Orthodontic treatment feasibility in adults with neurodevelopmental disorders: a case series highlighting interdisciplinary communication challenges

As more adults with neurodevelopmental disorders seek orthodontic treatment, clinicians increasingly face questions about treatment feasibility. Although psychiatric stability is often used to judge whether treatment can proceed, this alone may not predict whether patients can tolerate the long-term sensory, behavioral, and communication demands of orthodontic care. This case series is novel in focusing on adults for whom psychiatrists identified no psychiatric contraindication to treatment, yet neurodevelopmental characteristics and limited information sharing between psychiatrists and orthodontists led to major difficulties before or during early treatment. We report three adults with neurodevelopmental disorders who sought orthodontic treatment. Case 1 was a 20-year-old woman with attention-deficit/hyperactivity disorder who desired esthetic improvement. Although treatment was initiated, sensitivity to bodily and sensory change and fluctuating consent regarding tooth extraction led to repeated revisions of the treatment plan and delayed progress. Case 2 was a 31-year-old man with depressive disorder and attention-deficit/hyperactivity disorder who sought rapid treatment, partly because he believed his malocclusion was related to sudden hearing loss. Despite repeated explanations and treatment planning, inconsistent preferences, poor attendance, and loss of follow-up prevented treatment initiation. Case 3 was a 33-year-old woman with attention-deficit/hyperactivity disorder, autism spectrum disorder, and depressive symptoms who requested transfer of care. Difficulties in shared understanding, abrupt changes in preferences, irregular attendance, and restricted information sharing made agreement on treatment impossible, and care was terminated without starting orthodontic treatment. These cases suggest that a favorable psychiatric opinion alone may not establish orthodontic treatment feasibility in adults with neurodevelopmental disorders. The orthodontist remains responsible for the final decision about treatment indication and initiation. Structured, role-specific information sharing, staged decision-making, and repeated review may reduce misunderstandings and avoidable treatment interruption; however, these approaches require prospective evaluation.