Cooperation predictors for dental patients with autism

Resident: Cho
Author(s): Marshall et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2007. 29, 369-376.
Major topic: Autism
Type of Article: Scientific Article

Main Purpose: To identify and evaluate predictors of cooperation for pediatric dental patients with autism.

Methods: Subjects were recruited from CHRMC Department of Dental Medicine, UW Pediatric Dental Clinic, and 9 private practices in Western Washington. Subjects had a diagnosis of autism from the DSM-IV or equivalent.
Twenty-six possible predictors of cooperation (including demographics, appointment description, life skills, personal hygiene skills, and medical history) were evaluated by using parent surveys, direct questioning of the parents by the dentist or dental team member, and dentist treatment notes.

Findings:
108 autistic children (80 males and 28 females) were evaluated over a period of 6 months. The mean age was 9.8 years.
Life skills significantly predictive of uncooperative behavior were: nonverbal or minimal use of language, echolalic (repetition of words previously spoken) language, inability to understand language at an age-appropriate level, inability to follow multistep instructions, inability to read at 6+ years old, attending special education, and attending a specialized classroom.
Children who were unable to sit for a haircut or required coaxing or restraint were more uncooperative with the dentist.
Even with repeated dental visits, returning patients were not significantly more cooperative than new patients.

Key points/Summary:
Characteristic features of autistic children making cooperation difficult in a dental setting: language and social limitations, concurrent diagnoses, medications used to treat behavioral symptoms, learning disabilities/mental retardation, heightened sensory perceptions, and an inability to generalize previously learned behaviors.
Having multiple “risk factors” for uncooperative behavior predicted uncooperative behavior in the dental setting.
Five independent variables were identified as potential “risk factors” for uncooperative behavior: age 4-7 vs. >7, reading, toilet training, concurrent diagnoses, and expressive language. Having 2 or more of these “risk factors” was strongly associated with uncooperative behavior.

Assessment of Article:
Overall, good study. It was interesting that whether the patient was new or returning did not correlate with the predicted cooperativity of the patient.