title: Physiological and behavioral stress and anxiety in children with autism spectrum disorders during routine oral care.
abstract: BACKGROUND
  Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress.
  
  
  METHODS
  Participants were 44 children (n=22 typical, n=22 ASD) aged 6-12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings.
  
  
  RESULTS
  Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group.
  
  
  CONCLUSIONS
  Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic.
authors.affiliation: Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089, USA.
authors.forename: Leah I
authors.identifier: 0000-0001-7208-9401
authors.initials: LI
authors.lastname: Stein
authors.affiliation: Division of Biostatistics, Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, SSB 220X, Los Angeles, CA 90089, USA.
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Lane
authors.affiliation: Keck School of Medicine of USC, The USC University Center for Excellence in Developmental Disabilities (USC UCEDD), Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS No. 53, Los Angeles, CA 90027, USA.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Williams
authors.affiliation: Department of Psychology, of the Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, SGM 3620 McClintock Avenue, SGM 501, Los Angeles, CA 90089-1061, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Dawson
authors.affiliation: Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS No. 116, Los Angeles, CA 90027, USA.
authors.forename: José C
authors.initials: JC
authors.lastname: Polido
authors.affiliation: Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089, USA.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Cermak
mesh_terms: D001007:Anxiety / Q000503:physiopathology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000503:physiopathology* / Q000523:psychology*; D019140:Dental Care for Children / Q000523:psychology*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000503:physiopathology*