Interdisciplinary Medical And Dental Desensitization For People With Autism
Keywords:Occupational therapy, disability, pediatrics, primary care, intellectual disability, developmental disability, desensitization, interdisciplinary, autism, dental desensitization, medical desensitization
Premier HealthCare, a member of the YAI Network, specializes in outpatient healthcare services (such as primary care, dentistry, psychiatry, rehabilitation, psychotherapy, psychological testing, and nutrition) for people with intellectual and developmental disabilities in New York City. This is one of the most in need, yet underserved, groups of medical and dental patients. Many people with autism spectrum disorder (ASD) have difficulty understanding the significance of healthcare procedures and become overwhelmed by the unfamiliar environment and sensory input of medical and dental practices. They may also have difficulty with communication and socialization, which can exacerbate anxiety and challenging behaviors such as self-stimulation, self-injury, aggression, and tantrums. Additionally, this heightened level of stress can potentially translate into disruptive behaviors or physical reactions to avoid treatment. These challenges combined with a lack of healthcare professionals trained and experienced in working with people with ASD can result in ineffective preventative care and high-cost procedures.
At Premier HealthCare, a desensitization program was initiated to increase functional participation in medical and dental exams and decrease use of physical restraints or general anesthesia for people with ASD. An interdisciplinary team of occupational therapists, behavior analysts, doctors, nurses, and dentists collaborate to address how to make medical and dental procedures more tolerable for patients with special needs using a protocol comprising of four main stages: evaluation, treatment, generalization, and maintenance. They work with caregivers to provide person-centered individualized care, ultimately leading to decreased anxiety, fear, and aggressive behaviors; increased participation; and better health outcomes for people with autism.
Allely C., S. (2013). Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder. The Scientific World Journal, 916178. Retrieved from https://doi.org/10.1155/2013/916178
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl. 1), S1-S48.
Armfield, J., M. (2012). The avoidance and delaying of dental visits in Australia. Australian Dental Journal, 57, 1–5. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1834-7819.2012.01697.x
Armfield, J., M., & Heaton, L. (2013). Management of fear and anxiety in the dental clinic: A review. Aust Dent J, 58, 390-407. doi:10.1111/adj.12118
Bishop-Fitzpatrick, L., & Kind, A. (2017). A Scoping Review of Health Disparities in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 47(11), 3380–3391. https://doi.org/10.1007/s10803-017-3251-9
Brahm C., O., Lundgren J., Carlsson S., G., Nilsson, P., Corbeil, J., & Hagglin, C. (2012). Dentists' views on fearful patients. Problems and promises. Swedish Dental Journal, 36(2), 79-89. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22876395/#:~: text=Conclusion%3A%20Dentists'%20views%20of%20treating,do%20not%20appreciate%20their%20efforts.
Centers for Disease Control and Prevention. (2019). Disability and health U.S. state profile data for New York (Adults 18+ years of age). Retrieved from https://www.cdc.gov/ncbddd/disabilityandhealth/impacts/new-york.html
Croen, L., A., Zerbo, O., Qian, Y., Massolo, M., L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 814–823. https://doi.org/10.1177/1362361315577517
Davit, C., J., Hundley, R., J., Bacic, J., D., & Hanson, E., M. (2011). A pilot study to improve venipuncture compliance in children and adolescents with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics: JDBP, 32(7), 521–525. https://doi.org/10.1097/DBP.0b013e3182245b09
Evans, D., W., Canavera, K., Kleinpeter, F., L., Maccubbin, E., & Taga, K. (2005). The fears, phobias and anxieties of children with autism spectrum disorders and down syndrome: Comparisons with developmentally and chronologically age matched children. Child Psychiatry Human Development, 36(1), 3-26. doi:10.1007/s10578-004-3619-x
Farrugia, S., & Hudson, J. (2006). Anxiety in adolescents with asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21(1), 25–35. https://doi.org/10.1177/10883576060210010401
Hawkins, N., E. (1991). Bravery training: An approach to desensitizing young children to fears encountered in the hospital setting. Archives of Physical Medicine and Rehabilitation. 72, 697– 700.
Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, & Bölte S. (2016). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry, 208 (3), 232–238.
John’s Hopkin’s Medicine. (n.d.). Procedural sedation. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/procedural-sedation
Kim, J., A., Szatmari, P., Bryson, S., E., Streiner, D., L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4 (2), 117-132. https://doi.org/10.1177/1362361300004002002
Kuhaneck, H., M. & Chisholm, E., C. (2012). Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Special Care in Dentistry, 32, 229-233. doi:10.1111/j.1754-4505.2012.00283.x
Mouridsen, S., E., Brønnum-Hansen, H., Rich, B., & Isager, T. (2008). Mortality and causes of death in autism spectrum disorders: An update. Autism, 12(4), 403-414.
Nelson, T., Chim, A., Sheller, B., McKinney, C., & Scott, J. (2017). Predicting successful dental examinations for children with autism spectrum disorder in the context of a dental desensitization program. The Journal of the American Dental Association, 148(7), 485-492. https://doi.org/10.1016/j.adaj.2017.03.015
Nicolaidis, C., Kripke, C. C., & Raymaker, D. (2014). Primary care for adults on the autism spectrum. The Medical Clinics of North America, 98(5), 1169–1191. https://doi.org/10.1016/j.mcna.2014.06.011
Nicolaidis, C., Raymaker, D. M., Ashkenazy, E., McDonald, K. E., Dern, S., Baggs, A. E., Kapp, S. K., Weiner, M., & Boisclair, W. C. (2015). Respect the way I need to communicate with you": Healthcare experiences of adults on the autism spectrum. Autism: The International Journal of Research and Practice, 19(7), 824–831. https://doi.org/10.1177/1362361315576221
OPWDD (n.d.). Eligibility review process. Retrieved from https://opwdd.ny.gov/eligibility
Primeau, M., Gershon, A., & Talbot, L., (2016). Individuals with autism spectrum disorders have equal success rate but require longer periods of systematic desensitization than control patients to complete ambulatory polysomnography. Journal of Clinical Sleep Medicine. 12(3), 357-362. doi:10.5664/jcsm.5584
Putallaz, F., Rubins, S., & Schwartz, S. (1999). Mental health: Improper restraint or seclusion use places people at risk. Report prepared for United States General Accounting Office. Retrieved from https://www.gao.gov/assets/230/228149.pdf
Schell, A., B., Gillen, G., & Scaffa, M., E. (2014). Professionals, Communication, and Teamwork. In Willard & Spackman's Occupational Therapy (pp. 457-458). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Schwartz, J., Alam, J.,Cotayo, E., Espinosa, S., Grossman, D., Herdocia, P., Hernandez, V.,Lherisson, B., Lopez, K., Mejia, J., Rodriguez, C., Rodriguez, M., & Torres, J. (2019). Understanding health management for adults with autism. American Journal of Occupational Therapy. 73(4). Retrieved from https://ajot.aota.org/article.aspx?articleid=2755160.
Sine, R. (2008). Beyond ‘white coat syndrome’: Fear of doctors and tests can hinder preventive health care. Retrieved from: http://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome.
Thye, M., D., Bednarz, H., M., Herringshaw, A., J., Sartin, A., B., & Kana, R., K. (2018). The impact of atypical sensory processing on social impairments in autism spectrum disorder. Developmental Cognitive Neuroscience, 29, 51-167.
Tomcheck, S., D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. American Journal of Occupational Therapy, 61(2), 190–200.
YAI. (n.d.). About YAI. Retrieved from https://www.yai.org/about
YAI. (n.d.). Premier HealthCare. Retrieved from https://www.yai.org/locations/healthcare
Zerbo, O., Massolo, M.L., Qian, Y., & Croen, L.A. (2015). A study of physician knowledge and experience with autism in adults in a large integrated healthcare system. Journal of Autism and Developmental Disorders, 45(12), 4002-4014.
How to Cite
Copyright (c) 2020 Armenian Journal of Special Education
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.