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Authors: John Morgan, Bonnie F. Zimble

Special Care In Dentistry

Welcome to Module 3
Medical Considerations and Syndromes


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Autism Spectrum Disorders
Treatment


Study Questions

  1. What is behavioral intervention, and what is it used for?

  2. When should behavioral intervention begin, and how frequently should it be used?

  3. Who should provide behavioral intervention?

  4. Describe two behavioral methods for treating fears – systematic desensitization and video modeling.

Effective Treatments for Persons with Autism Spectrum Disorders?

Although there’s no cure for ASD, the main goal is to maximize communication and other critical skills of persons with ASD through structured behavioral intervention.1 Behavioral intervention is a highly effective method for teaching new skills. Prompts are used to cue desired behaviors (simple communication, peer interactions, self-care skills) which are then “positively reinforced” with immediate rewards. Behavioral intervention to teach new skills should begin as soon as possible following diagnosis (2-3 years of age), but it can then be used as needed throughout the lifespan. It should be carried out frequently (20-30 hours per week) and consistently. Parents of children with ASD should first seek out qualified home-based and pre-school service providers, often through state Birth-to-Three agencies. They should also learn to conduct behavioral intervention procedures themselves, which serves to enhance intervention effectiveness. After age three, the child will be eligible for early intervention services, which extend until the child enters school. Behavioral intervention should be continued seamlessly, becoming more sophisticated as the child learns increasingly advanced skills and progresses into adulthood.  

Behavioral intervention can also include methods for treating fears and anxieties. One method, systematic desensitization, involves teaching the person to relax, a response that, once achieved, is incompatible with anxiety. Once relaxation can be consistently cued, feared stimuli such as steps in a dental procedure can be introduced. Successful tolerance of the step is reinforced with praise or other rewards. Progress is made gradually, in stepwise fashion, giving the individual time to gradually adjust, or “desensitize” to each step in the procedure. 

Another behavioral intervention is called video modeling. This method involves showing videotapes of others comfortably tolerating a feared event or procedure and then receiving positive reinforcement. Theoretically, the person will adopt a more positive and relaxed expectation of the procedure. In one treatment comparison study with five adults with developmental disabilities, desensitization was highly effective at increasing compliance with feared dental procedures for all five patients, but video modeling alone was only effective for one.  

If you would like to read this study, the citation is J App Behav Anal. 2004 Summer;37(2):233-8.

Click here for more information on behavioral intervention in general. 

This video clip demonstrates the simple procedure of prompting a behavior (choosing an activity), then delivering immediate reinforcement. This simple prompt-behavior-reinforcement approach can be used from very simple to very sophisticated ways to teach new behaviors, including participation in dental routines.

References

1.  National Research Council (2001). Educating Children with Autism. Committee on Educational Interventions for Children with Autism. C. Lord & J. P. McGee (Eds.). Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press.