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

描述（由申请人提供）：虽然牙医看到的大多数儿童表现良好且合作，但20- 25%的儿童都有足够的痛苦和破坏性，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的口腔保健。这些问题在患有自闭症和相关发育障碍的儿童中更为明显。这是复杂的事实，大多数牙科学生报告很少或根本没有准备提供护理残疾人导致少数牙医治疗儿童发育障碍。这是一个特别令人关注的问题，因为发育障碍儿童没有能力理解和承担责任或配合预防性口腔健康做法，特别容易患上口腔疾病。尽管最近呼吁更多的非药物行为管理方法来解决这些挑战，有相对较少的非药物行为管理方法用于儿童和更少的控制良好的研究或针对自闭症或相关发育障碍儿童的研究计划的经验评价。本研究项目的目的是解决这两个需求：第一，进行一个良好的对照，一个有前途的行为管理程序的随机试验，第二，扩展一个研究计划，发现这种技术是有效的少数困难的儿童，但从来没有在大量的儿童或残疾儿童进行测试。参与者将是180名2-8岁需要牙科修复治疗的儿童，包括典型发育中的儿童以及自闭症和相关发育障碍儿童。实验条件下的参与者将接受牙医提供的预定休息计划，初步研究发现这是对高度破坏性幼儿的有效干预。对痛苦行为的观察以及对儿童反应的评级将提供对计划效益的直接评估，而对行为管理所花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专门用于评估牙医非药物行为管理方法的研究计划，该计划有可能改善所有儿童获得优质口腔保健的机会。 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，包括短暂的计划休息，以减少儿童接受修复牙科治疗的痛苦。该研究通过对一种有前途的行为管理程序进行良好对照的随机试验，然后在典型发育儿童以及自闭症和相关发育障碍儿童中测试其有效性，实现了几个重要的需求。此外，该调查扩展了一项专门用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有效，就像在小型试点调查中一样，它有可能改善儿童获得优质口腔保健的机会。

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.