Communicating with Patients with ASD
This section includes very practical information that will enhance understanding of information given by the clinician to the patient. These strategies are the result of personal experience and recommendations from the different behavior, occupational and speech therapists the author has worked with.
Use short, concise statements. Do not use abstract examples. For example, it is recommended to say, “Open your mouth” rather than “open your mouth like an alligator.” Individuals with ASD understand language very literally and may not understand sarcasm or examples like the alligator. Furthermore, if the patient is higher functioning and loves alligators, it may be difficult to refocus the patient away from alligators once the subject is brought up.
“Hands on belly. ”Teaching children to keep their hands on their belly is simply a way to keep little hands still. It is one of the first “rules” the author teaches to special needs patients … and just sounds friendlier and less scary than, “put your hands down” or “Stop.” It works wonders.
Give the instruction once and wait patiently. Imagine there is a small child in the dental chair. The clinician is trying to get the child to open and the conversation usually sounds a little like this: “Open your mouth, let’s see, open big like an alligator, open, open, open!” Each time an instruction is given the patient with ASD must try to process what is being said. Keeping instructions simple and direct promote understanding. So, when working with a patient with autism, it might sound like, “Open your mouth” and then we might add, “Like this” and open our mouth to show them. It is also my experience the “wait time” between when the direction is given and when the patient understands is generally longer with special needs patients than with typical patients.
Keep language consistent. Once the patient understands the clinician’s instructions, make a point to use the same phrases. How many different phrases can be used to tell a patient to open their mouth? It may be surprising to realize how many versions of “open your mouth” are available. “Open up,” “Open wide,” “Let’s see those teeth,” “Open please,” etc. Pick one phrase, “open your mouth” or whatever the staff prefers and stick to it. Be sure every staff member working with the patient knows what phrases to use. In my experience this helps decrease anxiety for the patient and improves compliance and understanding. Be sure to document what works.
It may not be what you say, but how you say it. The tone of voice used may be what the individual with autism understands, not the actual words. For example, if “open your mouth” is said in a sing-song like manner and higher pitched the patient may not understand the words but the tone of voice is not alerting the patient that an instruction was given and something needs to be done. If, on the other hand, “open your mouth” is said in a deeper, more direct tone the patient may recognize a request is being made. This takes practice. It may feel like you are being a little harsh or insensitive but it really makes a difference. Do not be loud or rude, just be direct with an even, neutral tone and a deeper voice than the one typically used for children.
Excitement can be scary too. For typical pediatric patients, clapping and getting loud when the patient has done something for the first time usually makes the child feel good. This is not always the case with patients with ASD. Clapping and yelling, “Yeah! You did it!!” may be enough to keep them from ever opening their mouth for the clinician again. Offer compliments freely, but do it in a calm manner for those patients that might be upset by the clapping and yelling.
Avoid questions that allow the patient to say “no” when “no” is not an option. At one time many clinicians make the rookie mistake of asking a child, “Can I polish your teeth now?” Then the child says, “No.” Now what? Do not ask questions that allow the patient to have control over something that needs to be done. Instead try, “it is time to polish your teeth. Please open your mouth.” Consent to treat has been obtained prior to this point in the appointment; handing over control of the appointment to the patient by asking questions like this make the appointment difficult. The clinician has the responsibility to explain to the patient every step of the way what is happening and what to expect. Unless an emergency arises, treatment decisions should be made in advance and not as treatment progresses.
Use visual supports. Pictures are concrete and easy to understand for individuals with autism. They can decrease anxiety, increase understanding and can be the gateway to successful dental treatment.