Monday with Maureen: “15 Tips for Helping Children With Sensory Sensitivity Brush Their Teeth”

If your kiddo fights toothbrushing time, these tips from Christina Kozlowski could be a great start for transitioning to a smoother routine. In particular, these thoughts can offer some guidance for parents and guardians of children with Sensory Processing Disorder or sensitivities specific to oral hygiene. While this post is certainly not the only reference you should consider before formulating a plan for toothbrushing time, some of these tips might help you generate ideas to use as stepping stones during further research and consultation.

 

Author: , OTR/L and owner of Sensory TheraPLAY Box, LLC, the monthly sensory toy box for children with autism and/or sensory needs.

Most kids run away from the sight of the “terrible toothbrush.” However, for children on the autism spectrum with sensory issues, this can be even more of a challenge. There can be many different factors and reasons for a child’s aversion to toothbrushing. There may be some hypo- or hyper-sensitivity and oral defensiveness going on. With hypo-sensitivity, kids might have less awareness of what’s going on in their mouths, which can contribute to anxiety related to the mouth area (think of it as a type of oral “numbness”). On the flip side, kids who are hyper-sensitive might be overly conscious and sensitive to oral stimulation. The slightest touch can be overwhelming and be perceived as painful.

Although I am a licensed occupational therapist, the tips below are general suggestions and not an individualized therapy plan. If you have concerns, a speech-language pathologist or occupational therapist trained in oral motor therapy can offer a complete an evaluation and put together an individualized therapy plan with recommendations that take all factors into consideration.

However, for some general ideas and helpful insights that can be used in a trial-and-error type of approach, read on! Below you will find my tips that might help your child be more independent with toothbrushing and keep those pearly whites squeaky clean.

1. Some children may find the sensation of the bristles uncomfortable. Try using a brush with extremely soft bristles or silicone bristles. A baby toothbrush could be a useful transition tool to help your kiddo eventually transition to a regular brush. For example, the Banana brush is a baby training toothbrush that has short bristles made of silicone that can help to desensitize.

2. A toothbrush that can get the job done faster. For example, a three-sided toothbrush such as DenTrust cleans faster and gets all three sides with just one brush motion. The bristles are super soft to gently clean the gum tissue.

3. Experiment with different toothpastes. Some kids don’t like the taste of the mint and can perceive it to be a painful, burning sensation. Try different flavors of toothpaste, such as bubblegum, strawberry, orange, etc.

GUM Crayola Squeeze-a-Color comes in toothpastes that are all different colors and flavors (melon blast, blueberry burst, and jazzy apple). You can let your child squeeze a little from each tube to mix and match the colors and flavors and have some fun with it. Also, Banilla Bling is a vanilla ice cream flavored toothpaste.

4. If your child is sensitive, maybe flavored toothpaste isn’t the best option. Also, the foaming of the toothpaste may be the culprit, causing unpleasant sensory sensations and discomfort. Oranurse is a flavorless and non-foaming toothpaste that was initially created for children on the autism spectrum who were were sensitive to strong flavors and taste. Overall, this toothpaste doesn’t foam and has zero flavor, which may help ease your child’s comfort.

5. Focus on finding the right toothbrush. Make sure the toothbrush is the right size for little hands and has soft bristles that don’t hurt gums. An electric Spinbrush can make toothbrushing more fun because some children love the feel of the vibrations. Another fun option is a flashing timer brush (Crayola makes one that lights up for two minutes, letting children know when brushing time is up.)

6. If your child is a music lover, consider a singing toothbrush. There are lots of varieties of musical toothbrushes on the market, from ones that sing songs to ones that make animal noises.

7. If a singing toothbrush with all the fancy bells and whistles doesn’t sound too appealing to you, simply sing a song your child loves while they brush. If the brushing stops, you stop singing. You can even play a favorite song on your phone and pause it if they stop brushing.

8. Brush when your child brushes. Brush your teeth at the same time as your little one. Be enthusiastic about it, making it look appealing.

9. Take turns brushing. Let your little one brush their own teeth first before you do it for them. You can also try and give your child your brush and let them brush your teeth while you brush theirs (it can be a good distraction!).

10. Try brushing teeth while in the bathtub. You can also give your child a cup and some bath toys while you brush his/her teeth at the sink. Water play at the sink is a simple distraction.

11. Brush in front of the mirror. This might help your child feel more control of the situation. Visually being able to see the toothbrushing process can help as opposed to a situation where you’re facing your child and they cannot see what’s going on.

