Tuesday, September 7, 2010
The Good Doctor
So after the visit at the doctor's that didn't go so well, I was dreading the new dentist visit. We've been to a few dentists attempting to peek in Jack's mouth. No way. And why in the world does he have to lay down in the chair? After I heard about a dentist from another special needs mom, I called the office and talked to the assistant.So, Doctors, nurses, medical staff? Listen up. A few tips from the Greatest Medical Visit Ever.
Be Flexible
Me, on the phone: See, here's the thing. There's no way he's going to lie down. He has a lot of anxiety about lying down in strange places, especially medical offices. He also has anxiety about a moving chair.Dental Assistant: He doesn't have to lie down. He doesn't even have to get in the chair. We can work with him standing up if he wants.
Me: Really?!
This office was willing to be flexible and creative to get an examination AND the patient relaxed.Ask What Works & What Doesn't For This Child
Still on the phone, pre-visit ...
Dental Assistant: Has he been to other dentists before?They asked what experiences Jack had with other dentists, the good, the bad, and the ugly. I threw in his doctor experiences as well, including the one that didn't go well, so she could be prepared. There is nothing better than for a doctor to have all the information about what works and what doesn't work with your child.
Find Out the Child's Special Interests
After I made the appointment, I set to work filling out the new patient form. In that, they asked for diagnoses, but they also asked for Jack's favorite toy, activity, TV show, or character. I took off with it. "Jack loves cars, keys, and Team Umizoomi. He likes talking about cars: your car, your first car, your favorite car, your dream car. It helps him relax and trust you."Parents: Tell Them What You Need in Advance. Doctors: Listen.
Since I'd just had the bad doctor visit, I also laid what we we'd need from this dentist in the new patient information: "We're looking for a great special-needs dental home. Jack has high anxiety about doctors. He is afraid of heights and moving chairs, like dental chairs. He is afraid of medical instruments and even of opening his mouth for medical professionals. We're going to need lots of time, patience, and play."And doctors need to heed parent's wisdom about their children.
It's Fear, Not Bad Behavior
I wanted some way to prepare Jack about the dentist visit. I know how much he likes YouTube and responds to stories, so I looked around for a child-friendly, anxiety-free, not-too-much-information video. While I was searching, I found one that featured a dentist giving other dentists tips about "managing" children with autism. He thought that children with autism just didn't know how to behave when they came to a dentist's office. He opined that they just needed to be shown over and over how to behave and, eventually, it would stick. Sorta like kids with autism are not naturally smart and are pretty slow learners.Begin boiling now.
This particular dentist's solution was to start by showing a child how to lie in the chair: to have them "learn" how to climb in the chair independently, to put their hands on their tummies, and to open their mouths. The seven- or eight- year old boy in the video was shown at the first visit refusing to get in the chair. He clearly looked frightened. How anyone could mistake the fear for being a slow learner is unbelievable. They showed the boy's "progression" in the next visit as the boy climbed up into the chair, but curled into a fetal position. Still doesn't come across as fear? Knock, knock, anyone home? The dentist continued running drills with the child on proper dental behavior until, I suppose, the child "got it."
Children with autism are not driven by a lack of intelligence or by bad behavior. They are driven by fear. Why? Because children with autism have sensory problems. Generally, children with autism are highly reactive to sensory input or under-reactive to it. If they are highly reactive, lights, sounds, movement are too much, and by too much, I mean 100 times too much. If they are underreactive, they are not taking in enough sensory information and crave input, like deep-pressure touch and loud noises. You aren't sure which one your patient is? Ask his parent. They'll know.
And please don't assume bad behavior. Please?
Get Down
After arriving at the dental office, we waited in the lobby until called. Nothing new there. But as we went down the hallway, the the dentist AND the dental assistant squatted down to be on eye level with Jack. My eyes lit up. Hey, that's a good sign! Getting down to their eye level is so much less intimidating to kids. Especially when they can't, and I emphasize cannot, not will not, raise their eyes easily. Need more information on the difficulty with eye contact? Read my post The Eyes of Autism. You'll totally get it.A Room of Our Own
Though Dr. Cathy had a communal room for the typical kids examinations, she also had a small room in the back - nice and quiet. That way, Jack wasn't overwhelmed in the sensory department by other kids, other exams, and other things going on.
