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First Published Sunday, 1 March 2009

Dr. Holly

Some children/adults on the spectrum have a harder time than others coping with the lead-up to necessary appointments and what those appointments may entail. Additionally, the sensory aspects and the sense of intrusion and interruption to the usual daily routine can take its toll causing great stress for all concerned. Quite a number of adults on the spectrum admit to foregoing examinations due to the sense of intrusion and anxiety experienced.

Appreciation for professionals whose interests genuinely lie in helping others towards achieving and maintaining healthier lives needs acknowledging. Certainly there are quite a few Doctors, Nurses, Dentists and other professionals, themselves on the spectrum, providing high standards of care, some within my own family. Thankfully, many of us live in a society with much higher standards of care than times past. Occasionally, you may stumble upon those who may require a little education on the autism front, and where opportunities present themselves for such education, hopefully both respect that goes both ways and knowledge, is gleaned.

In this article, we take a look at a number of helpful booklets, some interesting news articles, enlightening research and suggestions on how best to manage when appointments arise.

Doc and Child

Michael Fitzpatrick, GP and parent of autistic son on the following helpful booklets:

“Going to the doctor: a guide for autistic/AS children”

By Emma Jones. Published by the National Autistic Society £1


“Patients with autistic spectrum disorders

-information for health professionals”

By Christine Deudney. Published by the National Autistic Society £1


“Going to the dentist:

a guide for people with autism and Asperger syndrome”

By Kate Wilkes. Published by the National Autistic Society. £1


“When I brought my non-verbal 13-year-old son to A & E recently, I experienced some tension between my role as parent and my familiarity, as a doctor, with the world of hospitals. Like many people with autism, my son, is not good at waiting. As he sat quietly with his fingers in his ears, I was acutely aware that he could erupt at any moment. I was also aware that the nurses and doctors were under pressure to deal with all these people and their problems.

These NAS booklets will be a great help to autistic people and their carers and to the other health professionals they encounter. Both offer numerous useful tips, such as how to prepare for appointments and how surgeries and clinics can make things easier for people with an ASD.

As a parent I have often been impressed by how accommodating hospital staff can be, once they know that your child has special needs. As a GP, I know that much more can be done. These excellent booklets point the way forward.

Learning to be comfortable in your own skin is one thing, allowing others to ‘trespass’ in terms of providing necessary medical/dental and grooming care, is another. Many adults on the spectrum find it increasingly difficult to allow ‘others’ however necessary, access to themselves. Men often fall under the generalization of being the ones to hold back from seeking medical care, but I don’t doubt for one moment that this is the case for both sexes. But we mustn’t forget, sometimes what is considered as ‘intrusion’ can go a long way toward improving quality of life, let alone saving that life, in some cases. – Julie

“The Whole Tooth About Autistic Dental Patients”

Meet the Dentist

What kind of dentist uses peanut butter instead of toothpaste? Or strokes the side of your face with the toothbrush rather than put it in your mouth?

Wendy Bellis is not your bog-standard dentist, but then neither are her patients – she is one of the world’s foremost experts on treating children with autism. She was profiled in The Times of London.

“No child likes having their teeth brushed, but imagine what it’s like going to the dentist if you have extreme oral hypersensitivity, or you are terrified of new things?” said Ms Bellis, the dentist for Treehouse, the charity The Times is supporting in previous years’ Christmas appeals.

In other words, autistic children, while different from the rest of us, share a universal human condition: they hate going to the dentist – just they really hate it.

It was, until Ms Bellis started her pioneering work, an overlooked but very distressing side effect of the condition.

“Toothbrushing can be such a struggle, for parents already under a lot of stress, often they give up, understandably so,” she said.

“They can’t go to a dentist on the high street – a lot of dentists don’t like treating children at all, let alone a child who’s unpredictable and going to make a noise,” she said.

Autistic children may also be receiving sweets as rewards from their tutors, all the while developing serious toothache – with no way of telling anyone.

“That is a great worry for parents, that they might miss it.”

That means the only way to get even a check-up is by general anaesthetic -a risky procedure.

“When we examined one boy under anaesthetic we found a dead tooth on the top of his mouth, and the gums around it totally inflamed. His behaviour improved tremendously afterwards.”