12. Visual supports and schedules. A visual schedule can be created by taking photographs of the steps of toothbrushing. Option 1: You can cut and laminate the photos, putting velcro on the back of each one. Arrange in chronological order on a board and as each step is completed, the corresponding picture is removed. Option 2: Print photos of the toothbrushing process, laminate the pages, and a dry-erase marker can be use to check off each step (so that the page can be reused day after day). Option 3: Snap a picture of each step of the toothbrushing process, load the pictures on to a digital picture frame and program it so that each photo is displayed for 10-second intervals. This can be used in the bathroom as they are brushing their teeth so they have a visual prompt when it is time to move on to the next step.

13. Try a timer. Sand timers or using the stopwatch on your phone are great for making how long to brush more understandable. You can start with just a few seconds and work up to a full two minutes.

14. If brushing really is a battle, it’s completely OK to start small. If your child isn’t comfortable with a regular toothbrush, or the electric toothbrush, start with brushing only one or two teeth for a couple seconds, (maybe with the baby silicone bristle toothbrush?), then stopping. A couple days later, you can “up” the amount of teeth you attempt to brush and add on a few more seconds. It’s OK to try this method and go slow. Sometimes a desensitization process is needed.

15. Consider water temperature. Have you always brushed your teeth with cold water? Is cold water what you use when brushing your child’s teeth? If so, try switching it up and using warm water. You child may be sensitive to the cold water and tolerate a warmer temperature a lot better.

Mondays with Maureen: We Have Autism All Wrong

We have autism all wrong: The radical new approach we need to understand and treat it

Autism often gets portrayed as checklist of deficits. Rather than curb these behaviors, we should enhance abilities

The first thing I noticed about Jesse was the fear and anxiety in his eyes.

I was visiting a small New England school district when I heard about an eight-year-old boy who had recently transferred from a nearby district. There he had earned a dubious distinction: administrators called Jesse the worst behavior problem they had ever encountered.

It wasn’t difficult to understand why, given his challenges. Jesse, a sturdy boy with straight brown hair and wire-rimmed glasses, struggled with severe social anxiety, extreme sensitivity to touch, and difficulty processing language. He also had a seizure disorder that was detected when he was a toddler, about the time he lost the ability to speak. He communicated with little more than guttural sounds and grunts, pushing away people and objects or physically leading people to what he wanted.

Since it was so difficult for Jesse to make his needs known, he often seemed aggravated and miserable. He sometimes took out his frustration and anxiety on himself, pounding his fists against his thighs and his forehead, covering his body with bruises. When teachers tried to direct him from one activity to the next, he often reacted with flailing limbs or by pushing them away with his arms or legs. Reports from the previous school described kicking, scratching, and biting episodes escalating into fits so severe that almost daily, three or four adults had to pin the boy down to subdue him, then isolate him in a “time-out” room.

The staff had interpreted all of this as willful, uncooperative behavior. But Jesse’s mother knew better. She understood that his actions were his way of communicating—a direct reflection of his confusion, agitation, and fear. When she explained to the administrators that her son struggled with sensory challenges that made him unusually sensitive to loud noises and being touched, they had been dismissive. Clearly, they insisted, the boy was displaying noncompliant behavior. In their eyes, Jesse was strong-willed, stubborn, and defiant, and their response was to try to break him—to treat him as a trainer would treat a horse.

What did these educators offer to help Jesse learn to communicate? Practically nothing. The district’s policy was to focus first on controlling a child’s behavior, and, only after achieving success, to address the area of communication.

They had it all wrong.

I had heard so many awful things about Jesse that I was intrigued to come face-to-face with him. When I finally did, I didn’t observe any of what I had heard described—not the defiance, not the aggression, not the willful disobedience. What I saw was a boy who was understandably frightened, anxious, and constantly on guard. And I saw something else: Jesse’s extreme vigilance and anxiety were manifestations of the inevitable damage that occurs when people— however well meaning—completely misunderstand the behavior of individuals with autism.

How does this happen? The short answer is that caregivers neglect to ask “Why?” They don’t listen carefully or observe closely. Instead of seeking to understand the child’s perspective and experience, they simply try to manage the behavior.

Unfortunately this behavioral-assessment approach—that is, using a checklist of deficits—has become the standard way of determining whether a person has autism. We say a child has autism if he displays a combination of traits and behaviors that are deemed to be problematic: difficulty in communicating, trouble developing relationships, and a restricted repertoire of interests and behaviors, including repetitive speech—known as echolalia—and actions, such as rocking, arm flapping, and spinning. Professionals observe these “autistic behaviors” and then assess the people who display them by using a sort of circular reasoning: Why does Rachel flap her hands? Because she has autism. Why has she been diagnosed with autism? Because she flaps.

