. But there are others that are socially inappropriate. In these situations what do we do?
Should we stop the stim? Wrong question....
If you try and stop the behavior you may cause a child to withdraw or lose an awesome opportunity to engage or interact with him.
Why is my child engaging in this behavior? Now this is the right question to be asking and a great place to start.
There are many reasons why a child could be stimming. They could be over stimulated or under stimulated, in pain, overwhelmed emotionally or they may just need to self-regulate or calm down.
So What Should You Do About These Behaviors?
If it’s interfering with activities or preventing learning then you should take steps to reduce the behaviour or encourage it taking place at a more appropriate time.
If the behavior is socially inappropriate (like sitting on some random strangers lap??!!) the goal should be to figure out what’s the reason behind the behavior and find a way to make it more socially appropriate.
Sometimes the behaviour may be a symptom of an ongoing medical problem which your child may not be able to communicate.
Some types of stimming are self-harming or may cause harm to someone else. In situations like this you should definitely do what’s necessary to try and replace the stim with a more positive behaviour.
How do you do that?
Here are a few ideas:
- first and foremost, take your child to a doctor. Eliminate any possibilities of medical issues such as migraines or ear infections causing pain etc
- take your child to a behavioral therapist and occupational therapist - they’ll guide you and point you in the right direction especially if the behaviour is harmful or inappropriate
- manage the sensory and emotional environment, ensure your child is as comfortable as he needs to be. For example my son and the dreadful rooster, we stay in the car together with the windows all the way up while he plays a game on my iPad. No sense forcing him to get out of the car making the stim situation escalate. He doesn't hear the rooster crowing so there is no anxiety attack and during that whole time my son remains a very calm boy.
- exercise! Get outside and play with your child....run, jump, dance, whatever your child needs
- once he’s not hurting himself, interact with your child while he’s stimming, engage in activities without trying to stop the stim. Studies show this works and naturally reduces the stim.
- use stimming as a reward after a period of playing or work. If you make time for stimming he will feel comfortable being himself. Encouraging more interactions and reducing the total number of hours spent stimming.
- respect the stim and join the stim! If a child is spinning plates, then start spinning plates. If your child is drumming on his chest then you do the same thing.
Sounds strange but it’s been proven to work. Google Floortime Method of Therapy developed by Stanley Greenspan. In his book Engaging Autism, he says
“Some children become intrigued – they now have a partner in crime, so to speak – and we get some shared attention and relating.
..so join in the child’s activity to create a relationship, and then begin to use gestures so the child, in order to get what she wants, has to gesture purposefully back to you and maybe begin using some words…"
The overall plan being to offer your child activities that give the same sort of sensory feeling as the stimming activity but go further in developing appropriate self regulation, engagement, and interaction.”
Perfect example? My son used beat on his chest and jump on hardwood floors a lot, now he only does it sometimes because he gets to rock it all out on an actual drum set. Do you see what we did there?
So, tell me what's your stim?