AAAP Today

For families of persons with autism and other developmental disabilities, this article offers points to think about.

http://www.foundationforautismsupportandtraining.org/lifePlanning.html

Best,

Lirio Sobrevinas-Covey, Ph.D.

President, AAAP

TIPS FOR EASING TRIPS TO THE DENTIST

By Lirio Sobrevinas-Covey, Ph.D.

Regular visits to the dentist are necessary for maintaining dental health and avoiding painful and costly oral and dental problems. Among my contacts with parents of children and adults with autism, I have heard of significant difficulties as a consequence of infrequent dental visits, even when appropriate facilities are available. As a result of delayed or the lack of dental care, surgeries and hospitalization became necessary.

As described by researchers in a recent study “children with autism show heightened responses to sensory input and find these sensations uncomfortable. As such, the dental office, with its bright lights, loud sounds from the dental equipment, and touch of children in and around the mouth, presents particular challenges”.

The problem was addressed in a unique collaboration between pediatric dentists and occupational therapists.

Forty-four (44) patients seen at the Children’s Hospital Los Angeles, (22 with autism and 22 "typically developing" (defined as children not on the autism spectrum)) –underwent two professional dental cleanings. One cleaning took place in a regular dental environment, the other in a sensory adapted dental environment. During each session, the child’s physiological anxiety, behavioral distress and pain intensity were measured.

In the adapted environment, overhead office lights and headlamps were turned off, slow-moving visual effects were projected onto the ceiling, and soothing music was played.

Seat covers that looked like a gigantic butterfly whose wings wrapped around the child and provided a comforting, deep-pressure hug replaced the usual seat covers for dental chairs.

The result – both typically developing children and those with autism spectrum disorders exhibited decreased psychological anxiety and reported lower pain and sensory discomfort in the sensory-adapted environment.

The findings suggest that adaptations in the dental clinic to reduce sensitivities associated with autism could help improve oral health care for children and adults with autism — a group reported to suffer from poor oral health.

Reference: Cermak SA, Stein Duker LI, Williams ME, et al, (2015) Sensory Adapted Dental Environments to Enhance Oral Care for Children with Autism Spectrum Disorders: A Randomized Controlled Pilot Study. Journal on Autism and Developmental Disorders. 2015 May

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Asperger’s or not? Notes from a clinical exchange

By Lirio Sobrevinas-Covey, Ph.D.

Asperger’s syndrome (AS) is a condition that is on the high functioning end of the Autism Spectrum. AS is characterized by impairments in social interaction and repetitive and persistent behaviors, but not by deficits in intellectual ability or normal language development. In some cases it is recognized or diagnosed only during adulthood. Persons with Asperger’s may be regarded diagnostically as High Functioning Autisms.

Below are notes from an exchange in response to an inquiry emailed by a reader of our AAAP Internet materials. The inquiry has many interesting and important aspects relevant to understanding Asperger’s syndrome, possibly typical of the quandary experienced by some persons with Asperger’s-like symptoms. The maker of the inquiry gave me permission to share elements of our exchange. Her name is withheld.

The Inquiry:

“Truth is, I cannot point a finger on what made me suspect that I have Asperger’s. All I know is that I can’t connect with people in ways that I should.

For example, I am unable to tell a joke from a serious request. I take everything by heart, and then they’ll laugh at me and say "Of course we’re just kidding!" like it’s a no-brainer. I also unknowingly turn people off and break unwritten rules on many, many occasions. I’m pretty naive at times, and pretty offending at times. And the crazy thing is, I am not even aware when I look naive and when I look offending. It feels like everybody’s got their copy of social rules and I haven’t gotten mine.

I am learning how to act better in social situations though- smile, avoid bringing up ‘boring’ topics like design and macroeconomics, and try to respond in two or more sentences. That said, I often have trouble with the latter. The most common topics in social situations are TV shows and employment, and neither are in my large pool of thoughts and interests.

From all these small social defects sprung a lot of personal problems. And from all these personal problems sprung flares of anxieties. Or maybe not– I’m a constant worrywart since time immemorial and panic attacks just got worse after I’m 21. Whichever, the most difficult part is dealing without support- family and friends think that I’m just a hypersensitive, odd, and overreacting kid, all while I’m dragging from one anxiety bout after another. It gets me frustrated that nobody ever understood. I guess this problem has got to be named.

My response:

From your account, it looks to me that you have traits that could comprise Asperger’s syndrome. Whether you meet the diagnosis fully is not clear, however.

Do you also find yourself hampered by the need to do certain things over and over, and have difficulty changing routines? In addition to social interaction issues, problems with repetitive and restricted behaviors constitute one of the two basic criteria of Autism Spectrum Disorders (ASD).

About the anxiety issues, it is possible that those symptoms are occurring independently of whether you are diagnosable with Autism. If the anxiety symptoms are impairing your general functioning, seeking treatment for the anxiety would be beneficial. There is considerable knowledge regarding how to manage and treat anxiety.

Inquirer’s response:

“That’s odd. I don’t usually think hard about these things, but now you’ve mentioned routines, I suddenly got conscious about these:

-I only play one song, looped for the whole session in my Ipod. I do it that way because I don’t like it when one song changes to another.

-I cannot go to bed without my notebook beside me. I never used a notebook after laying down to sleep, but it just feels right. When I sleep over to another house (which I usually don’t unless I have no choice), I still look for a notebook to put beside or under my pillow.

-I have this habit of prancing when I’m walking. Prance when I just got out the door, prance when I’m in a wide pavement. I guess it steadies my nerves.

-Oh, and when I’m thinking hard, I walk fast, counterclockwise and then clockwise in an oblong pattern. It’s very comfortable, but I don’t do it anymore when somebody’s around. Already learned my lesson when I was a kid.

There could probably more I didn’t notice.

My Comment:

The behaviors the inquirer describes give the clinical impression of Asperger’s but more extensive assessment is required to make a confirmed diagnosis. There are no specific treatments that would “cure” Asperger’s syndrome. Behavioral treatments are the current approach for addressing the impairing social skills and obsessive-type symptoms.