Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children: A Randomized Crossover Trial.
Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children: A Randomized Crossover Trial.
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DOI：
10.1001/jamanetworkopen.2023.16346
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Cermak, Sharon A
中科院分区：
文献类型：
--
作者：
Stein Duker, Leah I;Como, Dominique H;Jolette, Caitlin;Vigen, Cheryl;Gong, Cynthia L;Williams, Marian E;Polido, Jose C;Florindez-Cox, Lucia I;Cermak, Sharon A
与常规牙科环境（RDE）相比，感觉适应牙科环境（SADE）对自闭症儿童的生理压力有何影响？在这项包括162名自闭症儿童的随机交叉试验中，与RDE相比，儿童在牙科就诊的所有阶段均表现出明显较低的生理压力，这表明SADE的交感神经活动减少，牙科护理期间的放松增加。这些发现表明，在牙齿清洁过程中使用SADE是改善自闭症儿童牙科体验的安全有效的方法。这项随机交叉试验评估了与常规牙科环境相比，在感觉适应的牙科环境中进行牙齿清洁的自闭症儿童的生理和行为困扰。自闭症儿童的口腔健康状况较差，口腔护理面临的挑战更大，这通常与感觉过度反应有关。重要的是要确定创新的解决方案，使牙医成功地执行标准的诊所为基础的程序，这一人群。确定与常规牙科环境（RDE）相比，感觉适应性牙科环境（SADE）是否减少了接受牙齿清洁的自闭症儿童的生理和行为困扰。这项随机交叉试验于2016年5月至2022年4月在一家大型城市儿童医院的儿科牙科诊所进行。编码员对生理学而非行为测量的研究条件不知情。6至12岁的自闭症儿童被确定并邀请参加。感兴趣的家庭连续入组;在确诊自闭症后，儿童被随机分组。本符合方案研究的分析于2022年4月至10月进行。每名儿童接受1次RDE和1次SADE牙齿清洁，以随机和平衡顺序给药，间隔约6个月。SADE包括改良的视觉、听觉和触觉刺激。主要结果是生理应激，通过皮肤电活动进行评估。次要结果是通过录像测量的行为困扰。在受邀参与的452个家庭中，220名儿童入组，162名确诊为自闭症的儿童（平均[SD]年龄，9.16 [1.99]岁; 136名[84.0%]男性）被随机分配，其中83名儿童首先接受RDE，80名儿童首先接受SADE。大多数儿童（94名儿童[58.0%]）有中度自闭症严重程度。与RDE相比，SADE中儿童在牙科护理期间的生理压力显著较低（皮肤电导水平的平均差异，−1.22 [95% CI，−2.17至−0.27] μS），表明SADE牙科护理期间交感神经活动减少，放松增加。在非特异性皮肤电导反应方面没有发现显著差异（平均差异，每分钟-0.30 [95% CI，-0.86至0.25]）。视频编码的频率和持续时间的行为困扰（但不是问卷）措施显着较低的SADE与RDE（科恩d =-0.84至-1.19）。生理压力与牙齿清洁期间的行为困扰相关（例如，与Frankl量表相关的非特异性皮肤电导反应：β =-0.29; 95%CI，-0.39至-0.19）;年龄，智商和表达沟通调节干预的成功。没有参与者因不良反应而退出。在这项自闭症儿童的随机交叉试验中，使用SADE在减少牙科护理期间的生理和行为困扰方面是安全有效的。这很重要，因为加强口腔护理对自闭症儿童至关重要;这种干预也可能对自闭症以外的人群有益。ClinicalTrials.gov标识符：NCT 02430051
What is the effect of a sensory-adapted dental environment (SADE), compared with a regular dental environment (RDE), on the physiological stress of autistic children? In this randomized crossover trial including 162 autistic children, children exhibited significantly lower physiological stress in SADE compared with RDE in all phases of the dental visit, suggesting decreased sympathetic activity and increased relaxation during dental care in SADE. These findings suggest that using a SADE during dental cleanings was a safe and efficacious way to improve dental experiences for autistic children. This randomized crossover trial assesses physiological and behavioral distress in autistic children undergoing dental cleanings in a sensory-adapted dental environment compared with a regular dental environment. Autistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population. To determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE). This randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022. Each child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli. The primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings. Among 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects. In this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism. ClinicalTrials.gov Identifier: NCT02430051
影响因子：
3.8
作者：
Stein Duker LI;Martinez M;Lane CJ;Polido JC;Cermak SA
通讯作者：
Cermak SA