Autism and the dental experience - Parent/Carer Questionnaire
please click the green 'ok' after each response

Question Title

* 1. The following questions relate to your observations and experiences in relation to supporting an individual who has autism, when considering/attending dental services.

Have you attended a dental visit with an individual who has ASD?
Please check the appropriate boxes below.

Yes - General dentist

Yes - Special Needs dentist

Yes - Public

Yes - School Dental

Yes - Private

Yes - Local

Elsewhere - please specify.

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* 2. If you have not attended a dental visit with an individual who has ASD whom you care for, are there specific barriers which prevent you form attending dental services with that person?

No.

Yes - Unsure of services

Yes - Patient anxiety

Yes - Carer anxiety

Yes - Transport

Yes - Cost

Yes - Previous negative experience

Yes - Concern regarding management of individuals' behavioural issues

Yes - Embarrassment

Other (please specify)

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* 3. What is the furthest you have had to travel (one way) for dental treatment with a person who has ASD?

Check one box.

Nil Travel

0 - 10 minutes

10 - 30 minutes

30 - 60 minutes

More than 1 hour

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* 4. Have you received supports that have assisted you in attending dental services for the person with ASD that you care for (for example - appointment times suited to your needs, medical history questionnaire sent out and returned before the appointment, a short wait in the waiting room before the appointment, a quiet waiting area, adapted/or separate waiting area, well trained staff, re-assuring staff, pre-prepared social stories or visual aids)?

Yes

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* 5. The following questions relate to oral healthcare/hygiene.

Have you used specific resources to help people with ASD with oral care? For example, custom-designed toothbrushes, herbal lollipops, interdental cleaners, probiotics.

Yes

If Yes, please list

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* 6. Does the individual with ASD you care for receive, or participate in, any tooth brushing?

No.

Yes - Once daily

Yes - Twice daily

Yes - Weekly

Yes - Monthly

Other - please describe

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* 7. Does the individual with ASD you care for receive, or participate in any rinsing or other techniques for oral health?

No.

Yes - Rinsing with water.

Yes - Rinsing with salt water.

Yes - Bathing with swabs (e.g. glycerine)

Yes - Wiping teeth/mouth with a damp face washer.

Yes - Chewing sugarless gum.

Please describe the frequency that this occurs.

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* 8. Does the individual with ASD you care for receive, or participate in dental flossing?

No.

Yes - Daily

Yes - Weekly

Yes - Monthly

Other - please describe.

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* 9. Have you had support from any health/allied health care workers in relation to oral care/hygiene for the person with ASD you care for? (eg social stories, scripts)

Please check as many boxes as relevant.

Dental Professional

Occupational Therapist

Speech Therapist

Nurse

General Practitioner (Doctor)

Paediatrician

School (Health Educational Programs)

No support has been received

Other (please specify).

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* 10. If you have never supported a person with ASD at a dental appointment you have now completed the survey and we thank you for your participation. Please go to the end of the survey and press Done.

The following questions are for carers who have supported a person with ASD at a dental appointment.

In your experience, do you feel that dental care has been tailored to suit the needs of the person with ASD you are supporting?

Yes

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* 11. What supports have you received from the dental provider for the person with ASD, with regards to preparation and arrival for a dental appointment.
select the relevant box(es)

Relevant medical history questionnaire sent out and returned before the appointment

discussion with the dental provider/receptionist to discover the individual needs before the actual appointment

Introductory desensitizing appointment

Quoting for Initial treatment

Offer of payment plan for further treatment

option of follow up phone call for further appointments

Preferred time for scheduling of appointments ( eg. morning)

low light in the waiting room

provision of an alternative or separate waiting room

Quiet waiting area

sample show-bag (Including touch feel items such as mask, gloves, dental mirror, cotton rolls, gauze, generalized social story)

personalized visual aids/social stories

Well trained and non judgmental staff

reassuring staff

Effective communication skills from staff

None of the above supports have been offered

Other (please specify)

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* 12. If supports were offered, please select the ones you found helpful, with regard to preparation and arrival for a dental appointment.

