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Treating Patients with Autism in a Dental Setting

Course Number: 402

Visual Schedules

The Indiana Resource Center for Autism lists several “advantages to using a visual schedule with individuals with ASD including (Mesibov et al., 2005):

  • It utilizes the individual’s visual strengths and therefore provides a receptive communication system to increase understanding;

  • It helps the individual to learn new things and broaden their interests;

  • It provides tools that allow the individual to use skills in a variety of settings;

  • It can increase the individual’s flexibility;

  • It helps the individual remain calm and reduces inappropriate behaviors; and

  • It helps the individual to develop independence and resulting self-esteem."8

Visual schedules are a series of pictures used to demonstrate the order of activities. A visual schedule may be pictures or it may be writing. Dental professionals use a visual schedule every single day, several times a day; it is just referred to as a patient schedule and not a visual schedule. The visual schedule can help the patient visually see what is happening and what will happen next. Implementing visual schedules are easy and very effective.

Implementing a visual schedule in the dental office:

Take pictures of each step of the appointment. Individuals who are older or who have experience in the dental environment will be fine with a visual schedule that does not include every single step. For patients that are very anxious or very young, each step will be broken down. Below is an example of a visual schedule for simply getting in the chair and lying down (Figures 1-4).


Figure 1.


Figure 2.


Figure 3.


Figure 4.

Visual schedule of steps for getting in the chair and lying down.

Putting the pieces together. If I were seeing a young child with autism or one that is very anxious, I would take these pictures with me to the waiting room. I would sit next to or kneel next to the child and in a calm voice say,

“Hi Ethan. My name is Josey. I am going to clean your teeth today. I promise to show you everything we do before we do it and will take good care of you and your teeth. I want to show you what we are going to do today. This is a picture of my special chair. You get to sit in my chair today. After you sit down, I am going to put a special napkin on and have you wear sunglasses. After that, you will lie down in my chair like you do in your bed. Come on Ethan, it is time to go get in the chair.”

Once we were in the operatory and the patient was in the chair, I would show the rest of the pictures for the appointment. The very last picture should always be a reward card. If the child is new to the dental environment or struggling to finish the appointment, reward cards can be placed throughout the appointment. Or, if the clinician knows of something specific that is particularly hard to the patient, place a reward card following that activity. For example, if we know polishing is difficult, immediately after the polishing picture place a reward card.