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CASP |
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Was there a clear statement of the aims of the research? |
The systemic review has provided a clear statement of aim that is ‘examining the effectiveness of specific technique and sensory environmental modifications to improve participation of children with sensory integration difficulties’ (Bodison and Parham, 2018). |
The study has mentioned the purpose or aim specifically that is introducing an experience of an authentic interprofessional education with the students of Communication science and Disorder and Dental Hygiene in order to develop strategies for the children with ASD (Anderson, Self and Carlson, 2017). |
The study has provided a clear statement of aim to report a case of behaviour management of a patient with autism by sedation through sub mucosal route. (Jo et al. 2017) |
The study has clearly mentioned its aim to evaluate the effectiveness of audio-visual distraction during the dental assessment and sealant placement for behaviour modification in the children with ASD (Fakhruddin and El Batawi, 2017) |
The study has provided clear aim that is to evaluate the effectiveness of specially designed dental book on the behaviour of ASD (Murshid 2017) |
The study aimed to analyse the effectiveness of visual schedule system in dental clinic in helping the children with autism (Mahand Tsang2016) |
The study aimed to analyse the use of the Picture Exchange Communication System (PECS) in autism spectrum disorder (ASD) children (Zink et al. 2016) |
The study clearly aimed to investigate preference of caregivers regarding dental stories for children with autism (Marion et al. 2016) |
The study clearly aimed to consider contemporary educational and behavioural approaches to provide dental care in patient with ASD (Nelson et al. 2015) |
The study was successful in providing a clear aim that is to address the dental fear in children with ASD (Isong et al. 2014) |
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Is a qualitative methodology appropriate? |
The qualitative methodology is appropriate for the study as it has used effective databases answer the research question. |
The methodology such as performing oral screening and other dental prophylaxis is appropriate. |
The methodology is appropriate as such case report is helpful to understand the effectiveness of behaviour management via sedation. |
Including 28 children with ASD for introductory appointment and treatment is appropriate method for the study. |
Survey within the parents and clinical oral examination was appropriate for achieving target. |
Method of using primary data from dental appointments is appropriate for addressing the aim. |
Method of using primary data from the pilot study is appropriate. |
Qualitative method was appropriate as it conducted surveys |
Qualitative method was appropriate as it conducted a literature study |
A randomised controlled study was conducted for this study which was apporapriate |
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Was the research design appropriate to address the aims of the research? |
The research design is appropriate as the study has defined all the structures of the research |
The research design is appropriate as it has provided proper structure. |
The research has designed properly. |
The research has used proper design. |
The research has provided clear design. |
The research has structured properly. |
The research design is appropriate as it has provided proper structure |
The research design is appropriate as it has provided proper structure. |
It was appropriate as it provided relevant information on dental care |
It was appropriate as it successfully screened the sample population. |
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Was the recruitment strategy appropriate to the aims of the research? |
The recruitment strategy is appropriate because the researcher has explained the chosen databases and the reason for choosing such databases |
The recruitment strategy is good however, the sample size is small. |
The recruitment strategy is appropriate as there was a few study that included sedation via submucosal route. |
The recruitment strategy is appropriate as the study has mentioned the selection process and discussion on selection of the participant, but the sample size was small. |
The recruitment strategy was appropriate, however the sample size was small. |
The recruitment strategy is appropriate but the sample size is small. |
The recruitment strategy is appropriate but the sample size is small. |
The recruitment strategy is appropriate however sample size could have been larger |
The recruitment strategy is good however, the sample size is small |
It was appropriate as a random sample was required |
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Was the data collected in a way that addressed the research issue? |
The researcher have mentioned the way of collecting data from effective databases that is adequate for address the aim. |
The data collection method is effective however, the study could recruit more participants to collect more generalised data. |
Data collected from an actual case which is appropriate to address the research issue. |
The data was collected through introductory session and treatment which is discussed properly and appropriate for answering the research question. |
Data collection through survey and clinical examination is adequate for addressing the research aim. |
The process of data collection from dental appointments was adequate for addressing the aim. |
The process of data collection from dental appointments was adequate for addressing the aim. |
Data collection through survey and clinical examination is adequate for addressing the research aim. |
Data collection through survey of literature is adequate for addressing the research aim. |
The data was successful in addressing the research issue since it shows the difference between the test and control groups |
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Has the relationship between researcher and participants been adequately considered? |
There was no participants as secondary resource has been used. |
The relationship between the participants and the researchers has adequately considered thus, the parents have provided positive feedback as well. |
Relationship is adequately considered as there was no biasness in the study. |
Relationship between the researchers and the participant is successfully considered as there was no biasness in the responsibility of the researchers. |
