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"D-Termined Program of Repetitive Tasking and Familiarization in Dentistry"

(Clip 1)

“D-Termined Program” – Clip 1 Transcript

Dr. Tesini: The thing about the D-Termined program that is new and helpful is that it teaches children with autistic disorders cooperation skills so once these skills are learned and mastered, they will be able to receive dental treatment in the private dental environment.

Interviewer: I see. Now, how did the program get the name “D-Termined?”

Dr. Tesini: It comes from a belief of mine that if the dentist, the parent, and the caregiver are determined to be successful, then we are going to succeed and the child will be able to accept dental treatment in our own private office. Some of my most respected colleagues have taught me that the most important thing in treating any patient is to be determined to succeed.

Interviewer: I see. So it was just too tempting not to call it the “D-Termined” program.

Dr. Tesini: That’s correct. Further to the question on where it came from, you’ll also notice that all the steps in this program begin with a “D” and so the “D-Termined” in terms of being successful and the “D” in terms of all the steps of the program, you’ll see how that will unfold later on.

Interviewer: Well, tell us more about the program.

Dr. Tesini: Well why don’t we come this way? The first step that I would like to show you is that there is a pre-treatment assessment form that we use that we ask the parents to fill out. So why don’t you come with me?

Interviewer: Ok great. Thank you.

Interviewer and Dr. Tesini walk away. The next scene begins with them standing at a reception desk looking over a pre-treatment assessment form.

Dr. Tesini: This pre-treatment assessment form is the means by which we gather information about what the problem is and also to find out a little bit about what motivates and rewards the child. We will use this information to tailor the program specifically for that individual. There is one other aspect to the paperwork and that is the form that we are able to document the learning and the progress of the patient from visit to visit. What this form will do is that it will allow us to take all the steps in the D-Termined program that we have broken down and follow it from visit to visit. It also will allow us to make suggestions to the parents on what aspects of the behavior they’ll be able to work on in between the appointment from one visit to the other. Before I begin to actually describe the sequence of how the program is implemented, I’d like to comment on the three most important elements of the program. You will notice these elements throughout the videos that we will see today. The first is eye contact, eye contact with the patient. If I can get a patient to look me in the eye, even if it is only for a brief moment, during the first or second visit, I can be fairly sure that we will be successful with that child.

An example of a dental visit with a young boy, Patrick, is shown. The boy is crying, is out of the dental chair, and noncooperative. Dr. Tesini says to the boy, “Look at me, look at me. You’re doing very good. Can you hop up? We’re almost all done.”

Dr. Tesini: You will hear the words, “Look at me. Look at me.” That is my instruction to the patient so that we can make eye contact. It forces the patient to pay attention and it helps me to establish a relationship with that child. So eye contact is the critical first step. The second is what we call educational modeling. That is to say, we show the patient what will happen in such a way that the patient feels safe. You will hear me say, “Feet out straight, hands on your tummy. Legs out straight. Hands on your tummy.” This is what we call educational modeling.

An example of a dental visit with a young girl is shown. Dr. Tesini says to the girl, “Ok, put your hands on your tummy. Hands on your tummy. Good, we’re going to sit up straight. Put your feet out straight. Mom’s been working on that at home with her. Very good. Hands on your tummy.”

Dr. Tesini: Once the patient is comfortable with that, we move along to the actual procedure and the patient will learn to accept it. The third is using the counting framework. Once I get a child to respond to a request, for example, to open up his mouth or allow me to put the mirror in the mouth, I ask them to hold that position and let me do it for a count of ten. In effect, we are training the child to hold still for a longer and longer period of time.

An example of a dental visit with a young child is shown. Dr. Tesini says to the patient, “Open up real big. and 10. Very good. Can I clean your teeth?”
Dr. Tesini: There are very few dental procedures, if any, that if given 10 second intervals, we are not able to complete.

Interviewer: Can you tell us how you actually implement the program?

Dr. Tesini: There are five steps, Joanna. First, divide the skill. This is the tasking part of the familiarization procedure. The concept is that every skill is broken down into smaller tasks. Second, demonstrate the skill. Many dentists have learned this in dental school and we call it the “Tell, Show and Do” technique. Third, drill the skill. Repetitiveness will help children with autistic behaviors to learn. Next, delight the learner. This can be fun. It should be fun for both the patients and the staff. And in fact, when we’re faced with some children with challenging behaviors, my staff often asks me, “Are we having fun yet?” And finally, delegate the repetition of the skill. Not only can other dental staff members be helpful, but also the parents and the caregivers can work with the patient on these skills.

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