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Treating Patients with Autism in a Dental Setting

Course Number: 402

Video Modeling

Video modeling is effective in teaching individuals with autism how to behave appropriately in certain situations.  In preparing for the dental appointment, ask the parents/caregivers to watch videos of others going to the dentist.  It would be ideal for a dental office to create a video specific to their office and staff and keep the video on the website for patients to view.  Showing the specific environment and staff members is more ideal than a “generic” video; although, either would work.  One company makes a dental video that allows a picture of the child to be inserted into the video so it is as if the child is watching himself going to the dentist.

Chairside to Autism: I have experienced great success in desensitizing children on the spectrum by using the “Look At Me Now” video. I worked with four children that had been turned away by several dental practices simply because they had been diagnosed with autism. In order to test the effectiveness of the videos I had the children come into the office without any preparation to see how they would respond to the dental environment. In the most difficult case one little boy refused to get into the chair during the initial appointment. All he did was spin in circles in the hallway and would not let me get close to him. His parents purchased the video which included having the child’s picture uploaded to the video so that it appeared as though he was watching himself behave appropriately in the dental setting. He watched the video every day, several times a day for two weeks and returned to the office. My experience led me to believe that our second visit might be a lot like the first; my only goal was to get the patient to allow me to get close to him and touch him. I was pleasantly surprised when he sat in the chair and let me put a toothbrush in his mouth! We continued in two week intervals and by the fourth visit I was able to polish his teeth while he was lying in the dental chair. Aside from my verbal resources and patience the only tool we used was the “Look at me Now” video. “Look at me Now” has dental videos as well as videos on getting a haircut, going to the doctor etc.

In 2015, I was approached by the makers of “Look at Me Now” videos to do some research into the effectiveness of using their videos to desensitize children with autism to the dental environment. I found four children on the spectrum that had either had a negative experience in the dental environment or who had never been seen in the dental environment to participate in the experience. I had the children come to the office without any preparation including my recommended pre-work referenced in this article. My goal was to see if the video truly made a difference in the experience without the use of other resources like a visual schedule, first/then cards etc. I treated them just as I would treat any other typical child and not as a hygienist that had special training in autism. Following the initial visit the children were sent “Look At Me Now” videos with their individual faces transposed into the video. The children watched the video at least once a day for two weeks and returned to the office for a secondary visit. We recorded both visits.

There was significant improvement in all four children with the use of the video. Three of the children had high functioning autism and required only two visits. On the first visit I was able to polish, floss, and place fluoride varnish. One of the children had a hard time with the sound of the suction and kept covering her ears. On the second visit all three children had four bitewings, a pano, polish, scaling, fluoride varnish and an exam by a dentist. The parents mentioned that all the children loved the video and watched it several times a day. During the second visit I did not have to take as many breaks, the child stopped covering their ears and they knew what to expect and what type of behavior was appropriate.

The fourth child had a more severe case of autism along with several medical complications. Anytime the child saw someone wearing gloves he associated that with needles and it caused him great anxiety that led to him being uncooperative. As you will notice in the before video the little boy never made it to the dental chair in the initial appointment. He resorted to spinning and repeating phrases like, “go to Dada school.” Having worked with many patients on the spectrum I was hesitant how much the video would assist in the process. After the appointment I sent the little boy his video and his parents watched it with him every day for two weeks. I was shocked when during our second appointment he jumped up in the dental chair. In my experience getting in the chair is often the most difficult hurdle; progress happens at a faster rate once the patient will actually get into the dental chair. During appointment two I was able to sit close to the boy while wearing my gloves but I was not able to complete any treatment including brushing his teeth. We continued to return in two week intervals while the family watched the video daily. What you see in the after video is our fourth appointment. We were successful in getting the patient to sit in the chair, lie back in the chair and let me polish his teeth. Unfortunately the battery died on the camera right before the best work happened. I was able to polish his teeth for short bursts while his Dad counted to ten; at one point the little boy said, “let’s go to 100!” and allowed me to work while his Dad counted all the way to 100.

Before this experience I recognized the importance of video modeling as I had witnessed it work extremely well with my son; however I was overwhelmingly surprised how effective the use of these particular videos were. It makes a difference when the patient feels like they are watching themselves in the video. I strongly recommend this as an effective option and resource for desensitizing patients that have never been to the dental office or who have had a negative experience.