So Ms Bellis decided something must be done. With 30 years specialising in special needs children, when the Treehouse school opened in London, she approached them with an innovative idea. What about a mock dentist’s office, right in the school?

This looks in every way like the real thing, complete with chair, light, and offputtingly clinical smell.

“We don’t treat them here, we just aim to reach the gold standard: being able to sit in the chair, and open their mouth to have their teeth brushed.”

After that, they can “graduate” to a dentist proper. Sounds simple enough, but here are two examples of her caseload during the visit to the school one morning last week: first, a 14-year old boy who had not been to the dentist in seven years, because he was too scared to leave the house. He could not even sit down.

And second, a bouncy teenager who, when passing her door (it has the sign for “dentist” on it in the pictorial code children are taught), pops his head around to give her the thumbs up. “He loves the dentist – although at first he couldn’t put a spoon in his mouth, he’d feed himself with his hands, he was so horrified by the thought of an object in his mouth.”

How does she get from one to the other? Through an imaginative series of tricks and rewards she has devised, and a commitment to the long term, “one boy took a year to open his mouth for me, another girl I had to sit with in the back of her mother’s car, as she wouldn’t come in.” All depends on working out exactly what is scaring the – possible non-verbal – child. If it’s the texture of the brush, she gradually brushes it closer and closer along their body until it reaches their face.

“The things I’ve done to get that brush in their mouth – I’ve covered it with peanut butter, or cream cheese. I wouldn’t put jam on, of course, I’m a dentist, I’m genetically programmed not to. Still, people would think I was mad if they saw me. But it’s a means to an end.”

One parent, Virginia Bovell, said that her son, 14-year-old Danny, never went to the dentist – “the level of fear meant it was a complete non-starter – any meaningful dental treatment had to be done under general anaesthetic.”

After “a gradual painstaking process” from Ms Bellis, using a lot of crisps as rewards along the way, he is now a toothbrushing, dentist-loving teenager. In fact, in his visit to Ms Bellis at Treehouse, he revels in every moment, asking for the light to be angled more on his face, before flashing Ms Bellis a toothy, happy smile.



Toy Dentist Set

NAS “Dentist: preparing for a visit”:


The best thing about visiting the Dentist when I was a child was the majestic, ancient rocking horse that awaited within the high-ceiling building in South Brisbane. I loved the smells, the charm of the very old, but well-maintained building itself, the friendliness of the Dentist(a male), very skilled and wonderfully warm toward children. He knew my story and would save colourful comic-strip cut-outs for me which he would frame and present to me along with some obscure coins from his travels abroad at the end of each check-up.

antique rocking horse

I remember the anxiety clearly, but I knew what to expect from the journey in, to the set up of the environment, (my valiant steed awaiting:))the friendly, warm staff and those familiar smells right down to the mouthwash. It all went a long way towards helping that anxiety abate.

For my own children, here in England, I made sure to be well-prepared with favourite books, favourite trains, that piece of silk in their pocket to calm and reassure etc. No such good fortune so as to find an ancient, magnificent rocking horse with flowing horse tail and mane! Also, it’s been a long road to finding a warm, even likeable Dentist who doesn’t condemn their instruments, openly cursing in front of children, regardless that their young patients sit before them hearing every word. You could say we’ve had our difficulties in this area since our move, but eventually we found a wonderful Dentist to whom we are very grateful along with a wonderful Orthodontist, faith thankfully restored.

My youngest son, who is extremely sensory sensitive, has a particular liking for the ToothTunes range of toothbrushes and uses Listerine Smart Rinse for Kids (Mild Berry flavour, which tastes primarily of strawberries) after brushing/rinsing. Often it’s a case of trial and error with toothpastes, rinses and brushes. – Julie

The following article comes courtesy of NAS Communication Magazine, Spring 2009 Edition.

Sweet Tooth

false teeth, the sweet kind

Visiting the dentist can be an ordeal for some people with an ASD but, with extra time, patience and a build-up of trust, this need not be the case.