Relationship between the researchers and the participants has been established properly as there was no biasness in the study regarding method and result and participants has provided positive feedback as well. |
There was no biasness regarding the method, recruitment process and result, thus effective relationship has been established between the researchers and participants. |
Relationship is adequately considered as there was no biasness in the study. |
The study has a biasness towards the male population |
There were no participants as secondary resource has been used. |
Relationship is adequately considered as there was no biasness in the study |
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Have ethical issues been taken into consideration? |
The study did not use any primary research thus, there was no need for ethical consideration. |
There was no ethical issues in the study as the researchers did not reveal the personal information of the participants and other ethical considerations has been maintained effectively. |
Ethical issues has been taken in consideration thus, the personal information about the patient remain confidential. |
Ethical consideration has been considered and the researchers mentioned there were no conflict of interest in the study. |
The study was approved by the ethical committee of the College of Dentistry Research Center at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia |
The protocol of the study was reviewer by University of British Columbia and Children’s & Women’s Health Centre of BC Research Ethics Review Board. |
There was no ethical issues in the study as the researchers did not reveal the personal information of the participants and other ethical considerations has been maintained effectively. |
Ethical issues has been taken in consideration thus, the personal information about the patient remain confidential |
The study did not use any primary research thus, there was no need for ethical consideration. |
Ethical issues were considered as it was overseen by a ethical committee |
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Was the data analysis sufficiently rigorous? |
The data analysis was sufficient as the chosen paper were analysed through number of steps and it has been discussed properly. |
The data collected from the session and parent interview has analysed effectively to interpret the result. |
Data analysis was sufficient to elaborate the discussion. |
Data was analysed sufficiently and the researchers has provided through discussion and evidence of the findings. |
Data was analysed rigorously and a detail discussion of data analysis has been provided. |
The study has provided sufficient rigorous data analysis with detail discussion of the result. |
The study has provided sufficient rigorous data analysis with detail discussion of the result. |
Data was analysed sufficiently and the researchers has provided through discussion and evidence of the findings. |
The data analysis was sufficient as the chosen paper were analysed through number of steps and it has been discussed properly |
The study was sufficiently rigorous, with detailed discussion of the results |
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Is there a clear statement of findings? |
The study has provided clear statement of their findings in the result and discussion. |
The findings were clearly discussed in the discussion. |
Clear statement of findings were mentioned in the report and discussion as well. |
Clear statement of finding has been provided in the result and discussion. |
Clear statement of finding were mentioned in the result and discussion. |
Clear statement of finding have provided in the result and discussion. |
The findings were clearly discussed in the discussion. |
Clear statement of finding have provided in the result and discussion. |
The study has provided clear statement of their findings in the result and discussion. |
Clear statement of finding have provided in the result and discussion |
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How valuable is the research? |
The research is valuable as it has provided effective information regarding the sensory integration difficulties and interventions to resolve the issue. |
The study has provided effective information and strategies for the children with ASD to cope up with anxiety. |
The research is valuable as theinformation regarding use of sedation via submucosal route to manage behaviour of the patient with anxiety is useful. |
The study is valuable as the finding regarding the effectiveness of audio-visual distraction in managing behaviour during autism is helpful. |
The study is valuable as it has provided the effectiveness of using preparatory aids in the dental clinics. |
The study is valuable as it has provided relevant information related to the use of visual schedule system in helping the children with autism. |
The study has provided effective information and strategies for the children with ASD to cope up with anxiety |
The study has provided effective information and strategies for preparing the children for dental visits |
The research is valuable as it has provided effective information regarding the sensory integration difficulties and interventions to resolve the issue. |
The study is valuable as it provided as it successfully addresses the fears in children for oral health process |
It has been recommended that Qigong massage is applicable for the pre-schooler with ASD and tactile over reactivity and has provided moderate to strong evidence for the recommendation. Effectiveness of the weighted vests is limited for the children with ADHD and it is not sufficient for the children with ASD, thus, the occupational therapist should consider the use of weighted vests cautiously in order to support elementary school-age children with ADHD. Some occupational therapist use specific sensory technique such as slow swing activity in order to calm the children that are in overexcited state. However, the slow linear swinging is not sufficient to effect immediately. Study has reported the specific sensory techniques as an effective intervention but it is also mentioned that the therapist should use the intervention cautiously for the pre-schooler with ASD. It is important for the occupational therapist that cares for the children with ASD to collaborate with other dental professionals in order to explore their practice and new interventions (Bodison and Parham, 2018).
