Looking to brighten a daunting world
Imagine a world in which you struggle to make sense of the mass of people, places and events you encounter on a daily basis and, as a result, suffer from considerable anxiety.
This is a world inhabited by the majority of people with autism, a lifelong condition that causes problems understanding and relating to other people, as well as taking part in everyday family and social life.
And, if everyday life poses a problem, it can only follow that a trip to the dentist must rate as terrifying.
Now, however, two senior NHS health employees are looking to make a difference in the way children with autism are treated.
Debbie Connelly and Lyndsay Ovenstone are looking to remove the fear factor associated with visiting the dentist via a pioneering new project.
Lyndsay is a Senior Dental Officer with the Salaried Dental Service and currently heads a paediatric dental service, incorporating student outreach, based within Bridgeton Health Centre in the east end of Glasgow.
She had noticed there was an increase in the number of children with autism attending the service, something she felt presented a number of challenges, as the service was not especially equipped for children with this condition.
“I’ve been working at Bridgeton for over five years,” Lyndsay told Scottish Dental magazine. “We had noticed an increase over this time, but it was an anecdotal observation. We’ve generally sought to promote our service since I started in the post and it could be that the parents of these autistic children may have experienced difficulty in accessing care elsewhere.”
Autism’s spectrum is wide and Lyndsay said some autistic children find dental care easier to accept than others.
“In general, however, autistic children like routine and find unfamiliar settings and experiences very stressful,” she said.
“They tend to experience a sensory overload in a dental surgery as they cannot process the sheer volume of incoming visual and auditory information.
“They can react in different ways, but may try to block out the stressful stimuli by covering their eyes and ears, or by rocking. They may also attempt to physically escape the unfamiliar setting. Many do not like their face to be touched and are averse to bright lights.
“I have no formal training on autism, although I have attended postgraduate courses and have direct experience of providing care for autistic patients. I have always had an interest in this patient group and felt that we could make our service more accessible for them.
“The experience of visiting the dentist can be hugely challenging for these children and their parents, and we felt that, although we have a number of autistic patients registered, there were likely to be many more that are simply not accessing care.”
These fears were confirmed by discussions Lyndsay had with staff from Bridgeton Child Development Centre, so she next got in touch with Debbie, who is a Health Improvement Senior for Oral Health, and part of a wider health improvement team that works closely with the community. Together the pair started to look at developing a solution.
“We looked at sensory equipment to make the surgery more user-friendly and in addition we wanted to explore developing the service to meet the needs of children and their carers,” Debbie said.
The project itself was funded by money from the Oral Health Action Team. This is ring-fenced money from the Scottish Government that is distributed via health boards to develop local projects for a positive oral health gain. In total, the whole cost of the project is estimated to be around £3,000.
“Overcoming communication barriers for treating children with autism is crucial,” said Debbie. “With the money, we’ve now developed talking picture books of the service and the dental team as a way of preparing children in advance of their visit.
“This is an innovative development, which should make a visit to the dentist less stressful for families and children with autism.”
The new talking books contain pictures of the health centre, staff and surgery. The books provide a narrative to accompany each picture as the child works through the pages. These are given to children prior to their first visit to help them learn about what they can expect at the surgery.
“Autistic children tend to respond best to familiarity and the talking books help to prepare the child for the forthcoming experience, so it seems less ’new’,” Lyndsay explained.
“Parents might also be concerned their child will not be welcome at a dental surgery and may not take them for routine care. The books help ensure that parents know they can access our service, as our facilities and experience make it more likely we will be able to meet the needs of their child.”
But treating children with autism and special needs requires patience and a lot of investment in time by staff, according to Debbie.
“Depending on the child’s communication and ability, it can be a stressful time for families and staff alike, especially if the child is in pain,” she said.
Lyndsay added: “These children tend to be acutely sensitive to sensory stimuli and this can potentially influence their dental experience in a negative or positive way.
“Our aim is to provide positive sensory stimuli. For example, light patterns and shapes fascinate some children, so we now have a laser projector that produces lights on the ceiling. Other children are obsessed by cartoon characters, so we have a ceiling-mounted DVD player. We also have various toys and resources, such as rainmakers, that were recommended by a colleague who has considerable experience of autistic children.”
There was also a general feeling that the overall layout of the surgery needed to change in order to better accommodate patients with autism.
“Children with autism don’t like clutter – things on worktops, or pictures and posters on walls. We’ve removed these things from view,” said Debbie. “We’ve also changed the colours of the walls to make them less clinical. Children with autism particularly like footprints on the floor too, so these have been purchased and fitted in the centre. Footprints are a form of signage used in hospitals and clinics. Again, this adds to the overall child-friendliness of the environment.”
In addition to the surgery receiving a physical revamp, students from the Glasgow Dental Hospital, who provide a service to the community as part of their on-going teaching and training, are also helping out.
“Student Outreach provides the opportunity for fourth and final year dental undergraduates to provide clinical care, under the supervision of an experienced clinician, in a primary care setting,” Lyndsay explained.
“Bridgeton Community Dental Service offers preventive-based care for children who might otherwise experience difficulty accessing appropriate care.
“The students are given the opportunity to treat a variety of paediatric patients, including those with special needs such as autism. The aim is to enable undergraduates to develop the skills and confidence needed to provide appropriate care for a wide range of paediatric patients.
“A minority of patients are unsuitable for treatment by undergraduates and are appointed to non-teaching sessions.”
As Debbie and Lyndsay have now established, dealing with autistic children is a challenge in itself, but when these children come from deprived backgrounds, it seems the situation is further exacerbated.
“There is evidence to support the fact that Bridgeton Health Centre serves a population that resides in an area of severe deprivation – in other words reports from Depcat and the Sc
ottish Index of Multiple Deprivation (SIMD),” said Debbie.
“Poverty and deprivation are indicators of poor general health and in particular poor dental health. These chaotic lifestyles and social circumstances present a number of challenges to the medical and dental profession.”
Lyndsay agreed, saying: “Socially disadvantaged children are likely to have a higher incidence of dental disease, they are likely to have much higher treatment needs, are less likely to come from dentally motivated families, less likely to comply with preventive advice and are more likely to have irregular attendance patterns.”
To address these challenges, Debbie said the revamped service now offers a host of welcoming features.
For example, children unsuitable for treatment in mainstream General Dental Service can now be referred into the specialised paediatric dental service at Bridgeton.
Lyndsay has also developed a questionnaire, where the parent or carer is asked about their child’s communication skills in advance of their visit.
“We’ll give parents a pre-visit leaflet, which requests some information about their child’s likes, dislikes and dental experience to enable us to tailor their visit accordingly,” she said.
“We’ll also suggest multiple short visits.
“I have no direct involvement in the diagnosis of autism though. If I was concerned that a parent was unaware of, or in denial about, their child’s condition, I would refer them to their GP for advice or onward referral. We would, of course, continue to offer dental care and support.”
The new service was launched on 11 May to coincide with National Smile Month and both Debbie and Lyndsay now hope their work will leave a smile on the faces of both children with autism and their carers alike.