New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Part 2: Support for individuals, families and carers
Part 2
prepared for the experience. Communication
difficulties mean that the individual may not
understand the need for unpleasant and invasive
procedures, such as establishing intravenous
lines. It is important that all health care staff
have education in the special needs of people
with disabilities, including ASD. Occasionally,
sedation or even general anaesthesia may be
required for procedures that could normally be
carried out on fully conscious children or adults.
Dental hygiene and care
Some evidence exists suggesting that the
oral hygiene of some people with ASD is
compromised and that people with ASD have
increased risk of caries and periodontitis 139 . The
only preventative measure recommended in the
literature sourced was providing information
and explanations on good dental hygiene in a
manner suited to people with ASD 139 142 .
Recommendations to manage problems
occurring within a dental consultation include:
• dentists telling their clients what they are
about to do, showing them the procedure,
then doing it, rather than simply doing it
straight off
• using short and clear instructions
• using positive reinforcement
• using sedation or restraint (an appropriate
approved approach by a health professional
with specialist skills) to enable treatment
and avoid more intrusive measures (after
explanation and obtaining written consent)
• organisational changes to the office
139 140 143
and appointment scheduling
(Recommendation 2.3.7).
Sleep disturbance
Research suggests that whilst sleeping problems
are frequent in normally developing children,
children and adults with ASD have significantly
more sleep problems 144-146 . In particular, adults
with ASD appear to have more difficulty
falling asleep, report less sleep and sleep
of poorer quality, feel more drowsy during
the day, are more likely to fall asleep during
free time and need longer periods of sleep at
night 146 . Research has indicated that children
with ASD exhibited the same range of sleep
problems as their normally developing peers
(eg, difficulty settling, night waking, early
morning waking, and co-sleeping), but were
more sluggish and disoriented after waking 144 .
Treatment by medication or behavioural sleep
management programmes or both has been
assessed by research studies, but more research
is needed 144 145 (Recommendation 2.3.8, see section
4.4.a). Standard sleep hygiene procedures may
be appropriate to use before medication and
other treatments.
Other health issues
Issues identified in the literature, but about
which no reliable research was found, include
constipation, allergies, medication reactions,
menstruation and need for regular exercise 147-149 .
There are examples in the literature of practical
suggestions for the health care of people with
ASD and advice should also be sought from
suitably experienced health professionals 150
(Recommendations 2.3.9, 2.3.10).
2.3.c Immunisation for children who
have an ASD
Immunisation is an important personal and
public health issue. All the diseases for which
immunisation is offered have the potential
to cause serious illness, disability and death.
A child who is immunised against a disease
is much less likely to contract that disease
than a child who has not been immunised.
Children who have ASD may not cope with
illness as well as their non-disabled peers. In
particular, children with ASD (and their parents)
find hospital admission very distressing.
Immunisation helps to prevent illness.
Some parents feel that they do not need to
get their child immunised, because they
think that disease will be less prevalent in the
community where many other children are
immunised. This is true and is sometimes called
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New Zealand Autism Spectrum Disorder Guideline