Following this approach means defining a child as the sum of his deficits. How best to help such a child? By managing those behaviors or attempting to get rid of them: to halt the rocking, to squelch the echoing speech, to reduce the flapping. And what denotes success? The more we can make a child look and act “normal,” the better.

This way of understanding and supporting people with autism is sorely lacking. It treats the person as a problem to be solved rather than an individual to be understood. It fails to show respect for the individual and ignores that person’s perspective and experience. It neglects the importance of listening, paying close attention to what the person is trying to tell us, whether through speech or patterns of behavior.

On top of that, in my experience it doesn’t work—and often makes things worse.

What’s more helpful is to dig deeper: to ask what is motivating these behaviors, what is underlying these patterns. It’s more appropriate, and more effective, to ask “Why?” Why is she rocking? Why does he line up his toy cars that way, and why only when he arrives home from school? Why does he stare at his hands fluttering in front of his eyes, and always during English class and recess? Why does she repeat certain phrases when she is upset?

The Challenge of Dysregulation

Usually the answer is that the person is experiencing some degree of emotional dysregulation. When we are well regulated emotionally, we are most available for learning and engaging with others. We all strive to be alert, focused, and prepared to participate in activities in our daily lives. Our neurological systems help by filtering out excessive stimulation, telling us when we’re hungry or tired or when to protect ourselves from danger. People with autism, primarily due to underlying neurology (the way the brain’s wiring works), are unusually vulnerable to everyday emotional and physiological challenges. So they experience more feelings of discomfort, anxiety, and confusion than others. They also have more difficulty learning how to cope with these feelings and challenges.

To be clear: Difficulty staying well regulated emotionally and physiologically should be a core, defining feature of autism. Unfortunately professionals have long overlooked this, focusing on the resulting behaviors instead of the underlying causes.

If you know a person with autism, consider what makes this person less able to stay well regulated: problems in communicating, environments that are chaotic, people who are confusing because they talk or move too quickly, unexpected change, excessive worry about things that are uncertain. Then there are associated challenges, such as sensory sensitivities to touch and sound, motor and movement disturbances, sleep deprivation, allergies, and gastrointestinal issues.

Of course people with autism aren’t alone in experiencing these challenges. We allfeel dysregulated from time to time. Speaking in front of a large audience, you might feel sweat collecting on your brow, your hands might quiver, your heart might race. Wearing a scratchy wool sweater might be so irritating that you can’t focus. When your normal morning routine—coffee, newspaper, shower— is thrown off by an unexpected intrusion, you might feel out of sorts for the rest of the morning. When these factors accumulate—you miss sleep, you’re under a deadline, you skip lunch, and then your computer crashes—it’s easy to beme extremely agitated.

We all have these challenges, but people with autism are unusually ill equipped to deal with them because of their neurology. That makes them far more vulnerable than others—that is, their threshold can be much lower—and they have fewer innate coping strategies. In many cases, they also have sensory-processing differences: they are either highly sensitive or undersensitive to sound, light, touch, and other sensations and therefore less able to manage. In addition many people with autism are innately unaware of how others might interpret their actions when they are dysregulated.

Feeling emotionally dysregulated affects different people in different ways. Often the reactions are immediate and impulsive. A child’s behavior may shift suddenly, with no apparent cause. When a child is exposed to a loud noise, for instance, he might drop to the floor. I often see children refuse to enter a gym class or the school cafeteria. Their teachers might mistakenly believe that this is willful disobedience, a planned attempt to escape an activity the child doesn’t enjoy. The reason is typically much deeper than that: the child can’t bear the volume or quality of the noise or the chaos of the setting.

When I worked in a preschool autism program based in a hospital, the children ate lunch in the classroom on trays brought up from the hospital cafeteria. Once a teacher and I led the four- and five-year-olds to the cafeteria’s kitchen so they could see how the trays were cleaned. At exactly the moment we arrived, the industrial-size dishwasher spewed forth steam and suddenly emitted a high-frequency SSSHHHH! Instantly all the children dropped their trays, some covered their ears and screamed, and they ran for the exit. It was as if a monster had suddenly appeared, inches from their faces.

That’s dysregulation, sudden and visible.

Sometimes the cause of dysregulation is less obvious. While visiting a preschool where I consulted, I was walking outdoors with Dylan, a four-year-old with autism, when suddenly and without warning, he dropped to the ground and refused to proceed. I gently picked him up and helped him along, but soon he dropped again. As I helped him again, we heard a dog barking. He immediately panicked and tried to run away from the sound. It dawned on me that Dylan, with his hypersensitive hearing, had heard the dog all along, but its bark had been so distant that it hadn’t registered with me. What might have appeared as uncooperative, random, or defiant behavior was in fact a very understandable expression of fear.

