Jay is 11 years old and recently diagnosed with autism and mild learning disability. He is a chatty and sociable youngster but is also very anxious and tactile defensive. He attends the dental surgery with his mother and younger sister. Jay has never co-operated in dental treatment but since his diagnosis, his family and school have found that with the right approach, Jay will do his best to co-operate even in things he finds difficult. Jay’s family have spent weeks preparing him to attend the dental surgery and today he has got as far as the waiting room. However, when asked to enter the treatment room, Jay starts to bite his hand and scream.

Strategies

• Entering the dental surgery should be considered a great achievement for Jay and he should be praised for this and reassured that he can leave without entering the treatment room. Provide Jay with a reward is linked to his interests.
• In consultation with Jay’s parents and school, draw up a staged plan of achievable steps towards Jay having a full dental examination. Entering the surgery might be one step, sitting in the chair another. Each step should be considered a goal with a meaningful reward attached (reward to be given for trying and not only for achieving). Consideration needs to be given to the time lapse between appointments so that Jay understands the process and is able to remember the previous stage.
• Consideration should be given to strategies that will help to familiarise Jay and alleviate his anxieties. For instance, a book of photographs of the treatment room and equipment can provide a reference point and basis for discussion with Jay. It may be possible to lend home/school some equipment so that Jay can explore it in his own time.
• Consider whether there are elements of the examination that can be undertaken without exposing Jay to touch.