Date Presented 04/04/19
Oral care activities, especially toothbrushing, are habitual occupations often perceived as mundane or predictable. However, for children with ASD, performing routine dental activities can be challenging. The purpose of this qualitative study was to understand the particularities in how oral care activities, such as toothbrushing, were performed by children.
Primary Author and Speaker: Dominique Como
Additional Authors and Speakers: Daniella Florindez, Evelyn Law, Leah Stein Duker, Sharon Cermak, Lucía Floríndez
Contributing Authors: Jose Polido
PURPOSE: Oral health remains one of the most prevalent unmet health needs among children in the United States. Oral care activities, especially toothbrushing, are habitual occupations often perceived as mundane or predictable. However, for children with Autism Spectrum Disorders (ASD), performing routine dental activities can be challenging due to the child’s sensory sensitivities. Therefore, the purpose of this analysis was to understand the particularities in how oral care activities, such as toothbrushing, were performed by Latino children with and without ASD.
DESIGN: In this secondary cross-case qualitative analysis of a larger multi-method study examining in-home oral care routines of Latino children with and without ASD, parents were purposefully recruited.
METHOD: As part of the main study, 18 Latino families with a child age 6-12 (n=10 with ASD and n=8 neurotypical) were interviewed to identify the factors that impact their in-home oral care, including how the presence of ASD may alter their child’s habits. Additionally, parents were asked to video record their child’s oral care activities for three days. These instructions were deliberately open ended, and left to interpretation by the parent, with the investigator emphasizing the value of capturing real-life events. Two blind coders analyzed 90 videos using a template coding approach based on the American Academy of Pediatric Dentistry’s practice standards for recommended oral care behaviors.Qualitative observations, including parent-child interactions, were also documented and examined using a cross-case analysis for a subset of cases.
RESULTS: Two themes pertaining to successful oral care practices were observed. Parent involvement identifies the role of parents and caregivers in the oral care routines, facilitating the activity physically or with verbal cues, and cultural roles about which family member participated in the process. Modifications describes modifying the activity to meet the needs of the children, including altering aspects of the activity, or using adaptations to help establish routines. Noticeably absent from the child’s oral care routine were flossing and the use of mouthwash.
CONCLUSION: For children with ASD, parents play a significant role in their child’s ability to access their in-home oral care. However, this study highlights that some aspects of the routine were easily completed, independently. This may be the result of modifications utilized and/or the strategies implemented by parents. Families and practitioners can take from this finding that independence and autonomy in toothbrushing is a possibility despite the challenges with oral care that many families of children with ASD express.
Flossing and using mouthwash, before or after brushing, are often seen as optional, supplemental tasks. This is true for both groups of children and most parents. However, they are important components of the dental routine. It is possible that parents would benefit from more education about the significance of their role in oral health. Occupational therapists are well suited to help parents and children develop a plan of action to incorporate these additional components into their existing activities of daily living.
IMPACT STATEMENT: An in-depth understanding of the strategies employed by parents and children with and without ASD to facilitate successful in-home oral care routines will enable design of new methods and procedures. The findings also highlight the unique role occupational therapists can fill in aiding parents to identify their child’s sensory sensitivities, develop a plan of action to expand their oral care routines and adapt the activity for the child’s needs.
References
U.S. Department of Health & Human Services (2010). Healthy People 2020, Oral Health: Overview, objectives, and interventions and resources. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32
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Stein, L. I., Polido, J. C., Lopez Najera, S.O., & Cermak, S. A. (2012). Oral care experiences and challenges in children with autism spectrum disorders. Pediatric Dentistry, 34(5), 387-391.
