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

(Clip 2)

“D-Termined Program” – Clip 2 Transcript

An example of a dental visit with a young boy with autism, Colin, is shown. The child enters the dental examination room crying and the dental assistant invites the boy to sit in the dental chair. The child’s mother is also present.

Dr. Tesini: This first session represents a very typical first session with a child with autism. Karen, the dental assistant, and the mom are teaching Colin to enter the operatory and sit appropriately in the chair. Let us watch more of that first session with Colin. We’ll speed up some of the sections in the interest of time.   

More footage from the example of a dental visit with the same young boy, Colin, is shown.

Colin: Up?

Karen: Yup. Come on up. Okay, big guy, sit in my chair. Now sit. Can you sit up? Colin, can you sit up?

Colin: I want to get down. I want mommy.

Colin begins to cry.

Karen: No. Sit up like a big boy. Sit up. Sit back down. How’s that? Put your legs out. Come on, big guy. Ok here now. Listen, Colin. Do you want to go down?

Colin climbs up into the dental chair and lies down, and the dental assistant attempts to get the child to sit up in the dental chair, but the patient is reluctant and wants to get down. He begins crying and kicking his legs in resistance. The video is then switched to fast-forward mode in the interest of time and we see the child get out of the chair and walk towards his mother who is seated beside the dental chair.

Dr. Tesini: You will see that it takes a good dose of patience to repetitively work with the child until he starts to get the hang of it and what is being asked of him. But the effort is well worth it. This footage is good representation of the first step of the D-Termined program. And that we have divided the skill into just the first step of coming into the operatory and being seated. We stay with that until the child can reliably repeat that step when he comes in for a visit. Once the child has mastered the first step, then we move onto the next step and subsequently to the next step until the child is able to accept all of the specific procedures that are involved. At each step of the learning curve, it’s important that we demonstrate the skill. Usually, when we say this, we mean that we are going to get help from the dental professional, the dental assistant or the dental hygienist but in this particular case we got some help from Colin’s older brother who also is diagnosed with an autistic disorder and had completed the familiarization repetitive tasking of the D-Termined program.

A scene from Colin’s visit to the dental office accompanied by his brother, Sean.

Dr. Tesini: Attaboy!

Sean: Barney!

Mother: Now how do you put your head back?

Dr. Tesini: Put your head back and show him how you put your feet out straight, Sean!

Sean sits back into the dental chair.

Mother: Put your feet out straight, Sean.

Dr. Tesini: Put your feet out straight and hands on your tummy. Do you remember?

Dr. Tesini assists Sean with putting his feet out straight while sitting in the dental chair.

Mother: Where do your hands go, Sean?

Sean: On.

Dr. Tesini: Where do your good hands go? Attaboy! Look Colin!

Dr. Tesini assists Sean with putting his hands on his tummy while sitting in the dental chair.

Mother: Oh Sean, do you have your hands on your tummy?

Dr. Tesini: And watch, can we show. Let’s show Colin how we go back.

Dr. Tesini reclines the dental chair back.

Dr. Tesini: Look Colin! And watch how he goes up!

Dr. Tesini brings the chair back to the upright position.

Dr. Tesini: And look, he keeps his feet out straight and his hands on his tummy.

Mother: He’s a good boy. Oh Sean!

Interviewer: So, the next step is to drill the skill. Now can you explain that one to us?

Dr. Tesini: It simply means that the patient will repeat the skill over and over again until they have mastered it. I think the film will speak for itself.

Footage from a dental visit with a young boy is shown.

Dr. Tesini: Look at me. Put your head back. Attaboy! And remember the mirror? Do you remember the mirror? Put your hands on your tummy. Hands on your tummy. Attaboy! Look at the mirror.

The boy resists and sits up.

Dr. Tesini: Okay? Good job! Can we put our head back in the pillow? Attaboy. Can you put your head all the way back and hands on your tummy? Good. Hands on your tummy! Very good!

Father: Good job, buddy.

The boy climbs out of the chair.

Dr. Tesini: Okay let’s try it again. Okay?

The boy climbs back into the dental chair.

Father: All right! You’re being brave! That’s good.

Dr. Tesini: Okay? Put your head all the way back.

Karen: Legs out straight.

Dr. Tesini: Hands on your tummy.  Open up real big for me. Big big big. 1. 2. Open up real big 3.4.

Karen: Open buddy open so you can be done. C’mon buddy, open.

Dr. Tesini: 5.6.7. Open up real big.8.9 and 10. Hands on your tummy. Very good!

The child begins to cry.

Father: Good job, buddy. You did great.

The child climbs down from the chair. The child climbs back into chair.

Dr. Tesini: One more time. All right. Ok, here we go. Let’s count your teeth. Open up real big. Can you say ahhhh?

Child: Ahh.

Dr. Tesini: Open up real big. Can you open? Look at me. Open up real big. Big big big. Open up real big.

The child starts to scream.

Father: He follows instruction if you say, “do this” and then show him what to do.

Dr. Tesini: Okay. Hey Brent, can you do this?

Dr. Tesini opens up his own mouth wide. The child opens his mouth and says “Ahh.”

Dr. Tesini: Good boy! Can you do this? Look at me. Look at me. Do this.

Dr. Tesini opens up his own mouth wide.

Child: Ahh.

Dr. Tesini: Good.

Father: More ahh, Brent.

Dr. Tesini: More ahh. Do this. Ahh. 1.2.3. All right. That’s right. Great job. 8.9. Oh we’re doing terrific. Open up real big. Ahh. Ahh. Attaboy! Hands on your tummy.

The child starts to cry.

Karen: It’s okay, Brent.

Father: Good boy.

Dr. Tesini: Look at me, Brent. Open up real big, like this.

Child: Ahh.

Dr. Tesini: Open up real big, like this.

Child: Ahh.

Dr. Tesini: Attaboy! Open up real big.

Father: Ahhh.

Karen: Hands down.

The child starts to cry.

Father: Doing good, Brent.

Karen: Doing awesome.

Dr. Tesini: Now wait, can you stay right there in the chair? Look at me. Put your head back. Put your feet out straight.

The child begins kicking the chair and crying.

Dr. Tesini: Look at me. Hey Brent. Brent. Look at me. We’re all done, look at me, but we’re gonna sit up now. Hold on tight. Look at me. Look at me. We’re going to put the chair up. Okay? Feet out straight. Attaboy. Good job!

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