**DISCLAIMER**.  The first half of this is the How Did We Get Here part.  The second is How Can You Maybe Get Here part.  Feel free to scroll to the second part…I promise you won’t hurt my feelings.

How Did We Get Here?

“How’d it go?”  I hacked out with the phone resting between my ear and the bed.

“Well,” my husband hesitated, “After he bit through the little mirror thingy and puked all over the dentist she told me that you should bring him from now on since you have more control”.

I usually took A2 to all medical appointments but had succumbed to a virus that resembled the plague and the only thing worse than me having the plague is A2 having the plague.  Normally, Mr ATeam and I are a pretty good team when it comes to him but one area I quietly held resentment was having to be the heavy when it came to medical stuff.  A2’s anxiety is through the roof if he even THINKS its possible he has a medical appointment.  For awhile I had to drive a different route to the highway because we PASSED THE STREET to his pediatrician on the regular route and we could count on screaming, thrashing and tears until we were well on the road.  He even developed  pre-cognitive psychic abilities regarding medical appointments and would wake up with a big pouty lip with his first garbled words of the day being “no doc-er”.  On a side note, my cat used to do the same thing for vet appointments.  He would already be completely missing by the time I would have the carrier waiting by the door. Maybe my poker face isn’t as good as I think.

I blew my nose without regard to the fact I was on the phone, ” Did you have extra clothes and a towel with you? Is he ok?”.

“Yeah, he’s fine.  But I think we should change dentists…what the hell?”  I knew he was referring more to his own bruised ego but also to having no idea just how difficult dental appointments were.  He had experienced the pre-appointment anxiety and even parts of the wind up to the meltdown but the full on explosion with physical aggression and vomiting was newish for him since this was my area to tackle as a free agent and not a team since I had more work flexibility.  He knew appointments were difficult but I don’t think until that day he fully realized my anxiety and careful planning around the twice a year dental check ups, the annual physical exam, the quarterly endocrinologist appointments, annual neuro, GI and orthotist visits.  In other words….at least once a month I had to carefully plan an entire day around a doctor appointment because I was never sure how it was going to go down.  It takes its toll as a mom.

And the most heartbreaking part for me wasn’t even absorbing A2’s anxiety or physically holding him down or by my own bruised ribs or aching muscles or watching him turn purple and sweaty in hysterics with a handful of my ripped out hair.  No…it was always that moment he knew the appointment was almost over and he would turn his head to the nurse or doctor or dentist and through his hyperventilation and tears he would give them a thumbs up.  Cru-shing.  He knew no one was really going to hurt him.  He likely heard all the gentle words about his safety and social stories about visiting the dentist.  He likely knew this was something we all have to do for self-care. And yet he also knows he has no control over that autistic brain of his to prevent the escalation.  Always a reminder that I just have to try harder for him.

Fast forward to yesterday.  11 years, 2 months, 26 days into A2’s short little place on the planet he had his very first REAL dental cleaning and x-rays.  Mild drama and tears….and he is still proclaiming “no doc-er” this morning. But no contusions, no sweating, no projectile vomiting.  He even left the office smiling covered in Avengers stickers and with an armful of autism-unfriendly prizes from the prize box (see exhibit A ).

I left the office knowing that my kid had no cavities, no gum disease and apparently he only has one more baby tooth left in his beautiful little mug. So how did this happen?   A2 still hates having his teeth brushed at home….this will likely never be something he ENJOYS. Certainly no miracles and no single place to take credit, but here are some things that have helped.

TOP 5 TIPS

1.  Find a dentist who recognizes sensory processing issues/oral aversions/autism/mental health issues as real conditions and not as being difficult to be difficult.  Make sure the dentist and their staff are not fearful and can approach your child in a calm but authoritative way.  If you are uncomfortable with any part of the procedure or philosophy or office set up, discuss it with the staff or move on.  And it does not hurt if the dentist is eye candy.  But that is just for you moms/dads….your kid probably won’t care about that part.
2. Consistency and exposure.  Don’t NOT take your child to the dentist because you think he will wig out.  This doesn’t mean you have to get him in the dental chair right out of the gate if it is too much like visiting with Willy Wonka’s dentist dad.  Take baby steps.  Bring him to sibling appointments. Bring him in between visits just to say hi to the staff, look at the fish in the tanks, or check out the new toys or stickers in the prize boxes. Read books about going to the dentist. We took pictures of step by step A1’s appointments and made a social story for A2.  Reward approximations toward compliance.  Document it for yourself so you can increase your expectations of him as you move forward.
3. Bear in mind what triggers your kid and plan for it.  While you don’t want to sneak attack your kid when it comes to appointments, if you know that too much advance warning will cause perseveration without extinguishing his anxiety or will cause escalation in the days ahead…then don’t tell him yet.  Figure out the “sweet spot” for that.  For A2, we nebulously talk about dental things between visits and tell him about the appointment in the car the day of.  Other kids all is well and good until they see the dental equipment.  Find out if there is alternate equipment available and have them use it while exposing him to the stuff that scares him.  For years, we used cups of water instead of the squirt gun and suction thingy from hell.  We used a regular tooth brush and the toothpaste from home.  The dentist wore my sunglasses instead of the big, nerdy lab glasses.  And for the love of all things holy….if your kid is a puker…DON’T feed him before the appointment!
4. Talk to others. Discuss the issue with a speech therapist to see if there are oral motor exercises that will help desensitize him before visits.  Your BCBA or psychologist should also have a trove of ideas or may even work on this as a behavioral goal with him.  Talk to the intervention specialist–especially if she is very experienced because it is likely she has helped other families in the past come up with ideas tailored to help specific problems.  She is likely the only other person who knows your kid’s quirks or difficulties with compliance and is constantly planning for it. Consult your autism village…another parent might have a helpful hint for you.
5. Know Thyself.  I no longer martyr myself when it comes to appointments.  My husband did not know I was heavily grieving and fearful of these appointments and I think he started recognizing my anticipatory anxiety as such instead of just assuming I was being histrionic.  If you need to trade off…do so.  It doesn’t have to be a spouse.  Your kid picks up on your anxiety even if you think you are cool as a cucumber….but you already know this from other experiences. You see cukes…he sees pickles. Ask for help if you can.  Leave the room if he is more compliant without you being present.  Do not see it as a failure if you cannot overcome this hurdle. Many families cannot.  Contact your local chapter of The Autism Society, Autism Speaks or Board of Developmental Disabilities to help you locate a clinic that is trained and licensed to sedate or restrain as a last resort.