title: Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media.
abstract: BACKGROUND
  Dental care is a significant unmet health care need for children with autism spectrum disorders (ASD). Many children with ASD do not receive dental care because of fear associated with dental procedures; oftentimes they require general anesthesia for regular dental procedures, placing them at risk of associated complications. Many children with ASD have a strong preference for visual stimuli, particularly electronic screen media. The use of visual teaching materials is a fundamental principle in designing educational programs for children with ASD.
  
  
  OBJECTIVE
  To determine if an innovative strategy using 2 types of electronic screen media was feasible and beneficial in reducing fear and uncooperative behaviors in children with ASD undergoing dental visits.
  
  
  METHODS
  We conducted a randomized controlled trial at Boston Children's Hospital dental clinic. Eighty (80) children aged 7 to 17 years with a known diagnosis of ASD and history of dental fear were enrolled in the study. Each child completed 2 preventive dental visits that were scheduled 6 months apart (visit 1 and visit 2). After visit 1, subjects were randomly assigned to 1 of 4 groups: (1) group A, control (usual care); (2) group B, treatment (video peer modeling that involved watching a DVD recording of a typically developing child undergoing a dental visit); (3) group C, treatment (video goggles that involved watching a favorite movie during the dental visit using sunglass-style video eyewear); and (4) group D, treatment (video peer modeling plus video goggles). Subjects who refused or were unable to wear the goggles watched the movie using a handheld portable DVD player. During both visits, the subject's level of anxiety and behavior were measured using the Venham Anxiety and Behavior Scales. Analyses of variance and Fisher's exact tests compared baseline characteristics across groups. Using intention to treat approach, repeated measures analyses were employed to test whether the outcomes differed significantly: (1) between visits 1 and 2 within each group and (2) between each intervention group and the control group over time (an interaction).
  
  
  RESULTS
  Between visits 1 and 2, mean anxiety and behavior scores decreased significantly by 0.8 points (P = .03) for subjects within groups C and D. Significant changes were not observed within groups A and B. Mean anxiety and behavior scores did not differ significantly between groups over time, although group A versus C pairwise comparisons showed a trend toward significance (P = .06).
  
  
  CONCLUSIONS
  These findings suggest that certain electronic screen media technologies may be useful tools for reducing fear and uncooperative behaviors among children with ASD undergoing dental visits. Further studies are needed to assess the efficacy of these strategies using larger sample sizes. Findings from future studies could be relevant for nondental providers who care for children with ASD in other medical settings.
authors.affiliation: 1Boston Children's Hospital, Boston, MA, USA.
authors.forename: Inyang A
authors.initials: IA
authors.lastname: Isong
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: Chloe
authors.initials: C
authors.lastname: Holifield
authors.forename: Dorothea
authors.initials: D
authors.lastname: Iannuzzi
authors.forename: Ellen
authors.initials: E
authors.lastname: Hanson
authors.forename: Janice
authors.initials: J
authors.lastname: Ware
authors.forename: Linda P
authors.initials: LP
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000704:Analysis of Variance; D001900:Boston; D002648:Child; D002652:Child Behavior / Q000523:psychology; D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000523:psychology*; D003146:Communications Media; D016854:Dental Anxiety / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005239:Fear / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009040:Motion Pictures; D010775:Photic Stimulation / Q000379:methods*; D010865:Pilot Projects
keywords: autism spectrum disorders; children; dental fear; electronic screen media