Effectiveness of a Tooth Brushing Social Story Among Children With Autism

Abstract

Objectives: To assess and compare preschool children’s performance in tooth brushing following a social-story-based dental health education (SSDHE) intervention compared to a conventional dental health education (CDHE) approach.Methods: Preschool children (332) with autism at special child care centre in Hong Kong were assigned to a test SSDHE intervention group (148 children) or a control CDHE intervention group (204 children) to learn the task of tooth brushing. Performance in tooth brushing was assessed using a standardized 13-step pro forma. Number of tooth brushing steps and number of effective tooth brushing steps successfully completed were assessed and compared over time, and between groups in a 6-month study.Results: The response rate to the study was 67% (222/332). Over time, there were significant improvements in the overall number of tooth brushing steps completed among the test group (p<0.001) and the control group (p<0.001). Likewise, there were significant improvements in number of effective tooth brushing steps completed among the test group (p<0.001) and control group (p<0.001). Those in the test group completed a greater number of effective tooth brushing steps compared to the control group at 3-months (p=0.009) and at 6-months (p=0.003). Controlling for other factors in regression analyses, improvement in performance of tooth brushing at 6-months was associated with baseline performance (OR 0.46, 95%CI 0.35, 0.60, p<0.001), social skill deficits (OR 0.19, 95%CI 0.16, 0.55, p<0.01), reading deficits (OR 0.21, 95%CI 0.05, 0.95, p<0.05) and parental education level (OR 0.45, 95% 0.24, 0.83, p<0.05).Conclusions: There was evidence of improvement in tooth brushing performance among preschool children with autism following the use of a social-story-based education intervention compared to a conventional education approach. However, child developmental factors, level of competency at baseline and parental education factors were key determinants of improvement in tooth brushing performance at 6-months post intervention.