An Evaluation of Brief Scheduled Breaks to Reduce Distress in Typical and Develop

描述(申请人提供)：尽管牙医看到的大多数儿童都表现良好并合作，但20%-25%的儿童足够痛苦和具有破坏性，以至于许多从业者不愿意为这些儿童提供护理，限制了他们获得高质量口腔保健的机会。这些问题在患有自闭症和相关发育障碍的儿童中更加明显。更严重的是，大多数牙科学生报告很少或根本没有准备好为残疾人士提供护理，导致很少有牙医治疗发育障碍儿童。这是一个特别令人关切的问题，因为发育障碍儿童没有能力理解和承担预防口腔保健做法的责任或与之合作，因此特别容易患口腔疾病。尽管最近呼吁采取更多的非药理学行为管理方法来应对这些挑战，但对儿童使用的非药理学行为管理方法进行良好控制的经验性评估相对较少，针对自闭症或相关发育障碍儿童的良好控制研究或研究项目就更少了。这项研究项目的目的是解决这两个需求：第一，对一种有前途的行为管理程序进行一项控制良好的随机试验，第二，扩大一项研究计划，该研究发现，这种技术对少数困难儿童有效，但从未在大量儿童或残疾儿童中进行过测试。参与者将是180名需要修复性牙科治疗的2-8岁儿童，既包括典型的发育中儿童，也包括自闭症和相关发育障碍的儿童。在实验条件下，参与者将得到牙医提供的预定休息时间计划，初步研究发现，这对高度破坏性的幼儿是一种强有力的干预。对困境行为的观察以及对儿童反应的评级将提供对计划好处的直接评估，而花在行为管理上的时间的比较将为成本效益分析提供数据。这项调查扩展了一项致力于评估牙医非药物行为管理方法的研究计划，该方法有可能改善所有儿童获得高质量口腔保健的机会。 公共卫生相关性：本研究项目的目的是评估一种行为管理干预措施，该干预措施包括短暂的预定休息时间，以减少接受修复性牙科治疗的儿童的痛苦。这项研究通过对一种前景看好的行为管理程序进行良好控制的随机试验，然后在典型发育儿童以及自闭症和相关发育障碍儿童身上测试其有效性，从而实现了几项重要的需求。此外，这项调查扩展了一项致力于评估牙医非药物行为管理方法的研究计划，并包括成本效益分析。最终，如果行为管理程序被证明对大量儿童像在小型试点调查中一样有效，它有可能改善儿童获得高质量口腔保健的机会。

DESCRIPTION (provided by applicant): Although most children seen by dentists are well behaved and cooperative, 20-25 percent of all children are sufficiently distressed and disruptive that many practitioners are not willing to provide care for these children, limiting their access to quality oral health care. The problems are even more pronounced in children with autism and related developmental disabilities. This is compounded by the fact that most dental students report little or no preparation in providing care to individuals with disabilities resulting in few dentists treating children with developmental disabilities. This is a particular concern because children with developmental disabilities, who do not have the ability to understand and assume responsibility for or cooperate with preventive oral health practices, are particularly susceptible to oral disease. Despite recent calls for additional nonpharmacological methods of behavior management to address these challenges, there are relatively few well-controlled empirical evaluations of nonpharmacological methods of behavior management for use with children and even fewer well-controlled studies or programs of research targeting children with autism or related developmental disabilities. The purpose of this research project is to address both of these needs: first, to conducted a well-controlled, randomized trial of a promising behavioral management procedure, and second, to extend a program of research that has found this technique to be effective with a small number of difficult children but has never been tested in large numbers of children or in children with disabilities. Participants will be 180 children, 2-8 years of age requiring restorative dental treatment and will include both typically developing children as well as those with autism and related developmental disabilities. Participants in the experimental condition will receive a program of scheduled breaks provided by the dentist, which has been found in preliminary studies to be a potent intervention in highly disruptive young children. Observations of distress behavior as well as ratings of child reactions will provide direct assessment of program benefits while comparison of time spent on behavior management will provide data for a cost-benefit analysis. The investigation extends a program of research dedicated to evaluating nonpharmacological behavior management methods for dentists has the potential to improve access to quality oral health care for all children. PUBLIC HEALTH RELEVANCE: The purpose of this research project is to evaluate a behavior management intervention involving brief scheduled breaks to reduce distress in children undergoing restorative dental treatment. The research accomplishes several important needs by using a well- controlled, randomized trial of a promising behavioral management procedure and then testing its effectiveness with both typically developing children as well as those with autism and related developmental disabilities. In addition, the investigation extends a program of research dedicated to evaluating nonpharmacological behavior management methods for dentists and includes a cost-benefit analysis. Ultimately, if the behavior management procedure proves as effective for large numbers of children as it has in small pilot investigations, it has the potential to improve access to quality oral health care for children.