Autism covers a wide spectrum and can affect all the senses. Someone with Asperger syndrome may come quite happily to the dental surgery for a check-up, without prior acclimatisation. Such patients can be inquisitive and often question exactly what the dentist is doing. It is extremely important to answer questions, however repetitive, in order that the patient can rationalise what is being done.

Wherever the person is on the spectrum, it is important that they are familiar with the dentist and their team, who ideally should remain the same, to maintain continuity, throughout any course of treatment. Prior to the first appointment, a visit to the surgery is useful to see the equipment and meet the dental team. The patient is often not even seen in the dental chair at the first visit but in neutral surroundings to allay any fears.

Gradually, they can come into the surgery and sit in the chair. Before the first appointment, we often use a ‘show, tell, do’ tool leaflet, to improve communication, which shows the dental ‘journey’, so that the person knows that there is a sequence to follow.

Encouraging parents to bring their children from a young age to acclimatise them and keeping treatment simple and easy-to-maintain is vital. It is often helpful to encourage the child to bring a toy and demonstrate on the toy what will be done to them.

Often associated with autism is the retention of the deciduous (or milk) teeth for longer than normal, or the appearance of the permanent teeth before the milk teeth have been lost. If the patient is familiar with the dentist then the milk teeth can be extracted easily. It is never appropriate to physically restrain the person and building up a good relationship with the carer is invaluable, if help is required to examine the person. It’s also important to involve the whole family and carers to establish oral care as part of maintaining good overall health.

Electric toothbrushes are best avoided, as the noise they make may affect some people with sensory issues. A toothbrush with two sets of bristles can be helpful, available from www.colliscurve.co.uk

It is also very important that when a specific appointment time is given, it is scrupulously adhered to. Also, during the appointment, try to give specific start and finish times. The dentist must speak clearly and consistently explain procedures so that the person has time to assimilate the information. Also, the dentist needs to be aware of any colours or sounds which may disturb the person and deter them from further visits.

If it becomes obvious that appropriate dental treatment cannot be provided easily, then treatment may have to be offered using sedation or even general anaesthesia.

Pauline Watt-Smith is a senior dentist with the Special Care Dental Service at the Rehabilitation Hospital, Leamington Spa.

dental care

More information on special care dental treatment is available from www.bsdh.org.uk

Copies of the leaflet Dental care and autism, by senior dental officer Michelle Golding, are available from the NAS Autism Helpline (0845 070 4004, Monday-Friday, 10am-4pm) or you can download a copy at www.autism.org.uk/dentist

Overcoming Dental Anxiety

published Wed, 25 Feb 2009



Do you feel anxious before every dentist appointment? Do you find yourself feeling sick to your stomach or getting sweaty palms? Is getting your child into the dentist chair like pulling teeth?

Though dental anxiety is quite common, the Pennsylvania Dental Association (PDA) reminds the public that this fear can be easily managed, and is even preventable.

Read More http://www.medicalnewstoday.com/articles/140155.php

A1 Dental/Medical Site:

book cover

Don’t Fear The Dentist

Experts share tips to help you overcome your fear of the dental chair.

By Richard Sine
WebMD Feature

Reviewed by Louise Chang, MD

Don’t Fear The Dentist

Experts share tips to help you overcome your fear of the dental chair.

John Gamba was 9 years old when a dentist failed to anesthetize a back molar properly and hit a nerve dead-on. The result was a lifelong fear of dentists that reached a peak in his 20s, when he stopped going to the dentist entirely. “I couldn’t even drive by a dentist’s office without getting stressed out,” he tells WebMD.

Gamba was 38 when a chipped back molar began to decay, putting him in constant pain. “I was paralyzed. I couldn’t even consider going [to the dentist’s office],” says Gamba, an Internet entrepreneur from Naples, Fla. “It was much easier to accept the pain, sick as that sounds.”

Few people look forward to a spell in the dentist’s chair. But serious anxiety prevents millions of Americans from seeking proper preventative care. The consequences of this problem may go far beyond dental pain or lost teeth. Gum disease is a serious infection that can affect other parts of the body. Studies now link it to illnesses including heart disease, stroke, and diabetes.

Fortunately, many dentists are specially trained in handling fearful patients; a variety of methods and treatments are available to reduce pain and alleviate fear in the dentist’s chair.

