William and the Dentist
William is an 11 year old boy who has a diagnosis of autism and global development delay. He attends a special needs school. He particularly enjoys watching his DVDs, and especially loves a selection of different story books. William is also motivated by music and singing, and by his favourite foods such as crisps and breadsticks. William couldn’t get his hair cut or visit the dentist as he wouldn’t sit still and his behaviour would become challenging. After a number of weekly visits from our project worker Callum, William was able to attend dental check-ups and hair appointments.
How we helped
Working in conjunction with his parents, we gradually desensitised William to all the different parts of a haircut. We used a token system as this gave him clear and immediate feedback on his behaviour and how well he was managing. Tokens were given when he was sitting calmly and behaving appropriately. When William got a full board, we would stop the haircut and he would get to do something he enjoyed e.g. songs, reading a book or watching TV.
We also used a haircut symbol as part of a visual schedule so he knew what was coming up and what would happen after he was finished.
We began by setting a basic expectation to enable any haircutting activity to be done which was just getting William to sit on a chair and wait appropriately. We then introduced each part of a haircut separately, e.g. gown, brush, comb, scissors, spray bottle etc. Each one was gradually built in to be part of his haircut until it was no longer an issue for William. For example, we would have the scissors on the table next to him in the beginning but over the next few practices we would begin to hold them in our hands around his head. When William was comfortable with that, we would begin to open and close the scissors so he could become desensitised to the sound they made. We continued to gradually increase the amount that we would do with each item until it was no longer an issue.
When William could have his haircut without any problem, we organised for a hairdresser to come out to the house. We used the same systems that we had used to teach William earlier to ensure that he understood that nothing had changed and there was still the same expectation.
William is able to sit very still, he can wear the gown and has no problems with getting his hair sprayed wet, brushed or cut with scissors. Tokens are still used to give him feedback and he might have one break half way through his haircut but he can now have a haircut at home by a hairdresser.
Using the same desensitisation technique with some visual aids we then went on to work on William’s issues around dentist appointments. We started by working on William simply sitting on a chair with his head back and gradually began to introduce each component of getting a check-up from the dentist. By working on each one separately and gradually increasing the use of each aspect (e.g. the mirror, the sponges, a brush, the mask, the gloves etc.), we could systematically work through each one until William no longer had an issue with getting a check-up from the dentist. William is now relaxed when a dentist comes out to their home to do the check-up and his family are no longer stressed about haircuts and dental check-ups. Since our intervention, William has even had fluoride varnish applied to his teeth.