Visual Schedule System in Dental Care for Patients with Autism: A Pilot Study

A pilot study to test whether a visual schedule system using picture communication symbols can help children with autism have successful routine dental cleaning visits. Study Design: 14 boys with autism between three- to eight-years-old presented to the dental clinic for four weekly consecutive dental appointments. Patients were randomly assigned to either the control group who received the tell-showdo method (i.e., standard of care), or the test group who received the tell-show-do method plus the visual schedule system. Results: Patients in the test group completed an average of 1.38 more steps, at 35.52 seconds per step faster, and with 18.7% lower levels of behavioral distress than those in the control group. Conclusion: The use of a visual schedule system, along with repeated weekly visits, showed some promise in helping children with autism successfully complete more steps, progress at a quicker rate, and exhibit lower levels of behavioral distress within a dental appointment, compared to a traditional tell-show-do approach.

Autism, Visual Pedagogy, Dentistry, Electrodermal Activity.

1. Blomqvist M, Dahllöf G, Bejerot S. Experiences of dental care and dental anxiety in adults with autism spectrum disorder. Autism Res Treat 2014:238764, 2014.

2. Brown J, Brown J, Woodburn J. Dental services for children with autism spectrum disorder. Learn Disabil Pract 17(3):20-25, 2014.

3. Stein L, Polido JC, Najera SOL, Cermak SA. Oral Care Experiences and Challenges in Children with Autism Spec... Pediatr Dent 34(5): 387-391(5), 2012.

4. Lai B, Milano M, Roberts M, Hooper S. Unmet Dental Needs and Barriers to Dental Care Among Children with Autism Spectrum Disorders. J Autism Dev Disord 42(7):1294-1303, 2012.

5. Marshall J, Sheller B, Mancl L. Caries-risk Assessment and Caries Status of Children with Autism. Pediatr Dent 32(1):69-75, 2010.

6. Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. Eur Arch Paediatr Dent Off J Eur Acad Paediatr Dent 16(2):205-9, 2014.

7. Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci 19(3):212-217, 2011.

8. Kopycka-Kedzierawski DT, Auinger P. Dental needs and status of autistic children: results from the National Survey of Children’s Health. Pediatr Dent 30(1):54-58, 2008.

9. Hicks CG, Jones JE, Saxen MA, et al. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies. Anesth Prog 59(1):3-11, 2012.

10. Cuvo AJ, Godard A, Huckfeldt R, DeMattei R. Training children with autism spectrum disorders to be compliant with an oral assessment. Res Autism Spectr Disord 4(4):681-696, 2010.

11. Hernandez P, Ikkanda Z. Applied behavior analysis Behavior management of children with autism spectrum disorders in dental environments. J Am Dent Assoc 142(3):281-287, 2011.

12. Loo CY, Graham RM, Hughes CV. Behaviour guidance in dental treatment of patients with autism spectrum disorder. Int J Paediatr Dent 19(6):390- 398, 2009.

13. Ospina MB, Krebs Seida J, Clark B, et al. Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review. PLoS ONE 3(11):e3755, 2008.

14. Mesibov GB, Shea V. The TEACCH Program in the Era of Evidence-Based Practice. J Autism Dev Disord 40(5):570-579, 2009.

15. Doehring P, Reichow B, Palka T, Phillips C, Hagopian L. Behavioral approaches to managing severe problem behaviors in children with autism spectrum and related developmental disorders: a descriptive analysis. Child Adolesc Psychiatr Clin N Am 23(1):25-40, 2014.

16. Schneider N, Goldstein H. Using Social Stories and Visual Schedules to Improve Socially Appropriate Behaviors in Children With Autism. J Posit Behav Interv 12(3):149-160, 2010.

17. Pilebro C, Bäckman B. Teaching oral hygiene to children with autism. Int J Paediatr Dent 15(1):1-9, 2005.

18. Bäckman B, Pilebro C. Visual pedagogy in dentistry for children with autism. ASDC J Dent Child 66(5):325-331, 294, 1999.

19. Isong IA, Rao SR, Holifield C, et al. Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media. Clin Pediatr (Phila) 53(3):230-237, 2014.

20. American Psychiatric Association, American Psychiatric Association, eds. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association, 2013.

21 Schopler E, Van Bourgondien, ME, Wellman, GJ, Love, SR. Childhood Autism Rating Scale, Second Edition. Western Psychological Services, 2010.

22. Blount RL, Bunke V, Cohen LL, Forbes CJ. The Child-Adult medical procedure interaction scale- short form (CAMPIS-SF): Validation of a rating scale for children’s and adults’ behaviors during painful medical procedures. J Pain and symptom management 22: 591-599, 2001.

23. Fletcher RR, Tam S, Omojola O, Redemske R, Kwan J. Wearable sensor platform and mobile application for use in cognitive behavioral therapy for drug addiction and PTSD. Eng Med Biol Soc 2011 Annu Int Conf IEEE 1802-1805, 2011.

24. Marques AH, Silverman MN, Sternberg EM. Evaluation of stress systems by applying noninvasive methodologies: measurements of neuroimmune biomarkers in the sweat, heart rate variability and salivary cortisol. Neuroimmunomodulation 17(3):205-208, 2010.

25. Orellana LM, Martínez-Sanchis S, Silvestre FJ. Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach. J Autism Dev Disord 44(4):776-785, 2014.

26. Leaf RB, McEachin J. A Work in Progress: Behavior Management Strategies and a Curriculum for Intensive Behavioral Treatment of Autism. New York: DRL Books, 1999.

27. Abdulla AM, Hegde AM. Salivary Cortisol Levels and its Implication on Behavior In Children with Autism during Dental Treatment. J Clin Pediatr Dent 39(2):128-132, 2015.