Sensory Adapted Dental Environments: Reducing Distress during Dental Cleanings in Children with Autism Spectrum Disorders

Friday, May 15, 2015: 5:30 PM-7:00 PM
Imperial Ballroom (Grand America Hotel)
S. A. Cermak1, L. Stein1, C. J. Lane2, M. E. Williams3, M. E. Dawson4 and J. C. Polido5, (1)Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, (2)Preventive Medicine - Biostatistics, University of Southern California, Los Angeles, CA, (3)University Center for Excellence in Developmental Disabilities, Keck School of Medicine of USC, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, (4)Psychology, University of Southern California, Los Angeles, CA, (5)Dentistry, Children's Hospital Los Angeles, Los Angeles, CA
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 using 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 (Children’s Dental Behavior Rating Scale) by researchers, (3) child-report of sensory discomfort (Dental Sensory Sensitivity Scale), (4) child-report of pain perception (Faces Pain Scale-Revised), and (5) cost savings as measured by the number of handsrequired 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 settings.