Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism

Resident: Adam J. Bottrill
Date: 18MAY11
Region: Providence
Article title: Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism
Journal: Journal of Dentistry for Children
Page #s: 84-91
Vol:No Date: 72:2, 2010
Major topic: Developmental disabilities, ADD, Autism, Dental care
Minor topic(s): None
Type of Article: Descriptive article

Main Purpose: The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.

Key points in the article discussion:

I. General:

A. 13% of all children peat the MCHB definition of children with SCHN.
B. SHCN Children almost twice as likely to have unmet oral healthcare needs.
C. Considerations: speciale diet, medication, self-unjurious behavior, communication problems, orofacial malformations,

II. ADHD
A. Prevalence of 4-12% with persistence into adolescence of 60-80%
B. Impulsivity, inatention, hyperactivity... I'm sorry, but this paragraph makes me laugh. It describes almost every child with whom I've ever interacted.
C. Three types:
1. Hyperactivity/Impulsivity
2. Inattentive
3. Combined
D. Suggestions for Tx:
1. Frequent breaks
2. Reinforcement of positive behavior.
3. Those children on meds may be more behaved after taking them.

III. Intellectual Disability (mental retardation)
A. Sub-average functioning in 2 or more of the following areas: communication, self-help, home living, social and interpersonal skills, use of community resources, self-direction, health, safety, leisure, work
B. Prevalence: 1%
C. Mild/Moderate/Severe/Profound
D. ID children often have co-morbidities
E. Anxiety and uncooperative behavior in the dental setting.
F. Abnormal tooth eruption, maloclusions, missing/fused teeth, microdontia, abnormal jaw structure, macroglossia, perio disease.
G. Latex allergy, cardiac problems
H. knowing the child's mental age will help with behavior management. Manage to the "mental age".
I. Communicate to the patient's level: reward behavior, verbal reinforcement.
J. Communicate with the parents in order to gain useful tips on how to control behavior.
K. "Desensitization visits", picture books, "blanky/bobo"

IV. ASDS
A. Autism, Asperger S, PDD
B. Prevalence: 6.5/1000
C. Common deficits include: language, social skills, restricted stereotyped patterns of behavior
D. Prevalence of ID in those with ASD: 50-60%
E. Unusual responses to common smells, tastes, textures
1. Can interfere with hygiene and nutrition
F. Higher prev of obesity
G. Challenging behaviors more prev during childhood than adolescence... ALTHOUGH rapid increases in size and strength make any of these behaviors more dangerous.
H. Sources of discomfort can always bring about behavior changes... Important to take thorough med history.
I. Generally, ASD kids have good oral health and average caries and perio rates.
J. Encourage parents and teachers to use NON food rewards.
H. Some medications have side effects including weight gain, abnormal movements and increased risk of diabetes.
I. Visual supports to increase chances of succesful visit: schedules, "social stories", books, pictures.
J. Some dentists keep a copy of a social story to send to families prior to visit.
K. Use the same staff, appointment time, day of the week etc...
L. ASK THE PARENTS... about everything.

Assessment of Article: The title of the article doesn't seem to accurately depict the content.