Welcoming the Neurodivergent by Drs. Eric Wu and Melanie Wang

Categories: Orthodontics; Pediatric;
Welcoming the Neurodivergent

9 tips to enhance treatment accessibility for patients with autism spectrum disorder

by Drs. Eric Wu and Melanie Wang

Is there a place in a busy practice for patients with autism spectrum disorder (ASD)? We enthusiastically say yes, absolutely! Welcoming ASD patients has been a huge practice builder for both of our practices. Many offices shy away from these patients, but if you can win them over, you win the admiration of the parents, siblings, the community and the local ASD community as well. In this article, we present strategies to make your office more accommodating for the neurodivergent.

1. It starts with the first interaction—ask about accommodations.
If a patient or caregiver identifies the patient as having ASD, be proactive in asking what accommodations you can provide. Give examples of accommodations you have made in the past. Provide detailed information about what to expect at the first appointment or share a short introductory video to help reduce anxiety. Frontloading is crucial with ASD patients: Provide as much information as possible about the appointment and the orthodontic process in advance of the appointment, including images if possible.

2. Optimize scheduling.
We strongly suggest early morning appointments for ASD patients, and their families happily oblige. This time slot eliminates patient anxiety buildup from thinking about it all afternoon, provides the calmest environment and reduces distractions. A bonus for orthodontic offices is they won’t choose the popular after-school appointments. We are also careful to not schedule on festive days such as Halloween, when the staff will be in costume.

3. Establish a positive rapport.
Morning and early-afternoon appointments also provide additional time to establish trust and evaluate the patient’s capabilities. Use simple language and avoid complex orthodontic terms to aid communication. Always have the same staff member work with the patient. Spend additional time training your entire staff on how to work with ASD patients.

Build trust and work hard to be the best part of your patient’s day. It is not difficult to win over an ASD patient. For some, their love language might be receiving specific gifts, like color-changing pencils. (One patient intentionally broke his wires just to receive another pencil. We pivoted and only gave pencils for visits that did not require repairs.)

4. Offer distractions.

Music and iPads are lifesavers for distracting patients! It offers a distraction from the actual appointment procedure and mitigates sensory stimuli for the patient. Consider offering stuffed plush toys as a distraction and remind patients they can bring their favorite toy to the appointment.

One patient was able to remain still for the pano only when the assistant calmly repeated, “Stand still like a soldier. Stand still like a soldier.”

Some patients still have a sensitive gag reflex, regardless of the distraction. For this, the “salt lick” trick almost always works: Have them put a tiny bit of salt on their wrist to lick. Most will stop gagging for the procedure.

5. Emphasize routine.

ASD patients are sticklers for routine and find consistency reassuring. Schedule appointments at the same time and on the same day of the week with the same staff member. Work with the patient and their family to make orthodontics part of their routine—brushing, cleaning appliances, aligner or elastic compliance, etc.

6. Mind the environment.
For individuals with sensory dysfunction, lights, decorations, noise, music, texture, odors and taste can be overwhelming. Try to keep stimuli to a minimum for these appointments and be creative with accommodations.

7. Break visits up into shorter sessions.
Long procedures might be overwhelming; offer to bond one arch or half an arch per appointment.

Some patients may need to become accustomed to the sounds and sensations. Consider allowing the patient to borrow cheek retractors to practice tolerating them. Offer to let the patient touch the instruments and hear the sounds before you use them in the mouth.

8. Include the caregiver in communication.
If the patient has communication difficulties, you may have to rely heavily on the caregiver/parent to facilitate and interpret.

9. Embrace technology.
Consider an intraoral scanner over impression material, which can be more tolerable for ASD patients with a strong gag reflex. Making them as comfortable as possible is critical.

Clear aligners are often easier appliances for ASD patients to tolerate. Provide a passive aligner initially, allowing the patient to become accustomed to the presence of an aligner before compounding the sensation with pressure. Begin treatment with a few aligners without ordering the complete treatment, to assess tolerance and compliance. Introduce attachments after the fourth aligner. For these cases, uLab Systems allows us to order as many or as few uSmile aligners as necessary, so our patients or their caregivers don’t have to commit to an expensive treatment upfront without knowing if it will work for them. We can also adjust the velocity and trimlines to be as comfortable as possible.

Implementing these strategies is certainly a compassionate approach, but is also a strategy that can enhance your practice’s growth and reputation. It will lead to meaningful connections, a loyal patient base, and a practice that stands out as a beacon of accessibility and empathy.
Author Bio
Dr. Eric Wu Dr. Eric Wu is an adjunct professor at the University of Nevada at Las Vegas and the Roseman University Postgraduate Department of Orthodontics, and teaches at Foothill Community College. Wu attended dental school at the University of Pennsylvania and a one-year Advanced Education General Dentistry residency at University of California Los Angeles before his orthodontic residency at the University of Pittsburgh. He also completed a miniresidency in sleep medicine at UCLA. In addition to his private practice in Palo Alto, California, Wu serves as a key opinion leader and clinical advisor to Orthoclassic and uLab Systems.

Dr. Melanie Wang Dr. Melanie Wang attended University of California San Diego and UCLA, completing her orthodontic specialty training at St. Louis University, and is boardcertified by the American Board of Orthodontics. The research for her thesis became a study published after her residency in a 2009 issue of Angle Orthodontist: “Mandibular Rotation and Remodeling Changes During Early Childhood.”
Wang owns practices in San Diego and Rancho Santa Fe, California. She is married to a general dentist and they have three children, the eldest of whom is on the autism spectrum.

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