Relevant medical history questionnaire sent out and returned before the appointment

discussion with the dental provider/receptionist to discover the individual needs before the actual appointment

Introductory desensitizing appointment

Quoting for Initial treatment

Offer of payment plan for further treatment

option of follow up phone call for further appointments

Preferred time for scheduling of appointments ( eg. morning)

low light in the waiting room

provision of an alternative or separate waiting room

Quiet waiting area

sample show-bag (Including touch feel items such as mask, gloves, dental mirror, cotton rolls, gauze, generalized social story)

personalized visual aids/social stories

Well trained and non judgmental staff

reassuring staff

Effective communication skills from staff

none of the above supports were helpful

Other (please specify)

Question Title

* 13. The following questions relate to challenges you have experienced when arriving at a dental clinic (reception/waiting room), in relation to the person with ASD you are caring for and their responses.

What have you found challenging on arrival at a dental clinic?
Select the relevant box(es)

Time of day

Getting the person with ASD from your vehicle through the front door

Bright lighting

Noise

Number of people in the waiting room

Carer anxiety about how the individual with ASD will respond

Communicating effectively between staff and person with ASD

Staff's level of understanding, and their responses to a person with ASD

Communication/behavior issues

Dealing with an unpredictable environment

managing the person with ASD's mood and reactions

Carer embarrassment /anxiety

Helping the person with ASD to sit/wait for long periods

Rushed environment (Not enough time allocated)

Other (please specify)

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* 14. The following questions relate to the challenges you may have experienced when supporting the person with ASD to receive their dental treatment

What have you found challenging when supporting the person with ASD to receive their dental treatment?
Select the relevant Box(es)

Rushed environment(not enough time allocated)

Not feeling in control (e.g. discomfort in asking for regular breaks or indicating the person with ASD is not coping and behavior may escalate).

Compliance ( getting the person with ASD to co-operate)

Concerns about the person with ASD touching the equipment

Unusual reactions to the environment by the person with ASD

Managing challenging behaviors of the person with ASD

Carer anxiety about the person they care for coping with dental treatment

Management of meltdowns

Responding to escapism

Trusting staff's ability to understand and respond to carer's advice on best management practices.L

Lack of opportunities to communicate between staff and the person with ASD

Trusting staff to best manage the individuals needs

Safety concerns for all involved

Uncertainty about the qualifications and experience of the dental staff

Completion of intended treatment. (e.g. What happens if issues arise and a filling is 1/2 done)?

Concerns for the individual with ASD not being able to communicate pain level

Other (please specify)

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* 15. Have you experienced the person with ASD you are supporting having a meltdown in the dental setting?

No, go to next question

Yes, if yes what helped?

Ending the appointment

Taking a break

Distraction

Weighted blanket or wrap

Sensory items (e.g. stress ball, Lycra, material etc.)

Deep pressure/Massage

A safe area (e.g. tent enclosed space)

Other (please specify)

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* 16. In the dental chair, have any of the following ever been offered by the dental staff to support, comfort and ease anxiety of the person with ASD
Select the relevant box(es)

Low light

Minimal Noise

Consistent staff

Consistent phrasing/terminology with appropriate tone of voice

Establishing a rapport

Social stories

Visual aids/ schedules

Sensory items to hold (e.g. stress ball, Lycra material)

Sunglasses

Tight fitting hat

Weighted blanket, wrap, lead apron

None of the above have been offered

Other (please specify)

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* 17. Has the person with ASD received any of the following dental related supports/pain management when receiving dental treatment?
Select the relevant box(es)

Local anaesthetic

Sedative (Valium or anti-anxiety medication-prescribed by the doctor)

Nitrous Oxide (Happy Gas)

Intravenous sedation in the dental chair

General Anaesthetic in a private setting

General Anaesthetic in a public setting

No supports have been used

Briefly describe any positive or negative experiences the person with ASD has had when using these supports

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* 18. Have you had any issues with returning for dental care due to a negative expereince?