The ‘Root’ Causes

Between 5% and 8% of Americans avoid dentists out of fear, estimates Peter Milgrom, DDS, director of the Dental Fears Research Clinic at the University of Washington in Seattle and author of Treating Fearful Dental Patients. A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary, Milgrom tells WebMD.

Milgrom’s dental practice specializes in fearful patients. About two-thirds of them relate their fear to a bad experience in the dentist’s office, Milgrom says. Another third have other issues for which fear of dentists can be an unpleasant side effect, such as various mood or anxiety disorders, substance abuse, or posttraumatic stress experienced by war veterans, victims of domestic violence, and victims of childhood sexual abuse.

Fear of dentists stems not so much from the experience of pain as from the lack of control that patients experience in the dentist’s chair, says Ellen Rodino, PhD, a psychologist in Santa Monica, Calif., who has studied dental fear. “You’re lying prone, a dentist is hovering above you, and he’s putting you in a situation where you can hardly talk or respond. That creates a lot of anxiety for some people because they don’t feel in control.”

Still, many dentists create unnecessary anxiety in patients because they assume that all patients have similar pain thresholds and will handle dental procedures in the same way, Milgrom says. “If all dentists were a lot more careful about pain control, took the time to be sure patients were comfortable, and didn’t go ahead if they weren’t [comfortable], then we would create fewer phobics.”

Fearful patients need to be more assertive about their needs, Milgrom says. Patients should say to their dentists, “I want to talk about what can be done to make me more comfortable. I don’t want someone to tell me something doesn’t hurt me.”

Treating Fear of Dentists

Some dentists who specialize in treating fearful patients go out of their way to create a nonthreatening environment. The place where Jack Bynes, DMD, works in Coventry, Conn., is barely recognizable as a dentist’s office. It’s housed in a renovated historic gristmill, with a treatment room that overlooks a waterfall. The waiting room contains a fireplace and soothing photography; it’s free of posters depicting the horrors of gum disease. Bynes himself fancies bow ties rather than scrubs. Many “people have a fight-or-flight reaction” to the sights, sounds, and smells of a dental office, and taking away these cues has a calming effect, Bynes explains. And Bynes should know. He specializes in fearful patients today because he himself had to overcome his own medical phobias as he trained to become a dentist.

Bynes first talks with patients in his office, rather than in the dental chair. “I tell them they can leave anytime they want,” he says. “Only one has done it in 40 years. It’s so they know they have control.”

The best dentists use simple methods to enhance that feeling of control, Milgrom says:

  • *They gently explain what the patient will soon feel, and for about how long.

  • *They frequently ask the patient for permission to continue.

  • *They give the patient the opportunity to stop the procedure at any time the patient feels uncomfortable. (“I give them a cue,” Bynes says. “If for any reason they need to stop, raise your left hand.”)

  • *They make time for breaks as requested.

Many dentists lack the patience to treat fearful patients with the care they deserve, Bynes says. Even those who advertise that they “cater to cowards” may not do a good job of it. If you’re looking for a new dentist, Bynes suggests being honest about your fears from the first call. Ask to speak to the dentist about your fears before you come in. If the receptionist seems dismissive, or the dentist never returns your call, don’t go, he says. “That’s not the right office for you.”

Taking Charge

Chances are, visiting a dentist won’t be nearly as painful as you expect. Surveys of patients before and after the most dreaded procedures — such as a root canal or wisdom tooth extraction — have found that they anticipated much more discomfort than they actually experienced, Milgrom says.

The root canal in particular gets a “bad rap” because it is typically preceded by painful toothaches, Milgrom says. The procedure itself relieves this pain, often in just a single visit. Wisdom tooth extractions get a bad name because of occasional jaw pain experienced several days afterwards, which can be treated with pills.

Still, even if your mind tells you you’ll be just fine, your body may still fear that dentist’s chair. Here are a few tips that may help you overcome your fear of the dentist:

  • *Go to that first visit with someone you trust, such as a close relative who has no fear of dentists, Bynes suggests. Bynes even encourages friends and relatives to sit with the patient during treatment.

