Improving Oral Hygiene in Children with ASD Using Video Modeled Social Stories: A Pilot Study

Background: Many children with ASD have habits placing them at risk for dental decay, and it can be difficult to treat these problems in the clinic. Consequently, providers often must complete treatment under general anesthesia in the operating room, straining families and the healthcare system. Improving oral hygiene is the most effective way to reduce decay in this population. Given the powerful impact of social stories and technology on individuals with ASD, the use of video-modeled stories for addressing dental decay risk in children with ASD is a promising, yet unexplored, area of research.

Objectives: To investigate the effectiveness of video-format social stories for educating children about dental hygiene techniques.

Methods:

Thirteen children with a diagnosis of ASD were recruited from a pediatric dental clinic (Mean age = 9.4 years; 5 females). ASD diagnoses were confirmed with medical records and the Social Responsiveness Scale-2, Parent Report. Participants were randomly assigned to one of two groups: experimental (n=6) and control (n=7).

Parents received a link twice daily for three weeks prompting them to watch an assigned video with their child and confirm their child’s brushing. The experimental video showed a girl using proper brushing technique with spoken instructions; the control video showed bright moving shapes and music. Post intervention, participants were given a link to their intervention video and allowed to watch it freely for the next three weeks. Following this final period, participants were given links to both videos and completed an outcome survey.

Children visited the clinic at intake (T1) and twice more at 1.5-week intervals (T2-3) over the course of the intervention. At each visit they received a four-tooth plaque index exam by a clinical examiner blinded to experimental condition. Parents completed a survey about their child’s functioning and oral hygiene at each clinical visit.

Results: Two children from each condition dropped out of the study and were excluded from analysis. Groups did not differ in age, SRS-2 scores, or number of times they viewed their video. A repeated-measures ANOVA assessing improvements in dental hygiene (measured by plaque index results) between groups over time showed that children’s oral hygiene improved in both groups (p<.05). While no group main effect or group x time interaction was detected, possibly due to small sample sizes, effect sizes suggested greater improvements in oral hygiene in the treatment group. At T1: Control group M=1.60, SD=.95 and Experimental group M=1.63, SD=.55 (Cohen’s d = -0.04). At T2: Control group M=1.45, SD=.74 and the Experimental group M=.75, SD=.74 (d = .95). Finally, at T3: Control group M=1.2, SD=1.05 and Experimental group M=.38, SD=.90 (d = .84).

Conclusions: Both groups improved their oral hygiene, suggesting that email reminders to brush or the routine of watching a video may promote dental health independent of the video’s content. This ongoing study shows that technological aids delivered to patients may be a helpful, low-cost strategy for improving oral hygiene in a large number of patients.