Well, our semi-annual trip to the dentist (aka D-Day) went pretty well. And by ‘pretty well’, I mean we achieved the following goals:
- His teeth got cleaned.
- He doesn’t require any additional dental work.
- The dentist, hygienist, and staff were nice to us and respectful of the J-Man’s needs.
- We didn’t freak out too many other children in the office. (Yay for the separate room!)
- He still agreed to live in our house after it was over.
- No one sustained any major injuries.
I tell people, to an outside observer the whole thing looks awful and probably something akin to torture. To us, everyone got through it, we made some progress, and at least it was better than last time.
We liked our new dentist, too, which was an unknown to us beforehand even though they came recommended to us. The office was smaller, so there weren’t dozens of people and lots of noise and overstimulating crap in the waiting area. It was all fairly chilled out really. I particularly like it when the dentist and hygienists are calm and of even temperament no matter what happens during the cleaning and exam. I think the J-Man could have sprouted flaming arms and horns out of his head and it wouldn’t have affected them any.
We, of course, had to hold him down for everything. I had his torso and legs and occasionally a shoulder. Mary had arms. The hygienist had his head between her forearms and braced against her body while she worked. The fact that she got that spinning cleaner/polisher thing in his mouth and cleaned all of his teeth was pretty amazing, though I know he was in terror pretty much the whole time. [Insert parental guilt here.]
We got through it in 10 minutes or so. When it was done, he calmed down almost immediately in my arms. His ability to decompress after something that stressful is quite a testimony to his growth and general bravery. I can’t imagine much that would be harder on a child with serious oral sensitivity than to go to a dentist. It breaks our hearts to have to do this twice a year. Our hope is that eventually he’ll get more or more tolerant of it if we can set good dental habits and lay the groundwork now.
All that holding him down is not only emotionally painful, it’s also physically rough. Last appointment six months ago, I pulled something in my back and partially sprained my wrist from holding him. Last night, my Achilles tendon hurt (from bracing my feet on the floor) and now my low back feels like I did some sort of marathon weightlifting in the gym or something. Well, Ibuprofen and an ice pack should have it back toward normal in a day or so.
Good news is that his teeth are excellent! I know a lot of parents of autistic children struggle with their dental care. It took us forever to get teeth brushing incorporated into our routine. If we could go to the dentist everyday (perish the thought), he’d eventually get to a point where he’d be much more tolerant of it, but obviously there’s no way in this world that would happen anywhere other than our nightmares. But we can do things that will hopefully reduce his oral sensitivities – something we’ve been working on for over three years now.
We appreciated the calm and positive attitude they had and the respect and sensitivity they showed to the J-Man. So we’re pleased we made the change in dentists and will go back in six months to do this all over again. Each time it seems to get a bit better, so here’s hoping.
Tomorrow is our scheduled, semi-annual dentist day, which we’ll affectionately call ‘D-Day’. We discussed the saga of his last mouth invasion in a previous post. Feel free to read about how much fun that was.
Since the J-Man’s last trip to the dentist, we made an important change. We fired his now former pediatric dental practice.
Were the dentists nice? Yes. There was one doctor in particular we really liked, in no small part because his wife used to work for the doctor who diagnosed the J-Man with autism, so there was awareness and understanding all around about our situation. The problem was, there was no way apparently – at least not for us – to request which dentist we got to see. (I think their practice currently has 4.) The other dentist we saw was OK enough. I thought the hygienists pushed him pretty far, but I kinda get the philosophy behind it. It seems like we weren’t allowed to ask for the one we really liked, and that was irritating.
For us, the decision to fire them was two-fold.
1. All special needs kids are seen only during the noon hour, which not only makes scheduling a nightmare and interrupts his school day (not like we can go back to school after all that), it feels like yet another example of us being segregated from the world. That said, I do understand one of their reasons behind it. Their staff shifts overlap around noon so they have more hygienists there who can gang up on the kids – so to speak – and provide additional support. And really I could live with this if it weren’t for the crap in point #2 below.
