Effectiveness of structural-visual model behavioral approach and predictive factors of cooperativity and compliance in dental examinations for children with autism spectrum disorder

Examination of children diagnosed with Autism Spectrum Disorder (ASD) during dentalappointments pose challenges owing to observed adverse behaviors. These behaviorsare linked to limitations in communication and social interaction during interactionswith dentists. Systematic data collection protocols for children are needed to predictcompliance and cooperative engagement levels during dental examinations, aiming totackle these challenges.Specific aims. The specific aims of this study include collecting the characteristics ofchildren diagnosed with Autism Spectrum Disorder in Yogyakarta and evaluating theeffectiveness of implementing the structural-visual behavior approach in enhancing thecompliance and cooperativity of children with ASD during dental examinations.Additionally, the study aims to analyze the association between predictive factors andcompliance and cooperative behavior during dental examinations. Methods. Phase 1involved a descriptive-analytic study of one hundred and fifteen parents of school-agedASD children aged 6-18 years in Yogyakarta. The subsequent phase included a clinicalintervention with thirty-seven subjects utilizing visual, structural, and behavioralmodels. The effectiveness of the intervention on adherence to examination steps andcooperative attitude in the dental examination was assessed using a quasi-experimentalstudy and the Wilcoxon test. Bivariate and multivariate analysis was conducted toidentify predictor factors associated with compliance and cooperative behavior duringdental examinations. Results. They found that 67% of children had visited a dentist, withonly 35.1% reporting that they received adequate dental care. Besides, only 39% of kidswere impressed with their last visit to the dentist. The study also found that the factorsstatistically significant (p<0.05) to receiving dental visit are bad oral habit (p = 0.033) andtriggering fear (p = 0.04). Whereas reward to children who are cooperative is statisticallysignificant to impression towards dental visit (p = 0.03). Evaluation of the structural-visualbehavioral model approach showed that 89.1% of subjects achieved the highest stage ofdental examination (score 10) and the highest Frank Behavior Scale score(score 4) in posttest3. Wilcoxon test analysis between pre and post-tests 1, 2, and 3 revealed significantdifferences in compliance and co-operation (p<0.01). Predictive factors that statisticallysignificant to compliance of dental examination: one-way direct communication (p =0.005), daily self-care: toothbrushing (p = 0.023), shampooing (p= 0.011), and clothing (p =0.026)), social abilities: sharing activity (p = 0.004), allowing the head to be touched (p =0.02) and verbal abilities (p = 0.49). Furthermore, factors associating to increasedcooperativity are the ability to perform daily self-care in shampoos (OR = 0.65, 95% CI,0.47- 0.90) and social ability in sharing activities (OR = 16.00, 95% CI, 1.77-144.72).Furthermore, regression analysis revealed that the ability to communicate oneinstruction (OR = 3.28, p = 0.010), allowing the head to be touched (OR = 2.22, p = 0.11),and the sharing activity (OR = 2.22, p = 0.19) were more likely associate to compliancewith the dental examination. A series of regression analysis revealed that social careability in sharing activities was a significant predictor to cooperation in dental visit (p =0.025).Conclusion. The structural-visual behavior model approach proved practical infacilitating dental examinations for children with ASD. Multiple factors associate to thecompliance in achieving dental examinations and cooperativity. However, the mostrobust and associate factors for dental examination compliance were the one-waydirection in communication, sharing activities, and allowing someone to touch the headwhile at the barbershop. Moreover, daily social care ability in sharing activity emergedas the most significant factor associate to cooperativity.