Background: Many children with autism spectrum disorder (ASD) have poorer oral health and greater oral care challenges compared to typically developing (TD) children. Prior research suggests these challenges are associated with sensory over-responsivity which may lead to distressing oral care experiences and discourage parents from bringing their child with ASD to the dentist for regular check-ups. Objectives: It is important to identify innovative solutions that enable dentists to perform standard clinic-based procedures for children with ASD. This study examined the feasibility and pilot tested the efficacy of a sensory adapted dental environment to reduce physiological stress and anxiety, behavioral distress, sensory discomfort, and perception of pain during dental cleanings for children with ASD. Methods: Participants were 44 children (n=22 ASD, 22 typical) ages 6-12 years. In an experimental crossover design, children underwent two dental cleanings, one in a regular dental environment (RDE) and one in a sensory adapted dental environment (SADE), administered in a randomized and counterbalanced order three to four months apart. Visual, auditory, and tactile stimuli were modified in the SADE. Outcomes included: (1) physiological stress and anxiety measured by electrodermal activity, a non-invasive way to measure sympathetic nervous system activation; (2) behavioral distress measured by two dentist-report surveys (Frankl Scale and Anxiety and Cooperation Scale) and objective coding of video-recordings of children’s behavior by researchers (Children’s Dental Behavior Rating Scale); (3) child-report of sensory discomfort (Dental Sensory Sensitivity Scale); (4) child-report of pain (Faces Pain Scale-Revised); and (5) cost savings as measured by the number of hands required to restrain children during cleaning. Results: Implementation of the SADE was feasible and accepted by children, parents, and dentists. Intent-to-treat analyses used repeated measures analysis of covariance to test the effect of two factors: dental environment (within) and autism diagnosis (between). The ASD group exhibited greater challenges than the typical group across all measures. SADE:RDE comparisons were all in the hypothesized direction in both groups. Moderate effect sizes were found in the ASD group for physiological distress, perception of pain, sensory discomfort, and number of people required to restrain the child throughout cleaning (d’s=.4-.7). Moderate effect sizes were also found in the typical group for physiological distress and perception of pain (d’s=.3-.5). Behavioral distress measures exhibited small effect sizes in the hypothesized direction in both groups. Conclusions: Enhancing oral care is critical for children with special needs. Using a SADE during routine oral care is feasible and indicates preliminary efficacy for children. The use of sensory adapted environments has potential for use in diminishing distress in children with ASD in a variety of healthcare settings.
Electrodermal activity (skin conductance level) of the first 20 minutes of dental cleanings in the regular and sensory adapted dental environments in (a) one participant with ASD, and (b) one typically developing participant. Note. RDE= Regular dental environment; SADE= Sensory adapted dental environment. Please note that the y-axis scale is different for the child with ASD (intervals of 2µS) and the TD child (intervals of 0.5µS).
Study Outcomes by Group and Condition
Note. RDE= Regular dental environment; SADE= Sensory adapted dental environment; Effect size is calculated for the dental environments within each group, adjusted for order of visit, and are Cohen’s D. For SCL, log values were used for statistics, though averages of raw values by minute are presented here. Number of hands was not applicable to the TD group, as only 1 child required restraining hands during treatment.
Study Outcomes by Group and Condition
Note. RDE= Regular dental environment; SADE= Sensory adapted dental environment; Effect size is calculated for the dental environments within each group, adjusted for order of visit, and are Cohen’s D. For SCL, log values were used for statistics, though averages of raw values by minute are presented here. Number of hands was not applicable to the TD group, as only 1 child required restraining hands during treatment.
Comments