Disabilities Research Paper: Autism Spectrum Disorder (ASD)

Kylie Werderman
Dental Hygiene III
Summer 2015

Autism Spectrum Disorder, or ASD, includes a range of diagnoses like autistic disorder,
Aspergers syndrome, pervasive neurodevelopment disorder, and childhood disintegrative
disorder (Gandhi, 2014). ASD is a new term brought up by the fourth edition of the DSM
(Diagnostic and Statistical Manual of Mental Disorders). In the past, this disorder has been
linked to a continuum from mild to severe (Gandhi, 2014). Autism was first recognized by Eugen
Bleuler, a Swiss psychiatrist and psychologist, in 1912. He stated this to be an escape from
reality. However, it wasnt until 1943 when a group including Leo Kramer provided the first
recognized documentation of autism. A few things that he noticed were language delays,
literalness, and ability to relate to objects in their surroundings-only when they wanted to-and it
did not interfere with their self-imposed isolation (Holaday, 2012). Autism is thought to be
hereditary according to Gandhi (2014). This, along with some environmental factors such as
parental age, low birth weight, and maternal infections while in utero, are all outcomes of
evidence-based research according to Tchaconas (2013). ASD affects 1 in 110 children and is
more prevalent in males than females by 3-4 times (Hebl, 2015). This means that 1-1.5 million
Americans are living with Autism (Gandhi, 2014). This disorder is almost always found in the
first few years of life (Hebl, 2015).
There are many visible or physical side effects of ASD like repetitive body movements
(Hebl, 2015), gastrointestinal issues like constipation and diarrhea, and sleep problems (Gandhi,
2014). Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for individuals
who have ASD and suffer from repetitive behaviors. ADHD medications like Ritalin are also
commonly used for ADHD symptoms in ASD patients, and melatonin is used for assisting with
problems sleeping. To help combat GI issues and symptoms, rounds of antibiotics like
Vancomycin or Metronidazole are commonly prescribed to help balance the bodys natural flora

(Gandhi, 2014). However, these medications come with side effects. Prozac and Zoloft (common
SSRIs) can produce side effects such as trouble sleeping, tremors, and an allergic reaction
appearing as a rash. Ritalin which is a regularly used drug for treating symptoms of ADHD can
increase anxiety, increase blood pressure, and cause the individual to have uncontrolled
movements. Melatonin used to help with sleeping can cause irritability. Self-injurious behavior
(SIB) can be treated with aripiprazole and or risperidone, which can also contribute to more GI
issues and restlessness. The antibiotics used to help with GI problems such as C. difficile can also
cause dizziness and unusual tiredness or weakness (Wynn, 2014). ASD is found to be a life-long
disability (Hebl, 2015).
Physical manifestations of the oral cavity include a higher incidence of caries because of
a poor diet (Hebl, 2015) contributed to by the reward of sweets used by positive reinforcement
(Gandhi, 2014). According to Gandhi (2014), there are orthodontic concerns in such a way that it
has been shown that there is an increased predisposition of an open bite, general dental
crowding, reverse overjet, and class II molar relationships. Individuals living with ASD are more
likely to have poor oral hygiene compared to unaffected individuals. The presence of visible
plaque and gingivitis in patients with ASD should be given special attention either by the
individual (if they can manage the daily need of proper oral hygiene) or a caretaker (Gandhi,
2014). The medications discussed above not only have physical effects on the body as a whole,
but also the oral cavity. SSRIs and ADHD medications have a tendency to cause xerostomia and
trouble swallowing, while antibiotics used to treat C. difficile are known to cause red, blistering,
and loosening of the skin and gingiva and also oral candidiasis (Wynn, 2014).
The need for a caretaker within the dental appointment depends on where the individual
falls on the continuum. If they are a high functioning individual showing few characteristics of

the disorder, then they might not need a caretaker present during the appointment. The patients
behavior can be gauged by scheduling a preoperative consultation. This is a way to desensitize
the patient to further their trust and adaptation. Doing this can result in increased cooperation
from the patient and make appointments go smoother (Gandhi, 2014). The use of books, color
pictures, and videos with children are ways to help a child respond better than to words, as most
with ASD understand and will comprehend pictures (Gandhi, 2014). Individuals with ASD also
respond well to positive reinforcement and extinction. Finding out what the patient reacts to most
like stickers, stamps, and other treats can help make the best of the dental appointment
(Gandhi, 2014). Removing stimuli from the operatory can also help the patient feel more relaxed
and not so distracted from the appointment. Things such as reducing noise or creating white
noise as a background and being conscious with the dental light or having the patient wear
sunglasses to eliminate the light stimulus can help (Hebl, 2015). When a patient is
overstimulated, twisting hands, flapping arms, making noises or other repetitive movements can
also help to dismiss the stimulation (Gandhi, 2014). Caretakers may need to watch ASD
individuals as they brush for fear of toothbrush impalement. This can be part of the self-injurious
behavior (SIB) that almost 5% of patients with ASD face. Finding a fluoride toothpaste that the
patient is able to use correctly and can be comfortable which is important. The help of the
patients occupational therapist or psychologist may be able to help with any sensory concerns
with oral hygiene (Gandhi, 2014). To modify treatment for the dental appointment, again, it is
important to remove all unnecessary stimulation for the comfort of the patient. Using the same
dental personnel for appointments and using positive reinforcement during treatment may help
the patient understand and recognize that there is nothing to be afraid of (Hebl, 2015). Many
patients given sedatives like Benzodiazepines such as diazepam or midazolam before the

appointment and in conjunction with nitrous oxide, have a greater success rate in completing
treatment (Gandhi, 2014). Ruling out any contraindications or drug interactions for the use of
sedatives is required before administering nitrous. General anesthesia is also an option for
individuals with ASD because of the high caries rate and uncooperative behavior. Immobilization
(also known as protective stabilization according to Gandhi (2014)) is also an option (Hebl,
2015). This means that the patient is stabilized or restrained prior to the appointment as a planned
manner rather than an emergent mode (Gandhi, 2014). Avoiding unnecessary conversation and
needless touching may also provide better patient compliance during treatment (Hebl, 2015).

References
Gandhi, R. (2014). Autism spectrum disorders: An update on oral health management. Dental
Hygiene, 14(1), 115-126.
Hebl, L. (2015). Dental Hygiene III, Kirkwood Community College.
Holaday, B. (2012). History of Autism. South Carolina Nurse, 19(2), 12-13.
Tchaconas, A. and Adesman, A. (2013). Autism spectrum disorders: a pediatric overview and
update. Current Opinion in Pediatrics, 25(1), 130-143.
Wynn, R. (2014). Drug information handbook for dentistry: Including oral medicine for
medically compromised patients & specific oral conditions (20th ed.). Hudson, Ohio:
Lexicomp.