Using visually structured strategies are most effective in order to complete oral health care process successfully. Using social stories to provide relevant information to the patients and their parents is useful as it provides information about the activities that would be taken in the oral health care process. It would help the children to assume what would occur in the session thus, could help them to reduce their anxiety. Providing the social stories via computer during the dental visits would help to reduce anxiety and the uncooperativeness of the children. The parents need to be provided a simple visual schedule to follow in order to understand what the parents could do in the home to prepare the children for the session. Interviewing the parents before the session to understand the specific limitations of their child. It would help to understand the need of the children and the dental hygiene procedure would be implemented in a better manner (Anderson, Self and Carlson, 2017).
Using sedation via submucosal route is effective than the sedation via intramuscular, oral or intravenous route. Sedation via submucosal route provides more effective result in a shorter time period as compared to the other routes. This is because during sedation through submucosal route, the sedation does not passes through the liver. Submucosal injection is recommended in the study as it is technically less feasible than intravenous injection and it can be administered through physical restraint, for example, Pedi-Wrap. One important intervention mentioned by the study is the using local anesthetics without vasoconstrictors while providing sedation through submucosal route. Due to the effect of the vasoconstrictor, delay in the effect of sedation may occur. However, there are some side effects of using sedation through submucosal route such as discomfort at the spot of injection, respiratory depression and vomiting reflex. The side effects vary for individual patient with autism, thus it is important to understand the clinical situation of individual patient in order to administer sedation via submucosal route (Jo et al. 2017).
Using tell-show-do modelling and AV distraction in the initial treatment of ASD could help to resolve the communication issues. Using dental model, toy dental drill and animated display would help to build an effective communication bridge with the child participants of the dental assessment. Application of tooth models, sound and suction and air-water syringe is helpful in order to desensitize the auditory, visual and tactile sensations of the children through non-threatening setting in an effective manner. Such modification in the clinical setting would help to encourage the children in order to cooperate in the session effectively. AV distraction along with a video eye wear could be used to distract the attention of the children from disturbing stimuli, feelings and thoughts. Study has recommended the ICDAS method as the accurate method for detecting early lesions that are preventable. The study has suggested to use dental sealants to the areas of demineralization and decay in order to prevent further damage. Using a Molt mouth prop is helpful to keep the mouth open of the children (Fakhruddin and El Batawi, 2017).
The intervention involved use of symbols of picture communicationto reduce the behavioural distress in children during the dental examination and the cleaning appointment. The children with oral health challenges were benefited from this intervention. Implementing the behavioural and the psychological methods across the various time points is helpful. The intervention was successful in bringing about an improvement in the oral health of these children suffering from autism. The system of visual schedule system along with the weekly repeated visits was successful in providing help to these children showing completion of more number of steps during the appointment. The process also progressed at a quicker rate and the children showed much less amount of distress in their behaviour during the dental appointment in comparison to the traditional method of tell-show-do ().
The intervention implemented Picture Exchange Communication System (PECS) for the individuals suffering from autism spectrum disorder. This intervention helps to reduce the deteriorating impact on the patients who suffer from limited communication skills. Use of this PECS intervention improved the patient and professional communication procedures especially for those who were already suffering from dental experience. A good patient-professional communication can help in preventing referral of the patient with low communication skills to the general anaesthesia procedure. The intervention also promotes minimization of stress and the reduction in the cost of the procedure thus favouring social inclusion of the patients. It is also seen to increase the number of professionals, who are able to cater to the needs of the patient in the outpatient setting. This intervention also emphasises on simplifying the environment of work along with creating of opportunities for communication with the patients suffering from autism spectrum disorder (ASD). Thus PECS has shown the best results in obtaining best results in patient-professional communication especially in the outpatient setting.
There are a number of problems faced by the diagnostic criteria for the children suffering from Autism Spectrum Disorder (ASD). The challenges faced are such as difficulty in social communication along with establishment of relationships and sensory stimulus responses. In order to address such challenges inventions were implemented like providing the caregivers of such individuals with a number of dental stories that the children would believe to be true. There were provisions of digital stories as well as printed ones. The study showed that there was a preference for the digital stories however some caregivers also requested for stories in printed forms with a conventional approach. It was required for the dental providers to enquire about the preferences of the children and their previous experiences before providing the stories. In addition the language preference and the home media preferences should also be kept in mind during the interventions. The intervention helped to find out the child’s preference for home media this served as useful indicators for the future preferences of dental stories. The caregivers and parents of the children were also of positive opinion of this intervention of dental stories in the dental environment. Therefore the intervention helped to serve the children in a relatively simple manner with low cost. It worked as an effective tool which assisted the families of the children with ASD in preparing them for their appointments with the dentists.