They really stretched their luck, however, in that we were seen well over 30 minutes late for our 12:00 appointment last time. Please do not make autistic kids wait that long in a crowded, noisy, pediatric dentistry waiting room with enough noise, TVs, fish tanks, video games, and other insane stimuli to drive us all batty with nothing he could actually do except wander in and out of the chairs like some obstacle course.
So they reserve this time for special needs kids, but can’t actually see any of us anywhere near on time. Well, thanks for nothing.
However, all that alone probably wouldn’t have driven us away.
2. It was the attitude of their staff that did it. They acted like they were doing us this huge favor to schedule us in the first place. Once we got his school schedule for the fall figured out, we realized his originally scheduled appointment fell on his second day back after this long break. So we called many weeks ago to reschedule since we knew he’d need consistency at school after this long break. It’s not like we were set on getting an earlier appointment. We actually asked for an appointment during his next break two months after his original appointment. (Reminder – we called and asked to reschedule weeks ago.)
“I’m sorry. We don’t have anything available until next year.” (insert attitude here)
We know [expletive expletive] well that they have appointments. Just not for him. Before we ever went there, we got in with maybe a couple of weeks notice. Now that I’m sure his file is painted with a giant red flag – or what I’ll call “The Scarlet A” – it’s a six-month wait.
So, we asked around and found a new, smaller dentist practice. Yes our appointment is still during the noon hour, and presumably for the same reasons, which I don’t have a problem with when combined with a respectful attitude toward our kid. At least they were up front about why and were polite and welcoming, and they were able to get us in quickly with no fuss. We’ll see how this carries over into the actual appointment.
Just to be clear – no I don’t expect anyone to roll out the red carpet for us. I don’t expect sympathy or special treatment or anything. But I do expect the J-Man to be treated with respect and as a child with feelings and integrity regardless of whether he can talk to you about them or not. He is scared to death of having his mouth worked on – and we feel like crap as parents enough as it is for putting him through that – and if you’re not understanding and sensitive to that about him, you can go to hell. And if you want our business, don’t act like you’re doing us favors. Nobody is that good.
Enough ranting. Gotta go practice my restraint holds and find something to wear to protect my more sensitive bits from injury again.
And welcome finally to Part 3! This is the continuation of our series “What’s Your Autistic Toddler Like Now?”, a journey through what’s happening these days in the life of our autistic 3 1/2-year-old son and sequel to our very popular original article, “What’s Your Autistic Toddler Like?”. I meant to write this sooner, but illness has swept through the Flashlight household and rendered us all pretty useless this week.
If you haven’t already, go back and read Part 1 and Part 2.
I’m calling this group “Moderately Present” as these things are generally more common than not around here, but not as prevalent as the “Significantly Present” group from before. As with the previous posts, some of these are challenges for us and others are just things that are part of our day-to-day life. None of these are meant to be value judgments, just information about what one autistic toddler is like so you can perhaps see similarities in your own children or learn more about how these things are part of another family’s life.
I’ll be dividing this group into two parts. So we’ll finish this up in Part 4 soon.
Note: Wherever you see “DSM-IV” below, this means that attribute is part of the diagnostic criteria for autism spectrum disorders in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition or DSM-IV. In medical terms, a specific combination of those DSM-IV criteria is what brings about a diagnosis of autism.
Same obvious disclaimer as before: We are not advising you on how to evaluate your child. Go get them evaluated by professionals with extensive experience with autism. Don’t just rely on some random people on the Internet – namely, people like us.
And here we go!
Characteristics That Are Moderately Present
Fixation or attachment to a particular object or parts of objects (DSM-IV; hard one to nail down for us) – For some, this manifests itself as obsessive-looking hoarding and organizing of objects. You might also see this as what seems like excessive fascination about a particular object (looking at a particular train for a long time or staring at a ceiling fan) or part of an object (a spinning wheel on a car).
The J-Man is all over the map on this one. It has gotten more noticeable over time, but I wouldn’t call anything he does here a major issue. The object(s)-of-the-day rotate regularly through an array of toys. For the longest time it was wooden blocks. Then it went to pieces of his farm animals puzzle, and then on to flash cards, and then wooden numbers, and then stuffed animals (which was cause for much rejoicing actually!), and then plastic food, and then randomly back through the order, occasionally mixing in some other things.
