Which behaviour guidance technique is generally CONTRAINDICATED for a patient with autism spectrum disorder?

Correct answer: C. Voice control

• A. Positive reinforcement works well and is a foundation of most behavioural programmes for autistic patients.
• B. Visual schedules and social stories are among the most effective tools available, because they make the sequence of events explicit and predictable in advance.
• C. CORRECT. Voice control uses a sudden, sharp change in volume and tone to gain attention. In a patient with the sensory processing differences characteristic of autism, an abrupt auditory change is aversive and frightening rather than attention-directing, and it reliably escalates distress and shuts down cooperation.
• D. Tell-show-do is highly effective here because it is predictable, sequential and removes surprise — exactly what this patient needs.

Note: Practical adaptations that work: same operatory, same team, same time of day; short desensitization visits building up gradually; sunglasses and noise-cancelling headphones for sensory load; minimize the overhead light and suction noise; and ask the caregiver what already works at home, since they have usually solved this before you.