title: A form of 'parental presence/absence' (PPA) technique for the child patient with dental behaviour management problems.
abstract: OBJECTIVE
  This paper reports on the use of early introduction of a specific parental presence/absence (PPA) behavioural technique to manage the initially uncooperative child.
  
  
  METHODS
  Using a prospective design, 440 healthy children aged 3 to 10 years visited a paediatric dental practice within 33 months. Children exhibiting initially Frankl 'negative' and 'definitely negative' behaviour were empathically offered parental presence only if they were cooperative. Otherwise, the parent stepped out until behaviour improvement.
  
  
  METHODS
  t-tests and Chi-square tests were used to compare characteristics of initially cooperative and uncooperative children, as well as proportions of parents who were asked to leave the surgery. The technique's success was assessed by a one sample binomial test.
  
  
  RESULTS
  75 of the children presented as Frankl either 'negative' (30) or 'definitely negative' (45) at their first visit; 70 (93.3%, p<0.001) responded to the PPA technique by displaying positive behaviour as their first visit progressed. 38 responded without the need to ask the parent to exit the practice room, while the other 32 responded only after their parent exited. 52 children had additional appointments, and 8 required an application of PPA at a second appointment; all children cooperated in all subsequent appointments.
  
  
  CONCLUSIONS
  Early and empathic application of the PPA technique appears very successful in managing initially uncooperative child patients, suggesting that a randomised controlled trial of the technique is warranted.
authors.affiliation: Department of Paediatric Dentistry, Dental School, Aristotle University of Thessalonica, GR-54 124, Greece. kotsanos@dent.auth.gr
authors.forename: N
authors.initials: N
authors.lastname: Kotsanos
authors.forename: T
authors.initials: T
authors.lastname: Coolidge
authors.forename: D
authors.initials: D
authors.lastname: Velonis
authors.forename: K N
authors.initials: KN
authors.lastname: Arapostathis
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002652:Child Behavior; D002665:Child Psychiatry; D002675:Child, Preschool; D019140:Dental Care for Children / Q000379:methods* / Q000523:psychology*; D006801:Humans; D010287:Parent-Child Relations; D010290:Parents; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D012054:Reinforcement, Psychology