Adapting Oral Care Protocols to Support Children with Sensory Sensitivities: Occupational Therapy and Dentistry

Duker, Stein; Leah, I

doi:10.1007/978-3-030-10483-2_4

Cited by 8 publications

(13 citation statements)

References 43 publications

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“…Use of these specific strategies were overwhelmingly reported to be successful in improving the visit. These techniques are commonly discussed and used by occupational therapy researchers and practitioners in their work with people with ASD in health care and other (e.g., school and therapy) environments and are well within their repertoire of skills (Case-Smith & Arbesman, 2008;Pfeiffer & Stein Duker, 2016;Stein Duker, 2019;Stein Duker et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

Duker

Kim

Pomponio

et al. 2019

The American Journal of Occupational Therapy

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OBJECTIVE. Our objective was to identify perceived barriers and strategies to improve primary care encounters, as reported by adults with autism spectrum disorder (ASD), caregivers of adults with ASD, and primary care providers (PCPs) treating adults with ASD.METHOD. As part of a larger mixed-methods design, adults with ASD, caregivers, and PCPs (N = 78) in Los Angeles and Philadelphia completed surveys examining barriers to care and strategies to improve care. RESULTS.Multiple barriers to care were reported by adults with ASD and caregivers, including communication and sensory challenges. Adults with ASD and caregivers reported minimal use of strategies during primary care visits but indicated that those used were helpful during care. Expert PCPs reported using strategies more frequently than novice PCPs. All respondent groups endorsed that strategies had the potential to improve care in the future for adults with ASD. CONCLUSION.Opportunities exist for occupational therapy collaboration in primary health care and primary care education to improve care for adults with ASD.P rimary care is envisioned as a patient-centered, medical-home model that provides first-contact care, continuity of care over time, and coordination with other integral parts of the health system (American Academy of Family Physicians, 2019). It exemplifies a patient-centered culture that values the patient's needs above all else and considers the entire patient versus a single attribute of the patient's health (Bodenheimer & Pham, 2010;Starfield et al., 2005). A strong primary care system is associated with improved population health outcomes, greater access to health care services, higher patient satisfaction, and reduced health care spending (Atun, 2004).Disparities in health status exist, however, between people with and without disabilities. Adults with disability have reported fair or poor health significantly more than adults without disability (40% vs. 10%, respectively; Centers for Disease Control and Prevention, 2008). Consistent with current disability research, adults with autism spectrum disorder (ASD) have greater unmet physical and mental health care needs, higher use of the emergency department, and lower use of preventive services than adults without ASD (Nicolaidis et al., 2013).Few studies have documented the challenges that adults with ASD encounter within primary care. Reported barriers include strained patient-provider communication, an overstimulating clinical physical environment, ASD-related stigma, incorrect assumptions about the patient's level of functioning, and a lack of ASD-specific education for the provider

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Section: Discussionmentioning

confidence: 99%

Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

Duker

Kim

Pomponio

et al. 2019

The American Journal of Occupational Therapy

Self Cite

View full text Add to dashboard Cite

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“…In the dental office, there may be challenges with the taste or smell of prophylaxis paste or fluoride, the dentist touching their face, bright lights shining in the child’s eyes, the high-pitched sound of dental equipment, and unusual smells [ 62 , 65 ]. These types of sensory sensitivities have been associated with the uncooperative behaviors of children with ASD in the dental office [ 65 , 66 ].…”

Section: Oral Health and Autism Spectrum Disordersmentioning

confidence: 99%

“…These strategies range from providing education about sensory sensitivities and creating a sensory-friendly environment; assisting with the development and use of visual supports and social stories, and/or use of video/virtual technology. These strategies all have, at least, preliminary support for their use for children with ASD [ 66 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ].…”

Section: Leveraging the Dental Strategic Initiative To Benefit Cshmentioning

confidence: 99%

“…Sensory-friendly environments can modify the sensory experiences encountered by children with ASD, either adding (e.g., weighted blankets, calming music) or removing (e.g., bright lights, loud noises) sensory stimuli encountered during dental care or in the waiting room to decrease stress and anxiety [ 66 , 85 , 86 , 94 ]. Strategies incorporating visual supports may improve cooperation and participation; these may include visual schedules, which are visual representations of a task broken down and sequenced into step-by-step directions, and visual clocks, which are particularly helpful in aiding the child to keep track of time [ 66 , 90 ]. Video tutorials have been developed to improve children with ASD’s toothbrushing technique by providing virtual modeling of target behaviors [ 91 ].…”

Section: Leveraging the Dental Strategic Initiative To Benefit Cshmentioning

confidence: 99%

“…Occupational therapy is a discipline that can aid the child through dental care either in the clinic during treatment (i.e., emotional regulation–the ability to monitor and modulate emotions) or before the clinic visit (i.e., in-home desensitization strategies, social stories). OTs can work with dentists to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD [ 66 , 99 ].…”

Section: Leveraging the Dental Strategic Initiative To Benefit Cshmentioning

confidence: 99%

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Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy

Como

Duker

Polido

et al. 2020

IJERPH

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Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.

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Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

Stein Duker,

Como,

Jolette

et al. 2023

JAMA Netw Open

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ImportanceAutistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population.ObjectiveTo determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE).Design, Setting, and ParticipantsThis randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022.InterventionEach child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli.Main Outcomes and MeasuresThe primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings.ResultsAmong 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects.Conclusions and RelevanceIn this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.Trial RegistrationClinicalTrials.gov Identifier: NCT02430051

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Adapting Oral Care Protocols to Support Children with Sensory Sensitivities: Occupational Therapy and Dentistry

Cited by 8 publications

References 43 publications

Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy

Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

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