Susan's Blog

Friday, March 22, 2013

Autism Mommy Swami: Braces

Dear Swami,

What advice do you have regarding getting braces put on?  

My son is almost 13, has minimal language and will not understand why his teeth will have these “things” on them. He doesn’t have sufficient receptive language for him to understand. In addition, how can we teach him to keep his mouth open long enough for braces to be applied to his teeth?  And finally, the braces will
hurt when first put in. We won’t know where exactly it hurts in order to put on the wax the orthodontists give the children to coat their mouth when there is a problem. My son will not be able to exactly pinpoint where he has discomfort.

The only positive aspect of this process is that my son has a twin (typical)  sister who just had her braces put on.

We are very worried about how upset he will be by this whole thing. But getting the braces put on seems line an undaunting process.

Can you give us any advice?

Thank you so much.

–Braced for Trouble


Dear Braced,

Thank you for bringing up such an important question. As you know, The Swami’s own darling son Nat got braces put on when he was about 12 or 13. We were able to bring this about because Nat happens to be very relaxed at the dentist to begin with. I don’t know how or why we did this, but we started him going before we knew about his autism definitively. So the whole experience for Nat was very “normative,” as our psychiatrist likes to say. I think he means “normal.” I guess it is like introducing less tasty, adult foods to babies while they’ll still try anything. That’s the theory, anyway. We did that for Ben. We put all of our dinner foods into a Mueli grinder and fed it to him mashed up. Oh, he ate anything we gave him alright.

And then suddenly, he did not. And he is still my PICKIEST EATER YET. So, there you have it. Nothing.

You already know that what works for one family may not work for another. You feel that your son will not sit through getting these things on his teeth, let alone keeping his mouth open for so long.

So, I think you have to dig down into your instinctual knowledge and grab onto clues for yourself. Here is the biggest clue you have offered: his twin sister just had them put on. Is your guy visual? The first thing I would try is writing your son a Crisis Story. Known these days as Social Stories, (but I created my own version when Nat was 3, before I knew about Carol Gray and her copyright), these are simple stories that explain, step-by-step with photos, exactly what your child should expect from this upcoming “crisis.” Unlike Social Stories, however, Crisis Stories contain real photos from the child’s life to accompany the text. While the Swami is aware that symbolic or iconic representative drawings do work for children on the Spectrum as a quick shorthand for grasping basic meanings, they do have their limits. For someone who is literal and has difficulty generalizing — like Nat — you need actual photos from the child’s immediate life. Then he sees it and connects it without a huge leap.

So what do you do first?  Determine just how important the braces are. You clearly want to do something for your son’s teeth, and the Swami understands. We parents want our children to have every advantage they can and straight teeth are important socially as well as in terms of health. But, temper this desire with compromise. Maybe you only have to do a little bit to correct the worst of the problem. Maybe you don’t have to get his teeth perfect. That’s what we went for with Nat: presentable, not perfect. You just can’t have everything, my dear Braced. So in this life, you make choices.

Next. Make sure that your practitioner is with it. Go to the dentist, sit down with the staff who will be working on your son and tell them his issues. Give them suggestions for how to deal with him. Be very clear that if they are not with the program you will take your business elsewhere. We did that. We made absolutely sure that our orthodontist knew what she was getting into and what we would and would not tolerate from her (the orthodontist). Yes, you are the client, so you set the tone of this relationship. This goes for any professional you work with. If they don’t get it, move the F on. Life is too short to waste on stupid insensitive “professionals,” and our children are too precious for that kind of nonsense.

In fact, let me step outside of this particular narrative for one moment and say: NEVER LET ANY PROFESSIONAL — ANYONE — MAKE YOU FEEL BAD ABOUT YOUR KID.

 Third, create the Crisis Story.

  • 1) You take pictures of your daughter’s braces — within her face, to keep braces connected to familiarity.
  • 2) You take pictures at the dentist’s office, of the person who will be working on your son and all the equipment.
  • 3) You take pictures of your son’s face, teeth, mouth.
  • 4) Try to get a fake picture, of your son already in the dentist’s chair! Stage it beforehand!!
  • 5) Write up your story with simple text that keeps the info clear and brief:
  • -Tell Johnny what is going to happen to him. (picture)
  • -Tell him that this already happened to his sister (picture). Show him his familiar dentist’s office (pictures of chair, tools, dentist).
  • -Then include the picture of him in the chair, showing him that this is what will be happening to him.
  • -Show him the inside of his sister’s mouth. Talk about keeping the mouth open (picture) for a LONG time.
  • -Talk about how he can have breaks, and treats (pictures) AFTER he does what is necessary.
  • -Talk about how it will end, and how proud he will be.

As for the wax, you might be able to ask his sister the most likely pain points. You might even be able to run your own finger inside his mouth and feel for sharp points to cover. Also give him pain reliever as long as the dentist allows it. But also know that one of the worst things about being a parent is that you cannot always take away your child’s pain.  You can prepare him in every way possible, though, and that is a great gift to him.  Good luck!






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