Assessing Perceived Impact of Behavior Guidance Tools on Cooperation During Pediatric Dental Visits for Patients within the Autism Spectrum Disorder

Jennifer K. Chou

Maria Velasco

Chou, Jennifer K., Tontat, Yasmin, Morrow, Morgan, Patel, Purvi, Budd, Jeremy
Faculty / Advisor: Velasco, Maria
University of Pennsylvania School of Dental Medicine, Department of Preventative and Restorative Sciences, Division of Pediatric Dentistry


Dental care is intimately linked to the overall health and wellbeing of all children, yet it is often an under-accessed aspect of healthcare for children with autism spectrum disorder. Children with ASD on average deal with higher rates of anxiety and averseness related to sensory-stimulating experiences, such as a dental visit. Factors such as potent flavors, loud noises, and unfamiliar textures can make a visit more difficult and can lead to lack of cooperation in the dental chair for children with ASD. As a result, children with ASD more often undergo general anesthesia (GA) and sedation as compared to neurotypical peers. GA procedures have increased complications associated with treatment, yet do not diminish the likelihood of recurrence. However, learning models that incorporate techniques such as desensitization, visual supports, and distractions have shown to significantly improve the pediatric dental experience of children with ASD.


A behavior modeling video was created at Penn Dental Medicine to simulate the pediatric dental visit experience with Dr. Morrow, which included sitting in the waiting room, an oral examination in the dental chair, and taking dental radiographs. Participants who were under 21 with After completion of the intervention, consenting parents of the participants were contacted via phone call to complete an IRB approved post-visit survey.


Sixteen of 19 total participants cooperated with dental radiograph procurement during the follow up dental visit. Ten of those 16 children had never been able to successfully sit for a radiograph during previous visits (p=0.002). 100% of the participants who were able to obtain radiographs’ parents were contacted via phone call to participate in the post-visit survey. 93.75% of parents found the video to be helpful. 81.25% noticed a positive change in their child’s behavior when compared to previous visits, and 75% believed that watching the video decreased their child’s anxiety.


The multi-modal intervention included behavior guidance principals such as desensitization, visual aid tools, and distractors. With the help of utilizing these techniques, several more patient participants were able to have radiographs obtained in the dental office, some for the first time. Through a follow-up IRB approved survey administered through a phone call, student providers were able to gauge patient perception of the impact that the intervention had on their child’s cooperation during and before a dental visit, and the data collected showed that parent attitudes were generally positive. This multimodal approach should be further explored as a behavior guidance supplement to help impact the cooperation of children within the autism spectrum disorder.