Brushing teeth has always been a huge demand for Little Miss M, one which causes a great deal of extreme demand avoidance. A short 90 second task, which a great deal of us do without any difficulty or thought, has her anxiety and fight, flight or freeze mode going through the roof because it is something we are told we MUST do each and every day and with PDA, MUST is something the brain fears. When PDA wasn’t on our radar, we tried sticker charts and rewards and we told her the reality of what would happen if she didn’t look after her teeth and although she clearly didn’t want to have unhealthy teeth and wanted to keep them clean, she just couldn’t bring herself to brush them, even once a day, let alone twice and if pushed her anxiety would escalate quickly. Little did we know that we were making it an even bigger demand for her by doing these things as she felt huge expectations from us to comply. It’s been the cause of a lot of worry and stress for us as parents and the cause of a lot of stress and anxiety for her. I thought I’d share with you though what has helped us to delicately balance the need for her to have healthy teeth against the anxiety and demand avoidance teeth brushing causes her…
We’ve tried every type of toothbrush going and have found an Oral B round head electric toothbrush has the most success, not only because Little Miss M likes that it does the brushing part but because the brush area is small and touching less of her teeth than a manual one (as sensory sensitivity plays a part in her avoidance too).
Another hurdle we had to overcome was the taste of the toothpaste. She has a very limited diet and rarely eats strong flavours and disliked the taste of mint from the beginning. We’ve tried a variety of different flavours and she found them all to be too strong in taste for her. She now uses OraNurse unflavoured, non-foaming toothpaste and this has made such a difference to her ability to tolerate teeth brushing.
We do whatever we can to distract her from the fear of the demand to brush her teeth so avoidance can be bypassed. At the moment we listen to her choice of pop song while she and I brush together and that is proving to be quite a good distraction. We have to change it up all the time though when novelty wears off. We’ve role-played dentists or other scenarios of her choice where I brush her teeth, I’ve told her stories while she brushes, I’ve done funny voices, made up silly songs, we’ve pretended we’re on a quest and teeth brushing is a task we need to complete to fulfil the quest, we gave the toothbrush a name (Mrs Toothbrush) and personality and I did its voice and asked her questions about her day while brushing (she formed quite a bond with Mrs Toothbrush who even came on days out with us for a while), we’ve watched TV while brushing, brushed in every room of the house, had a favourite toy do the brushing, brushed without toothpaste for a time, all sorts of things which appeal to her and distract her from the fear response her brain has to the demand. We re-visit some of them now and again too as they can work again after a while of not doing them. She still negotiates and it can take rather a long time to get the task done and there are often days when she is completely avoidant but doing something fun to distract her is her best chance of being able to brush her teeth, along with us remaining patient and flexible.
We also only aim to brush teeth once a day but don’t insist she does it when anxiety is really high or when a distraction doesn’t work and demand avoidance escalates (we may return and try again later but we remain flexible). We don’t have a set time it has to be done, nor do we make it something which has to be done before going out or going to bed as it was preventing us from leaving the house and going to bed. It’s just something that is done at some point in the day if we can and we’ve found this reduces how big a demand it feels.
It can still be hard not to stress over, when we’ve had a run of difficult days and not managed it, but I try not to otherwise she feels my stress and it becomes an even bigger demand and her avoidance becomes stronger. We’re fortunate that Little Miss M will visit the dentist so we make sure she has regular check-ups which help to ease my worry.
I hope this has been helpful and given others some ideas to try around this incredibly difficult every-day task. Do you have any teeth brushing tips or ideas not mentioned? If so, feel free to add them to the comments as it’s great to have more strategies in our pockets, ready to try.
Notes on PDA 