Efficacy of Social Story Intervention in Training Toothbrushing Skills Among Special‐Care Children With and Without Autism

Abstract

Toothbrushing is a routine practice for oral hygiene maintenance. It is also a challenging task for young children with special care needs. In this study, social stories were employed to teach toothbrushing skills for preschool children with special needs. Those children were recruited from the Special Child Care Centers, including 87 children with autism and 94 children without autism. A validated toothbrushing social story was used to demonstrate the toothbrushing procedure for all the recruited children. Parents were encouraged to show the stories to their children before or during their daily toothbrushing. Children's toothbrushing performance, oral hygiene status, and gingival health status were assessed at baseline and 6 months. Toothbrushing performance, oral hygiene, and gingival status of the recruited children were significantly improved after using social stories. Moreover, children with autism showed better oral hygiene status (P = 0.01) and better gingival status (P < 0.001) than their peers without autism. However, there were no significant differences in the toothbrushing performance among children with and without autism. The regression models indicated that the improvement of children's toothbrushing performance and oral health status were associated with children's intellectual functioning and parents' attitudes toward the usefulness of social story intervention. The principal findings suggested that social story intervention could be used to improve toothbrushing skills among children with or without autism, while it was more efficient in improving the oral hygiene status among children with autism. Autism Res 2020, 13: 666–674. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Toothbrushing is considered as a basic self‐care practice that should be advocated in early childhood. We used social stories to train toothbrushing skills among preschoolers with special care needs. The toothbrushing skills of the recruited children were significantly improved after 6‐months intervention, and children with autism showed better oral hygiene status than their peers without autism. These findings suggested that social story‐based health promotion could be implemented among children with special needs.

Is Visual Pedagogy Effective in Improving Cooperation towards Oral Hygiene and Dental Care in Children with Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

“…Studies selected were divided into two groups according to their primary outcome. In the first group, articles that investigated the effectiveness of visual pedagogy in improving oral hygiene skills in children with ASDs were included [14][15][16][17][18][19][20][21][22]. In the second group, articles that investigated the effectiveness of visual pedagogy in improving the patient's cooperation during dental care were included [4,[23][24][25][26][27][28][29][30][31][32][33][34][35].…”

“…Twenty-three studies were finally included in this systematic review: nine studies concerned tooth brushing and oral hygiene skills in children with ASDs and 14 studies concerned their cooperation during dental procedures (Figure 1) [4,. The majority of the papers included (21 studies) were published in the last decade, with 10 papers published from 2018 to 2020 [14,16,17,19,[21][22][23]26,28,32] (Table 1).…”

“…Regarding the type of study, five were RCTs [20,23,27,29,31] and 18 were non-randomized studies, of which 11 papers were interrupted time series studies (ITSSs) [4,14,15,[17][18][19]22,25,26,28,32], two were controlled before and after studies (CBAs), and five were before and after comparison studies (BAs) [16,30,[33][34][35]. Regarding the type of study design, 12 studies were single-arm trials [4,[15][16][17][18][19]25,26,28,30,33,34], 10 were double-arm trials [14,[20][21][22][23][24]29,[31][32][33], and one was a multi-arm trial [27]. Eight papers had a sample size greater than 50 participants [4,17,19,…”

“…Regarding the type of study design, 12 studies were single-arm trials [4,[15][16][17][18][19]25,26,28,30,33,34], 10 were double-arm trials [14,[20][21][22][23][24]29,[31][32][33], and one was a multi-arm trial [27]. Eight papers had a sample size greater than 50 participants [4,17,19,21,22,27,28,32]. Regarding study length, only 13 studies lasted more than six months [14][15][16][17][18][19]21,22,24,25,27,28,30], with a follow-up evaluation that ranged from one week to 12 months.…”

Toothbrush deterioration and parents’ suggestions to improve the design of toothbrushes used by children with special care needs

“…Children with sub-average social skills were less likely to follow the instructions given by the caregiver, and they were likely to brush their teeth with improper toothbrushing techniques. If children brushed their teeth with uneven strokes, their toothbrush bristles could be matted or splayed quickly [ 11 ].The prior study also revealed that children with low social skills showed poorer toothbrushing performance than their peers, and toothbrushing trainings in early childhood were recommended for children with special care needs [ 17 , 18 ]. The design of toothbrushes could also influence the deterioration levels of toothbrushes [ 4 , 19 ].…”