A bio‐behavioral intervention combining task analysis with skill‐based training to train toothbrushing among children with intellectual disability

Abstract

Individuals with intellectual disability (ID) have special health care needs.Teaching self-care behaviors like toothbrushing helps reduce their dependence on adult caregivers. We present a bio-behavioral intervention combining task analysis with skill-based teaching of toothbrushing behavior aimed to promote autonomy in children with various types of ID. Methods: One hundred twenty children with ID enrolled at a special school in the State were included in the study. After baseline measurements using task analysis, four methods were used to train the children -instruction, three-phase modeling, physical guidance, and descriptive praise. The caregiver was trained and given instructional videos for reinforcement. After 4 weeks, the children were asked to brush their teeth and performance was evaluated. Results: There was increased independence in the performance of toothbrushing behavior, the mild and moderate ID groups showing the most improvement.Steps like oral manipulation of the toothbrush showed the greatest improvement in these groups. The severe ID group showed improvement in certain skills, while requiring assistance for others that demanded dexterity. Conclusion: This intervention can be implemented by special schools and special care dentistry centers to foster autonomy in oral self-care skills in the mild and moderate ID children, and complemented with other methods for severe ID children. K E Y W O R D Sautonomy, biobehavioral approach, intellectual disability, task analysis, toothbrushing 1 INTRODUCTION Intellectual disability (ID)/intellectual developmental disorder (IDD) 1 is an increasing public health challenge. According to the Working Group on Mental Retardation © 2021 Special Care Dentistry Association and Wiley Periodicals LLC by the World Health Organization (WGMR-WHO), ID has been defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behavior and skills." 2 Early diagnosis and 588 wileyonlinelibrary.com/journal/scd Spec Care Dentist.

A tactile graphic book with Braille and audio use improved plaque score and toothbrushing performance in visually impaired individuals

“…21,27 Gaunkar et al found that task analysis with skill-based teaching of toothbrushing promoted autonomous performance in special needs child after 4 weeks and suggested that this method is practical and could reduce their dependence on caregivers. 25 The present study confirmed that school teachers can provide oral hygiene education; the results were satisfactory and consistent with those of Joybell and Krishnan. 11 Therefore, we suggest that for visually impaired persons, a specially designed multisensory program or guideline of oral health education should be established in the school curriculum.…”

“…Furthermore, most participants in the study were not totally blind and had intact intellectual abilities; thus, there was a high degree of communication with the teacher and their muscle coordination was satisfactory. Therefore, there were no intellectual disabilities that could affect the motor skills required for brushing skill acquisition 25 …”

“…Gaunkar et al. found that task analysis with skill‐based teaching of toothbrushing promoted autonomous performance in special needs child after 4 weeks and suggested that this method is practical and could reduce their dependence on caregivers 25 …”

“…Therefore, there were no intellectual disabilities that could affect the motor skills required for brushing skill acquisition. 25 The Bass brushing technique was used in this study because it is the method that emphasizes cleaning the subgingival area and is suggested for educating children 8years-old and above. 26 The plaque score results were similar to those of a study that used the Bass brushing method and proved to be effective in improving the oral hygiene status of visually impaired individuals.…”

Inclusion of Digital Literacy Skills in Transition Planning for Students With Intellectual Disabilities

“…Data, on the level of prompting needed to complete each step, are collected to monitor progress and make instructional decisions such as when to add the next step in the chain, or break a current step into even more discrete behaviors. The use of task analysis for instruction has a solid evidence base and has been used widely to teach a variety of skills to individuals with ID such as daily living skills (Bridges, Robinson, Stewart, Kwon, & Mutua, 2020), self-care-skills (Gaunkar et al, 2021), and academic content (Browder et al, 2018). Some of the digital literacy skills taught using task analysis include accessing, replying, composing, and sending emails on multiple devices (Cihak, McMahon, Smith, Wright, & Gibbons, 2015a) as well as bookmarking, downloading, and uploading documents (Cihak et al, 2015b).…”