Previsit Strategies for Pediatric Patients
with Developmental Disabilities

Many children with special needs may benefit from a gradual, desensitizing approach to dental treatment. By this we mean that cooperation may best be gained by utilizing some preliminary techniques - such as reading social stories, modeling, and/or scheduled "warm-up" visits to the dentist before the day of the actual dental appointment.

Social stories are short stories, often with visual or pictorial prompts, designed to improve communication and behavior in persons with special needs and/or children, by presenting social situations in simple, concrete terms. Social stories may be written for individuals to help them deal with new experiences, or to adjust to changes in environment or routine. The effect of social story use as a behavioral intervention is a topic of current research (see references below).

The dentist office is one setting which may prove stressful for all children, particularly those with special needs. Children or adults who struggle with communication and/or social skills may benefit from the use of a social story written to address a trip to the dentist. Although social stories are most effective when written for a specific individual, commercially produced collections of social stories are available from various sources - including ones written by the originator of social stories, Carol Gray. Books by various other authors are also available. Such publications may be useful in the dental office setting when adapted for the individual user.

Modeling simply involves the demonstration of a procedure or an activity on another individual, typically a parent, older sibling, or another cooperative child. Younger children may actually benefit from "play-acting" the dentist's role with a parent, sibling, or using a favorite doll or stuffed animal.

"Warm-up", or desensitization visits to the dental office may be particularly helpful for children whose specific disability may necessitate alterations in the physical set-up of the dental operatory - so that no last minute "surprises" occur that may be upsetting to both the patient and parent. Such disabilities may include those resulting in significant physical limitations, such as paralyis, hemiplegia (from "stroke"), spasticity (e.g., in
cerebral palsy), or seizure disorder. Potential positioning difficulties and any necessary modifications in the typical office procedure may be identified during the preliminary visit. This will hopefully help increase a sense of security for the child on the actual day of dental treatment.

Many patients with significant physical restrictions may need to be treated while they remain in their wheelchair. For wheelchair users, adequate maneuverability within the actual dental operatory (and dental office facility) may be assessed via a preliminary trip to the dental office. For individuals with intellectual disability, a preliminary trip to the dental office helps to familiarize them both with the office environment and staff, and allows the staff to meet the patient with special needs as well. Depending on the individual child, more than one visit may be required before the child becomes comfortable enough for actual dental treatment to proceed (a good strategy unless, of course, emergency treatment is required).

References

Adams, L., Aphroditi, G., VanLue, M., & Waldron, C. (2004). Social story intervention: Improving communication skills in a child with an autistic spectrum disorder. Focus on Autism and other Developmental Disabilities, 19(2), 87-94.

Kuoch, H., & Mirenda, P. (2003). Social story interventions for young children with autistic spectrum disorders. Focus on Autism and other Developmental Disabilities, 18(4), 219-227.

Scattone, D., Wilczynski, S.M., Edwards, R.P., & Rabian, B. (2002). Decreasing disruptive behaviors of children with autism using social stories. Journal of Autism and other Developmental Disorders, 32(6), 535-543.