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by Tim on February 5, 2009
I want to say this has been a crazy week, but I suppose it’s really just par for the course.
On Tuesday, the J-Man had a dentist appointment. I don’t think I need to give any more setup to this story than that; it speaks for itself. After being in the waiting room for an eternity, we finally got our turn. Both of the ’special rooms’ – where all the frantic, special needs kids go – were taken (we learned why later) so we were out in the common area where dentist chairs basically circle the room. Sometimes I think they should call that area something like The Freak Show where kids can either scream in full view of the other patients or show their utter terror at all things dental, but since I hate dentists too, I could be showing some bias.
So here I am, at 6′ 3″ tall, reclined and parallel to the floor in a pediatric-sized dentist chair, with the J-Man (a.k.a. Captain Orally Defensive) on top of me with his back against me. In addition to that, I have wrapped my legs around his and am holding both his arms from behind. Oh, and I’m trying to make it harder for him to move his head around by using the only thing I have left – my own head. And by the way, Mary, the hygienist, the dentist, and a second hygienist were all working on (mostly in restraining) him while I was holding him like this. And in the end, I strained something in my low back because the J-Man is that strong. Yeehaw!
Consumer tip – Don’t let your kids wear chunky, heavy, new shoes to the dentist because it makes it too easy for them to kick the skin off your legs.
Consumer tip #2 for the guys – Protect yourself carefully from said chunky, heavy, new shoes. Just sayin’.
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We got through it. Anything that can be described like that is a victory.
The dentist was really good. Turns out his wife used to work for the doctor who did the autism evaluation, hence the referral I assume. Regardless, he was calm, skilled, listened to us, understood the situation perfectly, and best of all, was quick. Can’t beat that!
I rarely drop the word “autism” into a conversation with a stranger about our son unless the conversation is actually about that. People’s automatic prejudices about that really get to me and only serve to piss me off, and if he’s acting a bit destructively – which is rare – I don’t want to be one of those parents who makes excuses for their kids. If I’ve heard “Oh, he’s just that way; he has ADD” while their child is rampaging around the playground knocking kids down and taking stuff from them, I’ve heard it a thousand times. I don’t care if J-Man is autistic or purple; I want to have the same boundaries and rules and expectations that I hope other parents have for their own.
He jogged laps around the waiting room and entertained everyone. He did many of his usual array of things others may find quirky, but since I find them endearing, I had a great time watching him. There was a ramp into the kids’ play area that he would take a step up, change his mind, and come back down. He did this at least two dozen times. He has this thing about inclines. He’ll do steps now with some help, but put a ramp in front of him and his wires seem to get crossed sometimes. He was his usual cute self and everyone responded accordingly, with adoration of our son like they’re supposed to. 
That preamble has a point. I figured they had a “special room” at the dentist’s office somewhere. The office is enormous and there’s a fairly open area with dentists’ chairs all over the place. I knew we’d have to do some wrestling with him to get this done and I’d rather not do it in public, freak him out even more, and then freak out the other kids – many of whom were very young and a couple who looked like it was their first time at the dentist and wouldn’t understand why this boy was screaming while some large adult (namely, me) was piled on top of him. So I sprinkled “autism” in a couple of places during our initial conversation with the hygienist. We got the “special room”. I usually don’t work a conversation like this, but it turned out to make life much more manageable for everyone.
The hygienist made little headway into checking his teeth so we all waited on the dentist for a few minutes. Singing and letting him explore the common area helped him calm down and pass the time. He never sits still in a new place so we let him work off some of that until the dentist was ready. He talked to us for a few minutes about concerns we had, was very understanding, knew completely what to do, and generally made us all feel better. His usual bag of tricks (e.g. show the kid the little dental mirror and let them play with it before using it) was pretty much pointless, but I appreciate the sentiment. J-Man was in the process of going over the edge at that point.
