Simple Strategies for Accommodating Neurodiverse Children in the Dental Setting

by Kari Slade, RDH

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Wikipedia defines neurodiversity, neurodivergence, or neurovariance as “Variations in the human brain and cognition, for instance in sociability, learning, attention, mood and other mental functions.”1 The term was first coined in the 1990’s by sociologist Judy Singer and tended to be used when discussing autism spectrum disorder and attention hyperactivity disorder within the self-advocacy movement.

Today, the term neurodiversity covers a range of conditions including ASD and ADHD, but also Down syndrome, Williams syndrome, Tourettes, Dyslexia, Bipolar disorder, Dysgraphia, Dyscalcula, and OCD. The neurodiversity paradigm states that no two human’s brains work the same way, and that it is important to include neurodiversity as part of a range of social normal. Patrick Dwyer explains that “’Neurodiversity’ can simply refer to the reality that diverse minds and brains exist, just as ‘biodiversity’ refers to the factual reality of biological diversity.”2 He goes on to say that neurodiversity is more of a social than scientific term that references the human condition, and not a diagnosis.

When considering diversity, it is important to consider differences in the processing of stimulus and information to improve the dental experience for everyone, but especially that of a neurodiverse child. Three easy interventions any office can include in their care of neurodiverse children include the use of sensory stimulation, social stories, and non-verbal signaling for autonomy during the dental procedure.

Sensory stimulators are aids that help to either increase or decrease stimulation based on the child’s preferences. Weighted blankets are an excellent way to help calm a child in the dental setting. The study “Weighted Blanket Use: A Systematic Review”3 looked at 8 studies and found that body pressure can sooth sensory overstimulation-related anxiety, especially in neurodiverse people. The dental setting can be an overstimulating place with lights, sounds and smells that are very different from the client’s typical environment. The use of one or two lead aprons over the client can be an easy adaptation that provides comfort, while being easy to utilize and disinfect. Noise canceling headphones can also be an easy option to limit the loud sounds that can accompany dental procedures. Alternately, the addition of light stimulation, such as a calming tube, or LED lighting, may also help to calm and distract a nervous child. Learning what a client’s sensory needs may include and making small, in-operatory modifications, can dramatically improve cooperation during dental procedures.

Social stories are small visual aids that prepare a child for what to expect before they enter the clinical setting. Social stories can be created utilizing premade picture cards, called pecs, or photos taken in office. Paired with short sentences and verbal instruction, social stories are an easy to implement and effective way to reduce social anxiety.4 By preparing the client for what to expect before the dental procedure, social stories can provide the opportunity for understanding and questions, which help to ease fear of the unknown. Stories can be printed and given to clients or put on the office’s website for easy reference. They can be very simple, showing the operatory and the dental professional, or more in depth, covering different procedures in the clinic setting and sharing tools and expectations. Adding a check list of steps, or a visual board of “first, second, next, last” (with last being some kind of reward), can also help to prepare a child by giving them a clear idea of what to anticipate, and providing the opportunity to ask questions before the procedure begins. More research is being done on the medical effects of social stories, but pairing them with short verbal cues has been shown to be the most effective approach.5

Lastly, utilizing a “magic wand” or stop sign as a non-verbal communication tool can also be effective in allowing the client to feel comfortable in expressing their needs. Selective mutism, or a child’s inability to speak when feeling sensory overload due to anxiety, can be a factor with neurodiverse children. Allowing for the client to express their needs in a non-verbal way may allow the child to feel more at ease in the dental setting. This visual aid accommodation provides the opportunity for autonomy, regardless of speech or language barriers. It can also be a great tool for distracting anxious hands during treatment.

We must remember as dental professionals that we remain in very close proximity to clients throughout their procedure, and that the environment is full of atypical stimulations. This can be very intimidating for all children, but especially children who have extra sensory considerations or have difficulty expressing their needs.  Taking the time to make small accommodations to the dental setting can have a monumental effect on the ability to complete treatment when working with neurodiverse children. Considering the sensory environment, providing opportunities for children to learn what to anticipate at the dental appointment, and providing a non-verbal means of communication are all ways one can easily make the dental environment less intimidating for all neurodiverse people.

References

  1. https://en.wikipedia.org/wiki/Neurodiversity
  2. Patrick Dwyer (2022). “The Neurodiversity Approach(es): What Are They and What Do They Mean for Researchers?” (PDF). Human Development. 66 (2): 73–92. doi:10.1159/000523723. PMC 9261839. PMID 36158596. S2CID 247062174.
  3. Eron K, Kohnert L, Watters A, Logan C, Weisner-Rose M, Mehler PS. Weighted Blanket Use: A Systematic Review. Am J Occup Ther. 2020 Mar/Apr;74(2):7402205010p1-7402205010p14. doi: 10.5014/ajot.2020.037358. PMID: 32204779.
  4. Crozier S, Tincani M. Effects of social stories on prosocial behavior of preschool children with autism spectrum disorders. J Autism Dev Disord. 2007 Oct;37(9):1803-14. doi: 10.1007/s10803-006-0315-7. Epub 2006 Dec 13. PMID: 17165149.
  5. Reynhout G, Carter M. Social Stories for children with disabilities. J Autism Dev Disord. 2006 May;36(4):445-69. doi: 10.1007/s10803-006-0086-1. PMID: 16755384.

About the Author

Kari Slade is an independent Registered Dental Hygienist, and the owner of Something To Smile About, in Brantford Ontario. She is a member of the clinical faculty at Southern Ontario Dental College and graduated from Aplus Institute of Dental Hygiene in 2007. Kari currently lives in Brantford Ontario with her husband, 2 children and menagerie of pets. You can follow her on Instagram at Somethingtosmileabout.


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