The primary focus of this intervention is on the use of approaches of Educational and therapeutic behavioural to the patients who are suffering from Autism Spectrum Disorder (ASD). Most of the dental professionals come across with problems during their practise. Behavioural changes associated ASD in these patients often become a barrier in receiving optimum dental care. Often pharmacological interventions are applied in such conditions, but are not that effective, therefore interventions like the creative educational approach are applied in such patients. This intervention involves investment of extra time in order to understand each child as an individual in order to make accommodations for supporting these children. This way the dentists are able to gain the trust of the children along with the confidence of the child and the family. The intervention promotes that the visits to the dental appointments must be short and the wait time during the appointment must be minimized. Scheduling of appointments must be implemented in order to prevent delays. Children suffering from ASD often have problems with giving attentions. Therefore the appointments must be divided into chunks which would be manageable and would require less time. This also helps to prepare the child for dental visits in a positive way for the lifetime.
In order to address the dental fear in children especially who are suffering from Autism Spectrum Disorders, intervention is used which utilises the electronic screen media. Most of the children are scared of dental procedures, hence fail to receive them. Therefore these children often are needed to be provided with general anesthesia for regular dental procedures which often makes the situation more complicated. This intervention makes use of two kinds of digital screen media for attracting the visual stimuli if the children. This intervention proved to be beneficial as it reduced the fear in children and improve cooperation in their behaviour during the dental appointments. This intervention was quite feasible to address the fear in the children. Then results were quite significant has the intervention had helped to implement a distraction during the ongoing dental procedures, thereby decreasing the uncooperative behaviour of these children.
For facilitating oral assessment of the children with autism spectrum disorders interventions are implemented that uses preparatory aid for facilitating the oral assessments. These Educational and behavioral preparation aids which includes visual pedagogy along with use of tablets and other computer applications in addition to social stories, help to deal with such scenarios. This helps to manage the behaviour of the children during their visits for dental appointments. The positivity of the intervention was derived from the fact that it was appraised by the parents of the children who admitted that the preparatory aids were helpful in addressing the problems of the children. They received assistance through this intervention in catering the needs of their children who were failing to receive dental care due their fear of dental procedures.
References
Anderson, K.L., Self, T.L. and Carlson, B.N., 2017. Interprofessional Collaboration of Dental Hygiene and Communication Sciences & Disorders Students to Meet Oral Health Needs of Children with Autism. Journal of allied health, 46(4), pp.97E-101E.
Bodison, S.C. and Parham, L.D., 2018. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72(1), pp.7201190040p1-7201190040p11.
Fakhruddin, K.S. and El Batawi, H.Y., 2017. Effectiveness of audiovisual distraction in behavior modification during dental caries assessment and sealant placement in children with autism spectrum disorder. Dental research journal, 14(3), p.177.
Isong, I.A., Rao, S.R., Holifield, C., Iannuzzi, D., Hanson, E., Ware, J. and Nelson, L.P., 2014. Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media. Clinical pediatrics, 53(3), pp.230-237.
Jo, C.W., Park, C.H., Lee, J.H. and Kim, J.H., 2017. Managing the behavior of a patient with autism by sedation via submucosal route during dental treatment. Journal of dental anesthesia and pain medicine, 17(2), pp.157-161.
Mah, J.W. and Tsang, P., 2016. Visual schedule system in dental care for patients with autism: A pilot study. Journal of Clinical Pediatric Dentistry, 40(5), pp.393-399.
Marion, I.W., Nelson, T.M., Sheller, B., McKinney, C.M. and Scott, J.M., 2016. Dental stories for children with autism. Special Care in Dentistry, 36(4), pp.181-186.
Murshid, E.Z., 2017. Effectiveness of a preparatory aid in facilitating oral assessment in a group of Saudi children with autism spectrum disorders in Central Saudi Arabia. Saudi Medical Journal, 38(5), p.533.
Nelson, T.M., Sheller, B., Friedman, C.S. and Bernier, R., 2015. Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder. Special Care in Dentistry, 35(3), pp.105-113.
Zink, A., Diniz, M., Rodrigues Dos Santos, M. and Guaré, R. (2016). Use of a Picture Exchange Communication System for preventive procedures in individuals with autism spectrum disorder: pilot study. Spec Care Dentist, 36(5), pp.254-9.
Zink, A.G., Molina, E.C., Diniz, M.B., Santos, M.T.B.R. and Guaré, R.O., 2018. Communication Application for Use During the First Dental Visit for Children and Adolescents with Autism Spectrum Disorders. Pediatric dentistry, 40(1), pp.18-22.
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