Tuesday, May 17, 2011

Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism

Meghan Sullivan Walsh May 17, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism

Authors: Jennifer Marshall, DDS, MSD; Barbara Sheller, DDS, MSD; Lloyd Manci, PhD; Bryan J. Williams, DDS, MSD, MEd

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 30, 5, Sep/Oct 08, pages 400-407.

Major Topic: Evaluating autistic parents’ ability to predict dental treatment cooperation and their attitude regarding behavior guidance techniques or (BGT).

Overview of Method of Research: Autistic children from a hospital, dental school and private practice were recruited for this study between 2003 to 2004. Prior to the child’s treatment at the next appointment parents were asked to predict what treatment would be accomplished and whether certain coping strategies would be effective. Post operatively another survey was handed to the parents regarding their acceptability of certain BGT’s and to rank their own anxiety at the dentist.

Findings: 85 Autistic children were analyzed with a mean age 9.6. The majority of the patients were from educated parents and most were treated for preventative recall (56%). Parents accurately predicted their child would allow for an examination (88%) and cooperate for radiographs (84%). However, they tended to overestimate their child’s willingness to cooperate regarding prophylaxis and fluoride treatment (54%) The parents did not differ before of after treatment on the efficacy of a particular BGT. 54% of parents also rated all BGT’s acceptable, basic BGT more acceptable than advanced. Protective stabilization acceptance were as follows; parental restraint (84%), staff restraint (63%), stabilization device (54%.) Dentists rated distraction (86%), frequent breaks (81%) and rewards (80%) the top three more effective BGT’s. When BGT’s were used, parents showed greater acceptability and efficacy post operatively. Parental opinion was also positive towards tell show do, mouth props, rewards, frequent breaks, parental restraint and hand-holding by a staff member.

Key Points: Summary: An important difference in this study to other studies on BGTs is that prior to the appointments, parents had consented and understood the methods of strategies and may have seen these methods already used on their children. The parents were overwhelmingly positive towards the many techniques and their efficacy. This is important to note that when parents are familiar to a particular technique or method before hand they are more willing to accept and act favorably towards the appointments. Interesting to note 92% were in favor of stabilization devices when they were directely involved in the care of their child. These finding emphasize the importance of informed consent and the positive impact it has on parental acceptance. Four major points were concluded for familial acceptance: 1) family involvement, 2) highly supportive and structured environment, 3) Predictability and routine, and 4) Functional approach to problem behaviors.

Assessment of the Article: Good clean research study. Would have liked to see parental attitudes towards BGT methods during more stressful appointments like operative, emergency, and GA. I do agree that having parents actively involved in the care and well aware of what is going on in the room, will save the clinician from potential miscommunications and misunderstandings regarding dental treatment.

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