Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are the most common neurobehavioral conditions in school-aged children. Nationally, anywhere from two to eighteen percent of people are affected. The total number of Americans diagnosed with ADHD has risen steadily since 2003.[1]
Special Needs Dentistry
Interested in more Special Needs
Dentistry posts from CDA? Click here.
ADHD is characterized by inattention, impulsivity, and overactivity, and usually begins during childhood. “It is a developmental disorder of self-control or the ability to regulate behavior,” said Lisa Dowst-Mayo, a dental hygiene program director at Concorde Career College in San Antonio. “Children with ADHD have a significant impairment in their ability to inhibit behavior that affects daily life. Working with these patients in the dental office can be a challenge.”[2]
A friendlier term for ADHD is spirited. It is more common in boys than in girls, is a lifelong condition, and is not preventable. Providing dental care for ADHD patients and others with special needs may be a challenge, but it is the specialty of the Center for Dental Anesthesia in Alexandria.[3]
A Brief History
ADHD was identified more than one hundred years ago. At first, it was named “brain-injured child syndrome.” Fortunately, that name did not stick, and it became known as “minimal brain dysfunction.” This term remained in use until 1970, when it was renamed “hyperactive child syndrome,” and then “attention deficit disorder.” Only in 1987 did the current term, Attention Deficit Hyperactivity Disorder, come into use.[4]
ADD, incidentally, is a type of ADHD. The two are not the same thing, since the latter involves a lot of movement and fidgeting. However, since 1994 all forms of the disorder have been referred to as ADHD. This article primarily addresses the hyperactive form, but readers should bear the distinctions in mind.[5]
Dr. Zeyad Mady has
dedicated his practice as a
save haven for all of his
patients, especially for
those who need additional
attention or who have had
poor experiences with
dentistry in the past.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), patients with ADHD cope with the following:
- Difficulty with sustaining attention and increased distractibility
- Impulse control or inhibition
- Excessive activity
- Difficulty following rules and instructions
- Excessive variability in their responses to situations
Compulsivity and excessive energy, of course, are hallmarks of most children. The DSM-5 lists nine ADHD personality traits. To be diagnosed with the condition, a patient must possess at least six of them.[6]
Sensory Overload
Raising a child is seldom easy, but the parents of children with ADHD – or any special needs condition – face additional challenges.
Kids with ADHD tend to have poor oral hygiene, and thus a greater potential for tooth decay. There are also higher rates of bruxism (teeth grinding), and a higher risk for dental/oral trauma than in other children.[7]
Many experts contend that children and adults with ADHD can be treated in a general dental setting, but this is not always practical. Young ADHD patients in particular tend to have more behavior management issues during dental appointments than do those kids without it. Just sitting through a checkup can be challenging for children with ADHD. The dental environment – its sights, smells, and sounds – can be enough to trigger an adverse reaction.[8]
Lisa Dowst-Mayo calls this sensory overload and advises dentists not to make too much of these reactions. “In the dental chair, it is best to simply ignore behaviors that may seem inappropriate, because they are usually unintentional,” she says. Fidgeting, for example, may seem excessive but can help ADHD children feel more relaxed. She also urges patience, because so many ADHD kids need extra time to process directions, such as “Open wide.”[9]
Parents can do a lot to help make things go smoother. Schedule appointments in the morning because most ADHD kids tend to do better earlier in the day. Bring a favorite toy or game to keep them occupied, and keep them informed about what is going on and what is expected. Rewards and positive reinforcement for cooperative behavior can also be effective.[10]
Superpowers
A diagnosis of ADHD may set someone apart from the crowd, and it can be challenging for those who live with it every day. But by no means does it limit what one can achieve in life.
Matt Curry was diagnosed with ADHD in the seventh grade. After graduating from high school he began working in automotive stores and discovered his passion; today he owns one of the largest independent auto-repair chains in the Washington, D.C. area. Behavioral strategies enable him to focus, and he attributes his business success to his condition. “ADHD is my superpower,” Curry says. “I’m successful because of it, not in spite of it.”[11]
For dental professionals and other health care providers, the keys are empathy and compassion. “Treating a dental patient with ADHD does not have to be a painful, strenuous experience,” Lisa Dowst-Mayo says. She recommends dental professionals abide by strategies summarized by the acronym, UNCAPPED:
U. Understanding for your patient
N. Non-judgmental attitude
C. Calm. Stay calm and relaxed
A. Attitude. Keep a positive attitude
P. Praise. Be generous with positive praise
P. Patient. Be patient with your client’s needs
E. Empathy
D. Directness
An excellent resource for information on ADHD is the Children and Adults with Attention Deficit Hyperactivity Disorder website (www.chadd.org). CHADD is a national non-profit providing information, advocacy, and support for people with ADHD.
The Center for Dental Anesthesia in Alexandria VA has always recognized the importance and necessity of special needs dentistry and welcomes patients with ADHD, Autism, Down syndrome, Aspergers and other special needs. CDA is committed to excellence in dentistry, and to being a safe haven for all of our patients, regardless of extenuating special needs.
_____
Notes
[1]
Number of Americans with ADHD: “ADHD, By the Numbers.” https://www.additudemag.com/the-statistics-of-adhd/. See also, “Pharmacologic Behavior Management of Pediatric Dental Patients Diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder.” https://www.aapd.org/assets/1/25/Seale_507-13.pdf
[2]
https://www.dentistrytoday.com/psychology/372-attention-deficit-hyperactivity-disorder-implications-for-dental-practice. Quote: “How to work effectively with patients who have ADHD,” by Lisa Dowst-Mayo, RDH, DSDH, p. 2. https://www.dentalacademyofce.com/courses/2696%2FPDF%2F1409cei_Dowst-Mayo_web.pdf. Hereafter referred to as “How to work effectively…”
[3]
More common in boys: “Attention Deficit Hyperactivity Disorder: Implications for Dental Practice.” (Author not listed.) https://www.dentistrytoday.com/psychology/372-attention-deficit-hyperactivity-disorder-implications-for-dental-practice. Lifelong condition, not preventable: “10 Key Questions About Attention Deficit Hyperactivity Disorder (ADHD).” https://www.everydayhealth.com/adhd/10-key-questions-about-attention-deficit-hyperactivity-disorder-adhd/what-is-adhd.aspx
[4]
“How to work effectively…” p. 2.
[5]
“ADD v. ADHD.” https://www.webmd.com/add-adhd/childhood-adhd/add-vs-adhd#1
[6]
“How to work effectively…” p. 2.
[7]
“Oral Health Fact Sheet for Dental Professionals: Children with Attention Deficit Hyperactivity Disorder.” https://dental.washington.edu/wp-content/media/sp_need_pdfs/ADHD-Dental.pdf. Referred to hereafter as “Oral Health Fact Sheet…”
[8]
“How to work effectively…” p. 5.
[9]
“How to work effectively…” p. 5.
[10]
“How to work effectively…” p. 5.
[11]
“Born This Way: Personal Stories of Life with ADHD,” by Eileen Baily. https://www.additudemag.com/adhd-personal-stories-real-life-people-living-with-adhd/?src=embed_link
[12]
Quote, and UNCAPPED: “How to work effectively…” p. 6.
Contact Center for Dental Anesthesia:
703-379-6400
Location (Tap to open in Google Maps):
5284 Dawes Ave
Alexandria, Virginia
22311
