Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism

Author(s): Jennifer Marshall DDS MSD, Barbara Shelles DDS MSD, Lloyd Manci PhD, Bryan J. Williams DDS MSD MEd
Journal: Pediatric Dentistry
Volume (number): Vol 30 #5
Month, Year: Sep/Oct 2008
Major topic: Parents ability to predict their autistic childs behavior in the dental chair and their reaction to behavior guidance techniques
Type of Article: Observational Study and Survey

Overview of method of research: Parents of autistic children were asked to predict what procedures they thought that their child could undergo, as well as whether certain coping strategies would help their child. Parents were then surveyed as to the acceptability of a variety of behavior guidance techniques (BGT’s) including: basic behavior guidance, tell-show-do (TSD), voice control, nonverbal communication, parental presence/absence, nitrous oxide/oxygen and advanced behavior guidance (protective stabilization, sedation, general anesthesia [GA]). They were also questioned as to whether they felt the techniques would be effective on their child. Behavior, local anesthetic use, treatment accomplished/completed and success/failure of BGT’s were recorded in the dental chart. The data was then analyzed. The mean age was 9.6 years +/- 3 years ranging from 2.7-19 years of age. Ethnicities mirrored that of the local demographics and there was a mix of insurance providers with only 2% with no insurance.
Findings: Parents were highly accurate in predicting cooperation for examination in the chair (>88%) and for radiographs (>84%) but were often overconfident in their child’s willingness to cooperate for prophylaxis and fluoride application (<54%).>90% acceptability) were in order: positive verbal reinforcement (PVR), TSD, distraction, rewards, GA, hand holding by parent and mouth-prop. Other popular methods: parental restraint (84%), staff restraint (63%) and a stabilization device (54%). In terms of parents acceptance of BGT’s, there was no difference between initial and returning patients, high school vs college education or the location in which the patient was seen. Ratings for success according to dentists: distraction (86%), frequent breaks (81%), rewards (80%), nitrous (67%), TSD (65%), PVR (60%) and oral sedation (33%). Most children were treated with 1 assistant (73%) although 27% needed 2 or more assistants. When protective stabilization was ised, the acceptance rate was 95%, a far cry form the reported 40% by parents whose children were not treated with it. All BGT’s were rated at 91% or higher acceptability once they had been used on a child, except for staff restraint which clocked in at 74%. Only mouthprops (48%) and staff restraint (35%) ranked lower once the technique was used.
Key points/Summary : Parents have a limited capacity to predict for which procedures their autistic child is capable of being compliant.

Brian Schmid DMD