A Case of Improved Dental Acceptance in a Child with Autism Spectrum Disorder：Emotional Regulation Support Based on the SCERTS Model

Abstract

Introduction：The SCERTS model is an educational model that takes a comprehensive approach to autism spectrum disorder （ASD） with social communication, emotional regulation （consisting of self-regulation and mutual-regulation）, and transactional support. In the present case, we observed an improvement in acceptance of dentistry in a child with ASD as a result of medication adherence management and emotional regulation of dental anxiety. Written consent was obtained from the patient for this report.

Case：A 7-year-old boy, Disability：ASD, Developmental age：4 years, Chief complaint：Treatment of tooth decay, Current condition：10 dental caries, height 120cm, weight 21kg.

Treatment and progress：At the time of the first visit, the patient refused to enter the room, so we conducted an oral examination in the waiting room and planned dental treatment under general anesthesia. After taking the sedative drug midazolam, anesthesia was introduced, and the progress was good. In the post-treatment training, pictures were shown to the patient as a form of self-regulation and he was asked to select what he could do, which was positioned as “what to do today.” Among the pictures that he judged to be unacceptable, the dental hygienist proposed to the patient to try some of them that were considered to be acceptable. Then, a picture that the patient agreed to was positioned as “the next thing to do.” Gradually, acceptance of dentistry improved. One year later, it was possible to extract milk teeth using the ordinary method.

Discussion and Summary：Oral administration of midazolam may be effective for reducing stress as premedication for children with ASD who refuse an injection. The SCERTS model of emotional regulation is a technique using realistic desensitization, and is thought to be useful for children with ASD.