(PS4-68) Say "AH," Not "AHHH!" - Parent Intervention for the Reduction of Dental Anxiety in a Child with Autism

The overall oral health status of autistic children is significantly poorer as compared to children without autism, primarily due to dental anxiety (Kotha et al., 2018; Sahab, 2017). This anxiety, coupled with deficits in communication and coping skills, results in behavioral distress and challenging behaviors for autistic children during routine dental cleanings, leading to higher rates of invasive, intensive dental procedures resulting from untreated cavities as well as greater use of anesthesia and sedation (Bossù et al., 2020; Prekash et al., 2021). In response to these unpleasant visits, parents often engage in reactive rather than proactive strategies (AlHumaid et al., 2020). Currently, there is limited research on effective treatment packages and procedures for managing dental anxiety in children with autism, and no studies have trained parents as intervention agents to treat dental anxiety in this population.

Using an AB single-case design, this study sought to examine whether a behavioral intervention package delivered by a parent in the child’s home would decrease dental anxiety and increase dental compliance in a 6 year old child with autism. The mother was taught to implement evidence-based intervention practices, including gradual exposure, counterconditioning, in-vivo modeling, and positive reinforcement. She was also taught to offer choices, an antecedent-based strategy which has not been used to treat dental anxiety in youth with autism. 

We used three different measures to assess the participant's level of anxiety prior to, during, and post-intervention. First, we used a Behavioral Approach Task (BAT), consisting of a 10-step dental exam fear hierarchy, to assess the child's dental anxiety. Second, masked research assistants rated the child’s anxiety using the Venham Anxiety and Behavioral Rating Scale (VBRS; Narayan & Samuel, 2020). Third, the parent rated her impressions of her child’s anxiety using the Anxiety Rating Scale (ARS; Liu et al., 2022). The child’s compliance with the dental exam was also measured as a secondary outcome variable. Finally, we assessed social validity (parental confidence, and overall satisfaction, as well as treatment acceptability and feasibility) using two separate questionnaires. 

Results revealed that the participant completed substantially more steps in the BAT at home following intervention than he did prior to intervention (3.3% steps completed at Baseline; 100% steps completed Post-Intervention). The NAP from baseline to post-intervention was 1.0, indicating a strong effect of the intervention (Parker & Vannest, 2009). Following intervention, the participant demonstrated decreased levels of anxiety (VBRS at Baseline = 3, VBRS Post-Intervention = 0), and increased compliance (VBRS at Baseline = 4, VBRS Post-Intervention = 0). Further, parents reported decreased anxiety on the ARS, rating anxiety a ‘4’ Pre-Intervention and ‘1’ Post-Intervention. Treatment effects generalized to a real-life dental exam at his dentist’s office, highlighting the effectiveness of the intervention. Finally, in terms of social validity, the mother’s self-report indicated that her confidence increased as well as her ability to implement treatment components.