That too is dysregulation.

Many children with autism flap their arms, either as an expression of their level of excitement or to calm themselves. When Conner felt joyful, and sometimes when he was anxious about a transition between activities, he did what his parents called his “happy dance.” He stood on his toes and stepped forward, then back, while flicking his fingers in front of his eyes. An earlier therapist had advised Conner’s parents to respond with a firm “Hands down!” And if he didn’t comply: “Sit down, sit on hands!” (To their credit, his parents ignored the suggestion, instead helping Conner to label his feelings or easing transitions by telling him what to expect.)

It’s easy to dismiss flapping or rocking or dancing as just so much “autistic behavior.” But parents raising children with autism, and the professionals who work with them, need to take an extra step. Like detectives, we need to examine and consider all available clues and work to discern what is underlying or triggering a particular reaction. What is making the child dysregulated? Is it internal or external? Is it visible? Is it in the sensory realm? Is it pain, or physical discomfort, or a traumatic memory? In most cases the child can’t explain the behavior in words, so it’s up to those close to him to sort through the clues.

Coping Strategies and Regulating Behaviors

Here is the important irony: Most of the behaviors commonly labeled “autistic behaviors” aren’t actually deficits at all. They’re strategies the person uses to feel better regulated emotionally.

In other words, in many cases they’re strengths.

When a child with extreme sensory sensitivities enters a noisy room and cups his hands over his ears and rocks his body, this pattern of behavior is simultaneously a sign of dysregulation and a coping strategy. You could call it “autistic behavior.” Or you could ask “Why is he doing that?” The answer is twofold: the child is revealing that something is amiss and that he has developed a response to shut out what is causing him anxiety.

Whether or not we realize it, all humans employ these rituals and habits to help us regulate ourselves—soothe ourselves, calm our minds and bodies, and help us cope. Perhaps, like many people, you find public speaking unnerving. To calm yourself, you might take a series of deep breaths or pace back and forth while you speak. That’s not exactly the way humans typically breathe or behave in public, but an observer would not judge this as deviant behavior. The person would understand that it’s your way to cope with the stress of the situation and to soothe your nerves so that you can do your best.

When I return home from a day of work, I immediately check the mailbox, then sort the mail, placing bills in one pile, magazines in another, and tossing what I don’t need in the recycling bin. It would take a significant distraction for me to skip that small but important ritual; then I would feel out of sorts on some level until I took care of it. It’s a calming routine; it’s how I come home. When my wife has had a bad day or feels worried, she organizes and cleans. If I come home and find our home more immaculate than usual, I know that something is bothering her. Religious services include layers of comforting rituals—chanting and praying, symbolic gestures and body movements—to enable people to let go of the worries and trivialities of everyday life and enter a higher spiritual realm.

For people with autism, comforting rituals and coping mechanisms come in all varieties: moving in particular ways, speaking in various patterns, carrying familiar items, lining up objects to create predictable and unchanging surroundings. Even proximity to certain people can serve as a regulating strategy.

Monday with Maureen: Red Flags of Sensory Processing Disorder

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We get asked often, what are the signs of Sensory Processing Disorder? I came across this great list that breaks it down by age.

Red flags of sensory processing disorder

Infants and toddlers

  • Problems eating or sleeping
  • Refuses to go to anyone but me
  • Irritable when being dressed; uncomfortable in clothes
  • Rarely plays with toys
  • Resists cuddling, arches away when held
  • Cannot calm self
  • Floppy or stiff body, motor delays

Pre-schoolers

  • Oversensitive to touch, noises, smells, other people
  • Difficulty making friends
  • Difficulty dressing, eating, sleeping, and/or toilet training
  • Clumsy; poor motor skills; weak
  • In constant motion; in everyone else’s face and space
  • Frequent or long temper tantrums

Grade-schoolers

  • Oversensitive to touch, noise, smells, other people
  • Easily distracted, fidgety, craves movement; aggressive
  • Easily overwhelmed
  • Difficulty with handwriting or motor activities
  • Difficulty making friends
  • Unaware of pain and/or other people
  • Adolescents and adults
  • Oversensitive to touch, noise, smells and other people
  • Poor self-esteem; afraid of failing at new tasks
  • Lethargic and slow
  • Always on the go; impulsive; distractible
  • Leaves tasks uncompleted
  • Clumsy, slow, poor motor skills or handwriting
  • Difficulty staying focused

—from SPDFoundation.net