Yes, if yes please describe the negative experience

Please describe

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* 19. After receiving dental care, have you had the opportunity to provide feedback regarding your experience which has been used to support more effective further treatment

Yes

Autism and the dental experience - Parent/Carer Questionnaireplease click the green 'ok' after each response

Question Title

* 1. The following questions relate to your observations and experiences in relation to supporting an individual who has autism, when considering/attending dental services. Have you attended a dental visit with an individual who has ASD? Please check the appropriate boxes below.

Question Title

* 2. If you have not attended a dental visit with an individual who has ASD whom you care for, are there specific barriers which prevent you form attending dental services with that person?

Question Title

* 3. What is the furthest you have had to travel (one way) for dental treatment with a person who has ASD? Check one box.

Question Title

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* 5. The following questions relate to oral healthcare/hygiene.Have you used specific resources to help people with ASD with oral care? For example, custom-designed toothbrushes, herbal lollipops, interdental cleaners, probiotics.

Question Title

* 6. Does the individual with ASD you care for receive, or participate in, any tooth brushing?

Question Title

* 7. Does the individual with ASD you care for receive, or participate in any rinsing or other techniques for oral health?

Question Title

* 8. Does the individual with ASD you care for receive, or participate in dental flossing?

Question Title

* 9. Have you had support from any health/allied health care workers in relation to oral care/hygiene for the person with ASD you care for? (eg social stories, scripts)Please check as many boxes as relevant.

Question Title

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* 11. What supports have you received from the dental provider for the person with ASD, with regards to preparation and arrival for a dental appointment.select the relevant box(es)

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* 12. If supports were offered, please select the ones you found helpful, with regard to preparation and arrival for a dental appointment.

Question Title

* 13. The following questions relate to challenges you have experienced when arriving at a dental clinic (reception/waiting room), in relation to the person with ASD you are caring for and their responses.What have you found challenging on arrival at a dental clinic?Select the relevant box(es)

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* 14. The following questions relate to the challenges you may have experienced when supporting the person with ASD to receive their dental treatmentWhat have you found challenging when supporting the person with ASD to receive their dental treatment?Select the relevant Box(es)

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* 15. Have you experienced the person with ASD you are supporting having a meltdown in the dental setting?

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* 16. In the dental chair, have any of the following ever been offered by the dental staff to support, comfort and ease anxiety of the person with ASDSelect the relevant box(es)

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* 17. Has the person with ASD received any of the following dental related supports/pain management when receiving dental treatment?Select the relevant box(es)

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* 18. Have you had any issues with returning for dental care due to a negative expereince?

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* 19. After receiving dental care, have you had the opportunity to provide feedback regarding your experience which has been used to support more effective further treatment

Autism and the dental experience - Parent/Carer Questionnaire
please click the green 'ok' after each response

* 1. The following questions relate to your observations and experiences in relation to supporting an individual who has autism, when considering/attending dental services.

Have you attended a dental visit with an individual who has ASD?
Please check the appropriate boxes below.

* 3. What is the furthest you have had to travel (one way) for dental treatment with a person who has ASD?

Check one box.

* 5. The following questions relate to oral healthcare/hygiene.

Have you used specific resources to help people with ASD with oral care? For example, custom-designed toothbrushes, herbal lollipops, interdental cleaners, probiotics.

* 9. Have you had support from any health/allied health care workers in relation to oral care/hygiene for the person with ASD you care for? (eg social stories, scripts)

Please check as many boxes as relevant.

* 11. What supports have you received from the dental provider for the person with ASD, with regards to preparation and arrival for a dental appointment.
select the relevant box(es)

* 13. The following questions relate to challenges you have experienced when arriving at a dental clinic (reception/waiting room), in relation to the person with ASD you are caring for and their responses.

What have you found challenging on arrival at a dental clinic?
Select the relevant box(es)

* 14. The following questions relate to the challenges you may have experienced when supporting the person with ASD to receive their dental treatment

What have you found challenging when supporting the person with ASD to receive their dental treatment?
Select the relevant Box(es)

* 16. In the dental chair, have any of the following ever been offered by the dental staff to support, comfort and ease anxiety of the person with ASD
Select the relevant box(es)

* 17. Has the person with ASD received any of the following dental related supports/pain management when receiving dental treatment?
Select the relevant box(es)