Case Study LH (Tooth Brushing)

LH is an autistic nine year old boy with global developmental delay (GDD).


At the beginning of intervention delivered by Middletown Centre for Autism (MCA), LH was attending an autism specific class within a mainstream school before transitioning to a learning support class within the same school.

LH was initially referred to MCA due to high levels of anxiety, difficulties in the management of attention, focus and concentration and complex sensory needs.  At the time of referral, a range of behaviours of concern included:

  • avoidance of work demands
  • easily distracted from tasks
  • limited communication with adults
  • little or no communication and interaction with peers
  • frequent engagement in sensory seeking
  • avoidance behaviours/escaping and not engaging during sensory breaks.

Sensory Processing Assessment and Analysis

Prior to conducting assessments, observations of LH were carried out at home and school.  This was followed by a Sensory Profile (Dunn, 1999) assessment which was completed with LH’s parents and teacher.  Analysis of this assessment’s responses paired with observations showed that LH presented with a mixed profile of sensory over-responsiveness, sensory under-responsiveness and sensory seeking.

This case study will focus on LH’s sensory over-responsiveness in relation to the personal hygiene routine of teeth brushing.

LH’s mum had reported that it was becoming increasingly difficult to engage LH in brushing his teeth. Each night, LH would seek to escape from this task, often running from room to room.   This would eventually end after an extended period with LH getting his teeth brushed in the living room.  LH’s difficulties with this hygiene routine indicated a hypersensitivity to tactile input along with both gustatory and olfactory defensiveness.


Use of strategies to help support LH included:

  • Use of a Dr. Barman’s toothbrush, a 3 headed brush which simultaneously cleans all surfaces of the teeth.
  • Utilisation of a highly preferred taste e.g. strawberry, through the use of strawberry flavoured toothpaste.
  • Relocation of where teeth were brushed to the bathroom in order to provide context and concrete visual cues that this is what should happen in the bathroom.
  • Provision of a seat in the bathroom to facilitate teeth brushing as mum reported that LH found getting his teeth cleaned/looked at easier when he was sitting in the dentist chair with his head tilted back.
  • Provision of visual supports such as First/then and provision of a highly motivating object or activity to follow engagement in brushing teeth e.g. LH liked to play games/watch videos on his iPad, play with superhero mini characters, receive surprise eggs and engage in recycling activities.
  • Use of Brush DJ app to visually signal when teeth brushing would be finished and to also provide a motivating element of music throughout. LH loved to listen to Johnny Cash music (this was amended to allow LH to hold his iPad and listen to Johnny Cash music while getting his teeth brushed as opposed to using the Brush DJ app as LH responded better to this).