  • *Seek distraction while in the dentist’s chair. Listen to your own music on headphones — “a new CD, not one you’ve heard a lot, so you’ll be a little more interested in it,” Milgrom suggests. Or find a dentist with a TV or other distractions available in the treatment room.

  • *Try relaxation techniques. Milgrom suggests controlled breathing — taking a big breath, holding it, and letting it out very slowly, like you are a leaky tire. This will slow your heartbeat and relax your muscles. Another technique is progressive muscle relaxation, which involves tensing and relaxing different muscle groups in turn.

  • *Review with your dentist which sedatives are available or appropriate. Options include local anesthetic, nitrous oxide (“laughing gas”), oral sedatives, and intravenous sedation. While oversedation can be dangerous, too many dentists are uncomfortable using any oral sedation, Milgrom says. And only some dentists are qualified to perform IV sedation.

  • *If you can’t bring yourself to go to any dentist, you might want to try seeing a psychologist first, says Ronald Kleinknecht, PhD, a clinical psychologist at Western Washington University and co-author of Treating Fearful Dental Patients. The most “tried and true approach” to treating dental phobia (and other phobias) is what Kleinknecht calls “direct therapeutic exposure.” It involves introducing the patient to feared items — say, a needle — in a gradual and controlled manner.

As the pain from Gamba’s back molar intensified, he found support online through a forum for people with dental fear. He also found a dentist, Fred Eck, DDS, of Bonita Springs, Fla., who advertises his skill with fearful patients. Before going, Gamba says, “I convinced myself that I wasn’t going to have any procedure, that I was just going to talk with the dentist.” But Eck put him so at ease that he agreed to the extraction of the back molar on the first visit. And it was painless, he says.

Comfortable with his new dentist, Gamba finally got some much-needed dental work done. He spoke to WebMD just an hour before an appointment to get his final wisdom tooth removed. “It’s been miraculous,” he says. “I’ve gained such strength, hope, and courage by getting through these experiences.”

Reviewed on July 3, 2008

Source: http://www.medicinenet.com/script/main/art.asp?articlekey=90854

Health Topics:  Dentistry



Cutting It Fine

There are quite a few hairdressers who find themselves on the spectrum. One in particular with who I am familiar is a trained stylist with one of the world’s leading hairdressing salons. He is a perfectionist, very dedicated and respected in the workplace with great aspirations for the future. Despite sensory difficulties as a child, an ability to overcome and tune out that which irritates, has held him in good stead so far.


When we look at where our children are at today, let us never lose sight of the fact that potential should never ever be underestimated. So much may be overcome as children progress and mature into adulthood.

child salon

Parents’ Comments re Hair Cutting:

“L is TOTALLY RESISTANT to having his hair cut. At first it didn’t bother us – we were able to clipper it really short ourselves but when it grew we noticed these beautiful curls, so let it be for awhile. Now, however, he looks like a young Tarzan – every trip to the hairdresser is unsuccessful. We went to a home hairdresser who just barely managed to do his fringe. Any ideas?”

“I’ve just looked at my 8 year old before he went to school and have had the usual butterflies in my stomach, because he needs a haircut again! After lots of terrible ordeals in local hairdressing shops with my son I decided to get a mobile hairdresser to come and cut his hair. The first couple of times he was fine but the last time she came he had a total meltdown. She wasn’t able to cut his hair, nor did she want to try!(I don’t blame her!)”

child's haircut

“I cut D’s hair myself – it’s an interesting style but when it’s tied back it’s not too noticeable!! I’ve never been brave enough to try taking her to a hairdresser’s.”

My response:

When all’s considered, we’ve been very fortunate in the haircutting department as I have read and heard about many others’ experiences, from cutting hair in the night whilst children sleep, to having children’s hair completely shaved/removed. There are a few things to consider when an autistic child dislikes having his haircut. Calling on some OT research and experience here.

Children may be sensitive to the movement, height and overall size of the chair. Head movement required to lie back in the sink may be unpleasant. Our 6 year old son and many others find that errant spray from the sink nozzle or spray bottle is annoying. Also visual and tactile sensitivity may be triggered by close proximity of the hairdresser. Sensation around the neck and noise of the vinyl drape or whatever smock is used to protect the child’s clothing may cause discomfort. Many children, NT or autistic may have trouble with the feel of stray, cut hair on their neck and clothes following the haircut.

