The Effects of Video-Modeling on the Oral Hygiene of Children with Autism: A Promising Paradigm

Friday, May 13, 2016: 10:00 AM-1:30 PM
Hall A (Baltimore Convention Center)
M. Mademtzi1, B. Popple2, C. A. Wall1, L. Flink3, J. Dikansky4, D. Do4 and F. Shic1, (1)Yale Child Study Center, Yale University School of Medicine, New Haven, CT, (2)White Oak Pediatric Dentistry, Newnan, GA, (3)Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, (4)Yale New Haven Hospital, New Haven, CT
Background:  Oral health is important for a person’s general health as well as psychological wellbeing. However, individuals with autism often face difficulties with their self-care skills and therefore there is a need for improved dental hygiene routines for these individuals (Pilebro & Backman, 2005).  One promising method to achieve this is through the use of video-modeling. Video-modeling is an evidence-based intervention that has various areas of application including self-care skills (e.g. Charlop-Christy, Le & Freedman, 2000; McLay, Carnett, van der Meer & Lang, 2015).

Objectives:  The objective of this study was to investigate whether video-modeling can be an effective method for children with autism to learn how to brush their teeth.

Methods:  A pilot study was conducted with eight children diagnosed with autism recruited from a pediatric dental clinic (Mage= 8.75 years). Assessments included clinical examinations and survey data completed by the children’s caregivers. Additionally, the Social Responsiveness Scale-2, Parent Report (SRS-2; Constantino & Gruber, 2002) was also completed. Participants were randomly assigned to either the experimental (N=4; 3 boys and 1 girl) or control (N=4; 2 boys and 2 girls) group.  Parents received a link twice a day for three weeks prompting them to watch a video with their child before tooth brushing. The experimental group watched a video of a girl brushing her teeth with spoken instructions and the control group watched a video with moving fractal shapes and with symbolic background music (demo).

Results:  Before the intervention both groups had visible plaque and did not differ in dental hygiene as measured by plaque index results (Cohen’s d= 0.14). After the intervention the experimental group showed greater improvements in the same measures compared to the control group (Cohen’s d= 1.17). The survey data completed by the children’s parents revealed a significant increase of oral hygiene for the control group (Cohen’s d= 2) but no differences for the experimental group (Cohen’s d= 0). Also, low correlation was found between autism severity and SRS-2 scores with plaque index results (r=0.22 and r=0.11 respectively).

Conclusions:  Although this study was conducted with a small number of participants, it holds a great potential for future applications on children’s with autism oral hygiene. Future directions should include larger sample sizes, greater selection of videos (e.g. different languages, gender of the children actors) and also participants with various cognitive skills levels. The current study involved higher functioning children with autism that they might not deal with the same self-care skills difficulties as lower functioning ones. Results from the current study will help us inform the next steps of the video-modeling for oral hygiene.  Our aim is to make the videos applicable to a larger number of participants, with different cognitive and cultural backgrounds and also make them more easily accessible by caregivers, practitioners and individuals with autism themselves. A prototype of this new system will be presented.