歯科診療時における自閉症スペクトラム児の個々の特性に合わせた対応

Individualized Support Based on Characteristics of Patients with Autistic Spectrum Disorder in Pediatric Practice

平田 涼子

海原 康孝

三宅 奈美

櫻井 薫

光畑 智恵子

天野 秀昭

香西 克之

小児歯科学雑誌

自閉症スペクトラム障害(Autism Spectrum Disorder以下ASD)の小児には,知的障害の有無に関わらず整理統合が困難で視覚優位である者が多い。また,ASD児の能力には個人差があるため,支援者は障害特性に配慮した個別対応が要求される。ところが,歯科診療時におけるASD児の対応法に関する情報はいまだ不十分である。

そこで,当科にて歯科診療時に行ったASD児への個別対応のうち効果的であったものを報告する。

症例1 初診時2歳11か月,男児,高機能自閉症・AD/HD(注意欠如・多動性障害)
この患児は,3歳時既に全ての干仮名と数字が読めた。そこで,診療に対する混乱の除去のため,文字情報で予定を可視化した(Word Schedule)。予定の最後を「ごほうび」と記し、強化子として患児の好きなキャラクターの塗り絵を使用した。

症例2 初診時6歳11か月,男児,白閉症(知的障害を伴う)
絵カードを予定の順に並べ(予定の構造化),入室前に患児へ見せた。治療のステップが1つ終わる度に,褒め言葉と同時に○のサインボードを見せた。これは,言葉だけでなく視覚的にもできたことや褒められたことを認識できるようにするための援助である。

以上の対応により,スムーズに診療が行えた。このように,ASD児の歯科診療の際には,個々の発達レベルや行動を十分に観察した上で個別化された支援方法により対応することが有効と考えられた。

Many children with autistic spectrum disorder (ASD) and with or without intellectual disability have weak central coherence and a tendency to learn in a visual manner. Because of individual differences in the developmental status of ASD children, personalized support is optimal. However, there is scant published information about methods for providing individualized support in dental practice for children with ASD. Here, we describe effective strategies for providing individualized support in dental practice for children with ASD treated at our clinic.

Case 1 : Boy, aged 2 years 11 months, with high-functioning autism and AD/HD
This child was able to read hiragana letters and numerals at the age of 3. Therefore, we showed him information about the clinical procedures (Word schedule) to remove emotional confusion about dental practice. We noted "reward" in red to give him a clear concept of the finish. The reward was included as a "reinforcer" and we used a drawing of his favorite cartoon character.

Case 2 : Boy, aged 6 years 11 months, with autism and intellectual disability
Picture cards portraying the events of the dental procedures in sequential order were shown to the child prior to and during therapy, with the picture card for each event removed when that step had been completed and a signboard with a red circle containing words of praise shown to the child. Thus, he received praise visually as well as through verbal encouragement. We also showed the child a timer that counted down the seconds until the procedure would be completed.

Using these approaches, we were able to successfully facilitate dental treatments for children with ASD. It is clear that an individualized method, generated by assessing the development and behavior of each child, is advantageous for providing support of children with ASD.

自閉症スペクトラム障害

歯科診療

症例

Autistic spectrum disorder

Dental treatment

Case study

医学 [ 490 ]

日本語

日本小児歯科学会

Copyright (c) 2014 Authors, 日本小児歯科学会

[ISSN] 0583-1199

[NCID] AN00116228