Some suggestions in this area would be to cut hair in a chair with surrounding support by placing pillows/adequate support under and around the child. Most hairdressers will automatically do this anyway – ensuring the child is at the right level and is comfortable. Providing favourable music(earplugs possibly), or perhaps you are fortunate to find a hairdresser with a TV/monitor for children’s viewing as some now apparently provide. Depending on the child, applying deep pressure before beginning the haircut may also help. This can be done directly using the fingertips or a towel can be used to rub the head. Allowing the child to manipulate a safe hair accessory/hair roller etc, or to hold a small vibrating device may help. Hand held games, a favourite object or toy(smooth pebbles or silk in pocket works for some) may help while hair is being cut. Those koosh balls or some Theraputty(we use this at home and it’s great!), or some sort of character with moveable body parts to play with during the haircut may help. Providing an alternative to the standard drape like a towel is yet another recommended intervention. Bringing fresh clothing for your child to change into following the haircut is another suggestion. Social stories are often beneficial and ensuring your child knows what is to follow the haircut, a favourite activity, an icecream from the corner store etc is recommended.

We have been very fortunate to have found very lovely, long-term hairdressers. Our current hairdressers have known M since birth and are like family to us, though he will sit for anyone! He doesn’t like the sprayer particularly (can totally understand this!) nor does he enjoy the painful vibration and noise of the clippers though he has desensitised enough and has self control enough to bear these and their use is kept to a minimum. M, when very young, say around 2 years of age, used to enjoy helping to sweep up the hair at the end of the haircut with his children’s dustpan and broom. He would enjoy having books read to him while we waited, and would always arrange appointments at the least busy times of the day. We had to work on desensitizing for hairbrushing and washing. Things like hairdryers and confusing sounds, voices, radios etc in salons can be very painful for autistic people, be they child or adult, of this there’s no doubt. Some are able to shut off from it for periods of time.

We now live primarily but not solely in a small, picturesque village. Our postman’s fiance is our hairdresser. As it turns out, my youngest son gets along famously with his hairdresser as she is into media, games and science as much as he is and they chat non-stop! She is patient, kind and great with the scissors!

– Julie

Going to the Hairdressers:

a Guide for Parents of Autistic/AS Children

By Laura Slade, NAS Autism Helpline.

Published by The NAS. £1.00


This leaflet highlights why some of the situations most of us accept without question, such as a visit to the hairdressers, result in such problems if you have sensory difficulties associated with ASDs.

I can well remember my son’s first trip to the hairdressers. We left having paid the full amount, with half a head of hair shorter than the other half. The following days were spent trying to snip another bit of hair off at any opportune moment!

The key points in the leaflet are easy to find for quick reference and the information is clearly presented, easily absorbed and understood. It covers lots of possible solutions in a very concise format, so that an understanding hairdresser might also have time to read the leaflet before the child arrives for a haircut.

Jan Cole, Parent and Parent Support Advisor,

Asperger East Anglia

Nail Biting and Trimming

cutting finger nails

The following is a response I wrote to a friend back in 2005 who at that time, was finding her non-verbal son chewing his fingernails into oblivion.


“Now that is one very common problem/habit in autistic children/adults! Intense nail biting is very prevalent, J has always done this as well and I guess with anxiety as the dominant emotion, it’s hardly surprising. Tends to increase at times of stress naturally.

Some suggestions would be to offer something else for __ to chew on. Best not to make reference to the actual nail-biting(ie never mention it and never tell __ not to bite their nails), but rather, direct him to an acceptable activity to ease the anxiety. Any attention we give to an unacceptable/negative behaviour is likely to reinforce that negative behaviour in an autistic child.

Some parents and older autistic people themselves, in an effort to break their nail-biting habit, use deterrants like an unpleasant tasting nail varnish(this worked for my sister), some use gloves, some rub lotion into their child’s hands as sensory input may be required. Some also brush the inside of their child’s mouth or have them chew on a specific item/toothbrush/chewy tube etc .