Like everything else, the winning plan is to be quick. I sat him in my lap facing me, then we tilted him back with his head into the dentist’s lap, Mary took one arm and the hygienist the other, and the dentist worked his magic. He managed to get a good visual exam in during all the commotion. Good for him. Verdict – no problems with his teeth!
He did have some staining on his upper, front teeth, mostly because all he’ll drink is iced tea. The dentist said a little pumice on the rotating brushy thing dentists use (no clue what it’s called) would clean that right up. It would take about 30 seconds. We figured we could survive anything for that long and it would look a lot better. So, we decided to do it.
Reinforcements were waiting by the exam room door (an extra hygienist if needed). I literally laid across him (useful side effect is that deep pressure helps) to hold his body and feet, everybody grabbed an arm, and 30 seconds later, voila! He got some serious crud off. Ewww. Verdict – Stain gone, everyone survived, good enough.
J-Man recovered well (which is normal for him). I held him and walked him around for a few minutes and we sang a few rounds of Old MacDonald. By the time we got to the car, he was pretty good with life again. He was pretty subdued, but an OK kind of subdued.
Some things we learned:
- Preparation is 9/10 of everything. We tried to get mentally and logistically prepared before we even got there. We planned the whole day around it, timing meals, giving him some extra chill out time, letting him watch a little extra TV, lots of loving attention, etc. Best call of the day – put the soft shoes back on in place of the big boy shoes in case he kicked because they hurt less!
- Learn from prior meltdowns and keep trying to figure out the best way to get through something like this. Fifteen progressively worse haircuts were great lessons. Still, probably a lot more we can learn.
- Skilled, understanding professionals are worth their weight in gold. They really made it as easy as they could. Again, speed is everything.
- Ask around, get referrals, ask around some more. This is going to be stressful, shopping around for the best person is worth the time. We relied on the referral of someone we trusted and it worked out well. We will definitely be going back there.
Final financial damage – $68, and see you in six months. We’ll take it!
I claim my own sensory issues. I really don’t like dentists. I’m being very diplomatic in saying that. If J-Man takes after me, the end of the world may be nigh.
So, now we have to take him to the dentist tomorrow for the first time ever. It originally took months of therapy just to get him to let us near his mouth and to eat table food of any kind, then it took us months to get him to let us into his mouth with spoons, washcloths, etc., and then it took a while to get him to put a toothbrush in his mouth. He still fights us brushing his teeth with a brush (we usually use a textured washcloth), but he will sorta brush his own teeth with one (emphasis on ’sorta’).
So, we know his teeth need cleaning. He seems to have an overbite too. Nothing good can come of this when a dentist gets involved.
Autistic kids often have problems with their teeth, primarily because it’s hard to negotiate with a kid about dental hygiene when having someone pillaging around in their mouths when they’re sensory-sensitive anyway isn’t really on their favorite activities list. It’s not like “go get your toothbrush and brush your teeth” is a practical course of action either at this point.
Here are some other things compounding the problem.
- Our dental insurance has no pediatric dentists in network. How dumb is that? So, this is out of pocket. Great.
- I fully expect him to fight to the death in the chair. Remember, this is the kid who required five people (and me of 225 lbs practically sitting on him) plus an entertainment committee and his favorite video to sort of get his hair cut. This time some stranger is going into his mouth with shiny, sharp, scary-looking instruments. You must be joking.
- Distractions are pretty much useless with him after a certain point. Once he slides past that point of no return, ain’t nothing you can do to get him back except wrestle or take him home. In really stressful situations, honestly the distractions don’t much work regardless. It’s more how long you can delay the inevitable.
- I also fully expect them to give up and say “you’ll have to come back and we’ll need to sedate him. By the way, go ahead and leave your wallet with the receptionist.”
- I personally hate dentists. This does not give off good vibes to J-Man I’m sure.
- It never gets easy watching him go through something this hard on him. It kills me every time.
- If he has cavities, I may start drinking heavily when we get home. There’s a ‘package store’ two exits before ours.
The one good thing – the doctor comes recommended by the person who did his autism evaluation. So, let’s hope for the best.
Urf. We’ll let you know…