Have Special Interests on Hand
When we got in the room, right there, on the chair and the desk, were toy cars. Wow! They had actually read about his interests and acted on them! Jack zoomed in on the cars, asking about them and checking them out. The assistant played with Jack, answering his questions, showing him the cars, while the dentist reviewed Jack's medical history with me.Then, Dr. Cathy moved on to Jack. She talked cars with him. She answered all his questions about cars: her car, her husband's car, cars she used to have. She acted like she had nothing else to do but talk about cars. And when she finally peeked in his mouth, she gave his teeth car names. Man, did she know cars. And, WOW, does she value kids.
Schedule Extra Time
This dentist, this wonderful dentist, scheduled extra time, more time than a regular appointment. Get this. Dr. Cathy spent forty-five minutes with us. Forty-five Minutes! Even though she had a full office. She had plenty of time to talk to Jack, to get him comfortable, and to try different approaches. Doctors may lose some appointment time during the day. But what you gain in cooperation, trust, and good will from the special needs community will be priceless.
Use Rewards That Work With This Child
Dr. Cathy and her assistant used rewards, but not just a "do this, get this" reward. That doesn't work well with kids with autism. But when Jack wanted to see the secret button that makes the chair elevate, Dr. Cathy jumped on the request.Dental Assistant: You want to see the secret button? Even though you're not a grown-up? I haven't even seen the secret button!
Dr. Cathy: If I show you the secret button, then you let me count your teeth. Is that a deal?This dentist was creative enough to see the motivator Jack presented (the secret button) and use it to leverage a request. Oh, yeah. He was all over that deal.
Again: Be Flexible
Dr. Cathy didn't ever ask Jack to get in the chair. She let him stand up. She let him be comfortable. She told me about some children with special needs who were so afraid that they sat in the hallway on the floor together to do examination. And eventually, they moved closer and closer to the chair.Show, Ask, Examine from Easy to Hard
Dr. Cathy showed Jack all the instruments first. She let him hold the mirror and put it in his mouth. She even let Jack put the instruments in my mouth, though she cringed.Me: It's okay, Dr. Cathy. We share everything. Even germs.
Well, we could always use another set.
Dr. Cathy asked Jack if she could count his teeth. Jack said no and she didn't insist. She started with something easier instead. She asked if he wanted to feel the tooth counter. She put it on his hand and his fingers several times. Then she counted his fingernails. When he still wasn't comfortable with the tooth counter going in his mouth, she simply asked him to open his mouth so she could look. And she respected his space by not even putting a finger in his mouth.
When he was finally comfortable, she asked him if she could brush his teeth. And he said yes. Do you know how big this is? We couldn't even get him to open his mouth at two previous dentists and his regular pediatrician.
Be Playful
I'm sure most doctors want to be taken seriously and have a hard time appearing silly or playful in front of other adults. Heck, most of us are trying to protect our image. But being playful really helps earn a child's trust. Especially children with autism. You're speaking his language. You're helping him relax. Some people call it distracting the child, but really, all children learn through play.And these were some playful people. Dr. Cathy and her assistant had a great time recalling car names. They even sang a tooth-brushing song! Can you imagine any doctor you have right now singing? They made sad faces and happy faces and made up silly names and silly rules.
At the end of the Greatest Medical Visit Ever, the dentist had examined his teeth, found no cavities, brushed his teeth, and even got some tooth sealant on. This from a child who won't open his mouth. And the best part of all? Jack trusts her. There was no pressure, no stress, no force. He will remember talking about cars, playing with cars, pushing the secret button. He'll have the beginning of a great, cooperative, playful relationship with his dentist.
And the dentist won't be fighting a frightened child and beginning a traumatic, forceful, stressed relationship.
Who could ask for more?
There are real helpful humans out there - you just have to find them - that's the social lottery - finding the one in a thousand?
