Wednesday 21 February 2018

Autism: Why won't my child clean their teeth?

"Why won't my autistic child brush their teeth?"  It's a question a lot of parents ask.  Some autistic individuals are of course very happy to brush their teeth.  Others, less so...

So, what's stopping them?  It could be one of a large range of things.

Autistic brains take in too much sensory information.  From scans, it appears that this causes literal overheating, as too many of the brain's electric circuits are used at once.  Then, we need downtime to let the brain temperature cool off.  If we don't let it cool, we could go into a painful/scary shutdown (7 out of 10 of us) or meltdown (3 out of 10 of us). Both are brain events, not a way to get out of doing stuff.

Firstly, what's going on around them at the time?  Are they expected to also shower/bath, change clothes, etc?  All of those are big sensory 'asks' for many children.  Are they expected to be in an area of a lot of noisy chatting from siblings and family at the same time?  Have they recently come in from a big noisy, sensory-challenging event, e.g. after-school clubs, supermarket visit?  They may need downtime between those kinds of things, and teeth-cleaning.
Let's now look at what teeth-cleaning involves for a good number of us:

Firstly, we need to understand the task.  Not many of us have a very good sense of where our bodies are.  Being able to feel their own teeth, and see them in a mirror, is a good first skill.

Then, noticing if teeth need cleaning.   It may help to watch another person clean their teeth, or it may not.  Some learn by watching, others mostly by learning to do the task themselves.
A social story can help, with pictures showing the steps.  Various ones of these can be found online.

Then, having skills to hold the toothbrush and clean something without dropping it.  It can be useful to practise cleaning other things with a small brush first, for example. Not the actual toothbrush - you probably don't want to teach them to clean the house with their own toothbrush...(yikes).   Try to get a brush that has an easy handle to grip, without ridges and bumps all over it.  It's possible to get 'easy grip' toothbrushes.  Look for a brush that has bristles all the same length, to start with, and very very soft, with a small brush head.

Make the room as quiet as possible.  Get rid of endless unnecessary smells in there, too.  The more relaxing it is, the more chance of success.

Let them choose a toothpaste they like.  There are all sorts of different flavours and smells.  It can take a lot of courage to sniff and taste even tiny bits of something new.  Especially if it's ones with different colours and different textures as part of it.  A tiny bit of toothpaste, or just water, might be a good first step.

Once they are used to the feel of the brush in their hand, they can practise putting it in their mouth and cleaning a few teeth.  This is very noisy, and (for us) often very painful on gums, cheeks and tongue, as well as hugely sensory-overloading ,with the toothpaste smell and taste.  They need to be sure that they can handle it. 

 Let them have a think about it and a relax at that point.  Quiet praise.  When they are confident, they can have another go.  Teach them about not swallowing all the toothpaste, and how much to use.

This way, they are keeping their brain at a good operating temperature.  It's not having to face a barrage of noise. It's not having to face overwhelming pain from texture and pressure.  It's not having to cope with undoable levels of smell.   Teeth cleaning is still a scary thing for me as an adult, even though it's something I have to do twice a day.  I can truly understand why an autistic child may think that we're torturing them.

It may take them a while to feel confident in balancing that brain temperature. 

Once they are confident, they can perhaps learn to time it by counting, or with a countdown-timer.  Then, they know how much time they have to do this for...and can work out how much downtime they need before and afterwards to keep that brain temperature correct.

If you are worried about tooth cleaning in the meantime, your dentists can help.  Find one that understanding autism, and can advise you on using alternatives.

Some people are now using assistance dogs to help children learn about teeth cleaning and other daily skills, and to help keep children calm and focused.  It is worth contacting good respected charities such as Dogs for Good, to talk to them about pet dogs (PAWS scheme) or assistance dogs, and see what might help your family.

The photo is of three toothbrushes in different colours.