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Treating Patients with Autism in a Dental Setting

Course Number: 402

Using Rewards Appropriately

Rewards help shape behavior. When a child exhibits a behavior that is undesirable, it is best to simply ignore the behavior and turn away until the behavior stops. It is important to know how to use rewards correctly so the child understands what behavior is positive and what they are being rewarded for. When using rewards be sure to keep in mind the following guidelines

  • When teaching a skill, rewards should be given each time the child attempts the task until they understand what is being asked. For example, if a child is learning to sit in the dental chair, offer the reward even if the child sits on the end of the chair or only sits for a few seconds.

  • Fade rewards once the task is understood and the patient is ready to move to the next step. If the child knows to sit in the chair and does so appropriately, withhold rewards until they learn to open their mouth or sit for longer periods of time. Once the skill is mastered rewards should not be used.

    • Keep in mind if a patient with autism learns a new skill during the appointment that does not mean the child will automatically understand that at the next appointment, especially if a significant period of time (like 6 months) has passed. This is especially difficult for families as their child may use a word functionally one day but then may take months to use it again.

  • Rewards should be highly motivating to the child. It is important to have the parent interview before the appointment and try to have rewards that are motivating for that patient. It is also ok to ask parents to bring in a reward that can be used. Many children have a favorite character they are particularly interested in - do an internet search for images of the character and print off small pictures. This has been a useful reward for many patients.

  • When teaching a skill, be sure to have the reward ready to offer as soon as the attempt is made. As soon as the patient’s bottom hits the chair, offer the reward (if sitting in the chair is the skill being taught). It needs to be obvious to the child what they are being rewarded for.

  • When giving the reward, offer a very simple explanation. For example, “good sit” or “good open.”