In Support of Addressing Sensory Differences to Improve Preventive Dental Care Among Autistic Children

Abstract

One of the core and distinguishing features of autism is differences in sensory processing and modulation. 1 Differences in the ability to process and integrate auditory, tactile, olfactory, visual, proprioceptive, and vestibular input affect the participation in daily routines and activities of autistic individuals, including seeking and receiving medical care. Routine medical care most often involves input in all sensory systems, making it challenging for individuals with sensory processing, integration, and modulation differences to tolerate needed medical interventions. For example, individuals may be sensitive to noise, lights, and tactile input common to medical settings and procedures. Among clinical procedures, improving participation in dental care is especially important for children with autism because poor oral health is more common and receipt of oral care more challenging than for neurotypical peers.In terms of the mechanism for these differences, the medical community theorizes that increased activation of the sympathetic nervous system and decreased parasympathetic functions may contribute to sensory hyperreactivity for autistic children. Targeting increased input to specific sensory systems may activate the parasympathetic nervous system, which is thought to regulate sensory reactivity and undergirds sensory-integration therapies. 2 Addressing sensory integration and processing differences and disorders, key to improving care for autistic children, involves determining the sensory profile, integration abilities, and modulation skills of an individual in multiple contexts and guiding modifications to environments and tasks to better match the individual's needs. 3 These insights have prompted the development of approaches to address the sensory differences that are common among children with autism. For example, guidance exists for making medical settings more accommodating for autistic children and some hospitals have implemented autism-friendly initiatives that include modifying the sensory environment. 4 Without these approaches to address sensory needs, children may forego or fail to tolerate needed medical services, including basic preventive medical and dental care. This is particularly important because autistic youths have much higher frequency of health care visits compared with neurotypical youths. 5 Despite the importance of addressing the sensory needs of autistic children, few high-quality intervention studies have been conducted to evaluate the effectiveness of sensory modifications to health care environments in improving the experience for these children. A 2021 review identified 30 papers that evaluated interventions to improve health care access or care experiences for people with autism; of these, none were randomized clinical trials. 6 These results underscore the dearth of high-quality randomized trials investigating interventions to meet the needs, including the sensory needs, of autistic individuals who represent nearly 3% of US children.The study by Stein Duker et ...

The management of patients with autism in pediatric dental clinics: a review of the literature

“…One of the main challenges when dealing with autistic patients in the dental office is the sensory hypersensitivity common to many children with ASD. The lighting, sounds, and textures present in the dental environment can trigger aversive responses, generating anxiety and resistance to treatment (WALLIS et al, 2023). Therefore, strategies that aim to minimize sensory stimuli, such as the use of soft lighting and the gradual introduction of dental instruments, become indispensable to create a more pleasant and receptive environment (DUKER et al, 2021).…”