Some information I found on the net:

“Nail biting for most people seems to be a minor and almost trivial thing. But for some people it is a major problem.

When biting nails becomes so compulsive that you really feel you have no control over it, then you are gripped by an obsession, not just a minor habit.

With some nail-biting sufferers, the nail gets bitten right down to the cuticle, often so that the nail becomes deformed, discoloured and in some cases infected or falls out.

Very often the nail-biter will also resort to biting the skin around the nails, resulting in further damage.

What is often underestimated is the disruption caused to the self-esteem. In both male and female nail-biters, the hands become a part of the body the sufferer hates to display or have seen. This undermines the person’s sense of well-being and self-esteem. This then further causes stress and aggravates the compulsion.

All compulsive habits, nail biting included have their root in stress, anxiety or some other emotional issue. By negatively effecting the self-esteem and causing additional stress, the visual damage done to the person’s image amplifies the original cause.”

For further reading on nail biting and other habits which may be of interest(including thumb sucking, nail biting, nose picking, bruxism – clenching and grinding teeth, breath-holding spells, head banging, rocking and rhythmic movements):


Cleanliness is next to ...

In response to a parent in regard nail trimming:

So far as nail trimming goes, it sounds like you’re doing great and you’ve already incorporated things an OT would suggest.

Reasons for our children’s dislike of having their nails cut can be that the actual cutting of the nail may be painful or uncomfortable for them. Having another person hold the child’s finger may be uncomfortable for the child and fear of cutting too close to the quick or cutting skin may be anxiety-provoking.

Some recommended interventions include rubbing the child’s hands with lotion using deep pressure before beginning to cut the nails. Cuticle scissors may be more tolerable than larger fingernail clippers. Using an emery board in lieu of clipping nails to keep them at a manageable length as you are already doing is another. Some have resorted to trimming nails while their child sleeps. You could cut nails as part of the bathing routine following playtime(this works well for us) when the nail is softer and more pliable. You could try breaking the task into smaller increments such as two fingers at a time over a period of time. Some find that having their child place his/her fingers over a table at counter edge, pressing down gently to provide deep pressure to the fingertip but leaving the nail edge exposed for clipping, works well. Lastly, using a social story to describe the steps of nail clipping and the hygiene and social benefits of well-groomed nails is recommended.

Play Dentist - Nostalgia


In closing, we take a look at some books and resources that may help in the journey for self-care:

Caring for Myself

“Caring for Myself: A Social Skills Storybook”

Authors: Christy Gast and Jane Krug

“An amazing book! Christy Gast and Jane Krug have provided a fun and informative text that will assist children on the autism spectrum in learning important life skills. Each step is broken down clearly and concisely with great visual representation. As an individual on the autism spectrum who has trouble with fine motor tasks, tasks which involve multiple directions and the fact that I tend to be a visual learner, I would have greatly benefited from a book like this as a child. Highly recommended!”

Nick Dubin, presenter and author of Asperger Syndrome and Bullying


Book Cover

“Taking Care of Myself: A Healthy Hygiene, Puberty and Personal Curriculum for Young People with Autism”

Author: Mary Wrobel

Using a unique combination of social scripts and easy-to-understand activities, Taking Care of Myself provides accessible information on health, hygiene and personal safety issues for people with autism spectrum conditions or other developmental disabilities.

Presented as seven distinct units, this new curriculum covers all aspects of day to day life paying particular attention to areas that may cause confusion or distress, including illness and visits to the doctors. The authors also offer advice on puberty, appropriate sexual behaviour and ‘stranger danger’, making this a comprehensive manual for children and adolescents from the age of five upwards.


Book Cover

“Personal Hygiene? What’s that Got to Do with Me?”

Author: Pat Crissey

Personal Hygiene? What’s that got to do with me? is a curriculum developed for students with autism, Asperger’s Syndrome, learning and developmental disabilities, designed to help them understand how others perceive their appearance and the social implications of neglecting personal hygiene. Simple factual information is accompanied by humorous cartoons that emphasize how others view someone with poor hygiene. Step-by-step cartoons explain exactly what the student needs to do to ensure good hygiene. Quizzes and activity pages provide numerous opportunities for repetition and reinforcement of the key points. There are also hands-on activities to demonstrate why and how to perform various hygiene tasks. Several social stories are also provided, along with a set of worksheets that help students set up a daily schedule to allow time for completing necessary hygiene tasks.


