AIM Clinics is now a partner of Hopebridge Autism Therapy Centers.

Tolerating Toothbrushing

1/25/2022 By Christelle Nilsen

I’ll never forget the first client I attempted toothbrush toleration with. His mother explained that getting his teeth brushed was a daily struggle that resulted in them giving up. As a BCBA trainee, I was tasked with the responsibility to write a program for him to tolerate toothbrushing. Program was written, materials were provided by the parents, and we were ready to begin the process. “Okay, it’s time to brush your teeth,” I said to my client after he washed his hands. What followed was a 5 minute tantrum filled with him screaming “No,” crying, stomping his feet, hitting himself and hitting me. If you are a parent or caregiver of a child with autism, this scenario might resonate with you. It is possible that you have attempted time after time to brush your child’s teeth and it just isn’t working. I bet you are feeling tired, defeated, and concerned about the health of their teeth.

Here are a few tips and rules that we use to teach clients how to tolerate toothbrushing:

Shaping

The first tip we will discuss is a process we call shaping. Shaping is just a term for breaking down big tasks into small steps and working towards individually completing each step until the total task is complete. If I walked into a gym and decided I wanted to lift 75 pounds, I could not do that on my first try. I would start small and shape my muscles so that over time I could lift 75 pounds. The same is true for your child and tasks that seem daunting to them. Take the big task and break it down so you can shape it step by step. The step you start on will vary depending on your child.

A sample breakdown of shaping looks like this:

1. Put toothbrush on counter

2. Touch toothbrush to lips

3. Touch toothbrush to teeth

4. Brush for 5 seconds

5. Brush for 10 seconds

6. Etc.

15. Brush for 2 minutes

Celebrate the small steps

An important part of shaping is celebrating each step. For example, your child is starting on Step 1 “put toothbrush on counter.” As soon as the toothbrush is on the counter, you praise your child. Praise will be different for each child, maybe they like tickles, or fidget spinners, or have a favorite toy. Whatever it is, have it ready and available to give as soon as they have completed the current step. In the clinic, we use “first/then” language. For example, your child loves their fire-breathing dragon. If this is what you are using, have it in sight but out of reach as you state “First brush teeth, then dragon.” As soon as they complete the current step, provide high verbal praise (ex. “I love how you let the brush touch your teeth!”) and the toy.

Follow through

This tip is just as important as the last. Once you have given a directive, there must be a follow through. For example, my client mastered his first two steps of tolerating toothbrushing and it was now time for the toothbrush to touch his teeth. “Okay, it’s time to brush your teeth, do this (as therapist gave a closed teeth grin for him to imitate.)” He made the closed teeth grin but as soon as the toothbrush got close to his mouth he began to scream and threw the toothbrush across the room. After a 23 minute tantrum, he realized this was not going to get him out of the task at hand. He then allowed the therapist to touch the brush to his teeth. After doing so, he received high verbal praise and his dinosaurs. If the therapist had given up during those 23 minutes, the next time the directive was given, he would exhibit those challenging behaviors again in order to escape that task.

After 3 consistent months of shaping the behavior, celebrating the small steps, and following through with each directive, my client was able to tolerate his teeth being brushed. 5 months of teaching him how to brush his teeth and he is now able to go through the entire task with no assistance and no challenging behaviors. Each child is different and my client's timeline will likely be different from your child’s, do not let this discourage you! Break it down, celebrate the little wins, follow through and remain consistent. Your child can do this and so can you!