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Wikipedia defines neurodiversity, neurodivergence, or neurovariance as “Variations within the human mind and cognition, as an example in sociability, studying, consideration, temper and different psychological capabilities.”1 The time period was first coined within the 1990’s by sociologist Judy Singer and tended for use when discussing autism spectrum dysfunction and a spotlight hyperactivity dysfunction throughout the self-advocacy motion.
As we speak, the time period neurodiversity covers a variety of circumstances together with ASD and ADHD, but additionally Down syndrome, Williams syndrome, Tourettes, Dyslexia, Bipolar dysfunction, Dysgraphia, Dyscalcula, and OCD. The neurodiversity paradigm states that no two human’s brains work the identical means, and that you will need to embrace neurodiversity as a part of a variety of social regular. Patrick Dwyer explains that “’Neurodiversity’ can merely check with the fact that various minds and brains exist, simply as ‘biodiversity’ refers back to the factual actuality of organic range.”2 He goes on to say that neurodiversity is more of a social than scientific term that references the human condition, and not a diagnosis.
When considering diversity, it is important to consider differences in the processing of stimulus and information to improve the dental experience for everyone, but especially that of a neurodiverse child. Three easy interventions any office can include in their care of neurodiverse children include the use of sensory stimulation, social stories, and non-verbal signaling for autonomy during the dental procedure.
Sensory stimulators are aids that help to either increase or decrease stimulation based on the child’s preferences. Weighted blankets are an excellent way to help calm a child in the dental setting. The study “Weighted Blanket Use: A Systematic Review”3 looked at 8 studies and found that body pressure can sooth sensory overstimulation-related anxiety, especially in neurodiverse people. The dental setting can be an overstimulating place with lights, sounds and smells that are very different from the client’s typical environment. The use of one or two lead aprons over the client can be an easy adaptation that provides comfort, while being easy to utilize and disinfect. Noise canceling headphones can also be an easy option to limit the loud sounds that can accompany dental procedures. Alternately, the addition of light stimulation, such as a calming tube, or LED lighting, may also help to calm and distract a nervous child. Learning what a client’s sensory needs may include and making small, in-operatory modifications, can dramatically improve cooperation during dental procedures.
Social stories are small visual aids that prepare a child for what to expect before they enter the clinical setting. Social stories can be created utilizing premade picture cards, called pecs, or photos taken in office. Paired with short sentences and verbal instruction, social stories are an easy to implement and effective way to reduce social anxiety.4 By preparing the client for what to expect before the dental procedure, social stories can provide the opportunity for understanding and questions, which help to ease fear of the unknown. Stories can be printed and given to clients or put on the office’s website for easy reference. They can be very simple, showing the operatory and the dental professional, or more in depth, covering different procedures in the clinic setting and sharing tools and expectations. Adding a check list of steps, or a visual board of “first, second, next, last” (with last being some kind of reward), can also help to prepare a child by giving them a clear idea of what to anticipate, and providing the opportunity to ask questions before the procedure begins. More research is being done on the medical effects of social stories, but pairing them with short verbal cues has been shown to be the most effective approach.5
Lastly, utilizing a “magic wand” or stop sign as a non-verbal communication tool can also be effective in allowing the client to feel comfortable in expressing their needs. Selective mutism, or a child’s inability to speak when feeling sensory overload due to anxiety, can be a factor with neurodiverse children. Allowing for the client to express their needs in a non-verbal way may allow the child to feel more at ease in the dental setting. This visual aid accommodation provides the opportunity for autonomy, regardless of speech or language barriers. It can also be a great tool for distracting anxious hands during treatment.
We must remember as dental professionals that we remain in very close proximity to clients throughout their procedure, and that the environment is full of atypical stimulations. This can be very intimidating for all children, but especially children who have extra sensory considerations or have difficulty expressing their needs. Taking the time to make small accommodations to the dental setting can have a monumental effect on the ability to complete treatment when working with neurodiverse children. Considering the sensory environment, providing opportunities for children to learn what to anticipate at the dental appointment, and providing a non-verbal means of communication are all ways one can easily make the dental environment less intimidating for all neurodiverse people.
References
- https://en.wikipedia.org/wiki/Neurodiversity
- Patrick Dwyer (2022). “The Neurodiversity Method(es): What Are They and What Do They Imply for Researchers?” (PDF). Human Growth. 66 (2): 73–92. doi:10.1159/000523723. PMC 9261839. PMID 36158596. S2CID 247062174.
- Eron Okay, Kohnert L, Watters A, Logan C, Weisner-Rose M, Mehler PS. Weighted Blanket Use: A Systematic Assessment. Am J Occup Ther. 2020 Mar/Apr;74(2):7402205010p1-7402205010p14. doi: 10.5014/ajot.2020.037358. PMID: 32204779.
- Crozier S, Tincani M. Results of social tales on prosocial habits of preschool kids with autism spectrum issues. J Autism Dev Disord. 2007 Oct;37(9):1803-14. doi: 10.1007/s10803-006-0315-7. Epub 2006 Dec 13. PMID: 17165149.
- Reynhout G, Carter M. Social Tales for kids with disabilities. J Autism Dev Disord. 2006 Might;36(4):445-69. doi: 10.1007/s10803-006-0086-1. PMID: 16755384.
In regards to the Writer
Kari Slade is an unbiased Registered Dental Hygienist, and the proprietor of One thing To Smile About, in Brantford Ontario. She is a member of the medical school at Southern Ontario Dental Faculty and graduated from Aplus Institute of Dental Hygiene in 2007. Kari at present lives in Brantford Ontario together with her husband, 2 kids and menagerie of pets. You’ll be able to observe her on Instagram at Somethingtosmileabout.
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