“Joey Goes to the Dentist”

Authors: Candace Vittorini and Sara Boyer-Quick

‘Hi! My name is Joey. I’m 5 years old. In a couple of days, I am going to the dentist.’

Many children find the experience of visiting the dentist an uncomfortable one, and Joey is no exception.

He has Asperger Syndrome, which makes him particularly sensitive to the sensations that he experiences during a visit to the dentist: the feeling of cold instruments in his sensitive mouth, the piercing sound of the drill and the strong taste of mouthwash. He also dislikes the invasion of personal space which a trip to the dentist always involves.


However, Joey has strategies that will help him and other children to cope. Before he visits the dentist, he marks the date of the visit on his calendar, he practises counting his teeth with his dad, and also opening his mouth for other people to take a look inside.

Joey explains what to expect during a visit to the dentist – he describes how x-ray machines work and why they are important, why you need to wear a bib, and lists the different kinds of tools that dentists use.

This colourful picture book features photographs throughout. It will be a source of information and advice for families of children with autism spectrum disorders or related conditions, and the professionals who work with them, including dental professionals.


Book Cover

“Health Care and the Autism Spectrum: A Guide for Health Professionals, Parents and Carers”

Author: Alison Morton-Cooper

“You’ll just feel a little scratch then it will all be over.” This well-worn phrase to reassure patients about injections is unlikely to win over the patient if they happen to have autism. Communication difficulties, sensory overload and extreme discomfort with physical contact are all traits common in autism that make basic patient care and routine medical procedures extremely difficult.

In a patient who is exquisitely sensitive to touch, how do you go about taking blood pressure or dressing a wound? How can you be sure that your autistic patient has given ‘informed’ consent to treatment if you aren’t sure that they have really understood the implications? What do you do about it? Equally, for people with autism, or the parent or carer of someone on the spectrum, healthcare issues loom very large in daily concerns.

Health Care and the Autism Spectrum is a ground-breaking volume that addresses the ethical issues as well as the practical challenges that everyone involved has to deal with. Every health care professional will have an increasing number of autistic patients on their list as diagnosis of this condition continues to spiral. Consequently, this book is urgently needed.


“Prescription for Success: Supporting Children with Autism Spectrum Disorders in the Medical Environment”

Author: Jill Hudson, M.S., CCLS

Because of the unique needs of children with ASD, it is important to pay special attention to the details of their experience in the medical environment. Designed to help make the medical experience easier for all involved, this book presents information on ASD, the varying developmental levels, interventions, and assessments that medical staff, parents, educators, and key service providers can use to more effectively interact with and support children with ASD while in the medical setting. The information and techniques presented in Prescription for Success can be used by doctors, nurses, medical technicians, residents, interns, and even administrative staff to support children with ASD and their families in what can otherwise be trying circumstances. A CD at the back of the book includes forms and worksheets that can be printed and duplicated.



“In New Jersey, One Fix for Health Care Is Free Dentistry in a Fire Truck”:

“Free I-Phone App Prepares Autistic Kids For Visit To Doctor, Dentist & Other ‘Scary’ Places”:

Getting a haircut, going to a noisy mall or visiting other new places can be very frightening for children on the autism spectrum. One way parents can lessen the anxiety of new places is by preparation, using a variety of visuals to show the child what to expect and how to navigate challenging locations in the community. Model Me Kids has created such a tool in its Model Me Going Places TM, a free, portable and downloadable I-phone application.

The application includes six  locations — the Hairdresser, the Mall, the Doctor, the Playground, the Grocery Store and a Restaurant. Each location contains a photo slide show of children modeling appropriate behavior.


This app is based on the DVD “Model Me Going Places™â€, the latest addition to the popular Model Me Kids® social skills training series for children and teenagers with Autism and Asperger Syndrome, and is recommended for children from 2-8 years old.
To view sample screenshots form the application and to order the free application, visit  Model Me Kids – Model Me Going Places under the Age 2-8 button.
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Children's Books