Exploring companion robots for children with autism spectrum disorder: a reflexive thematic analysis in specialist dental care

Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home-based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their child's oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.

Autism spectrum disorder (ASD) presents intricate challenges in managing oral and dental health, necessitating a comprehensive understanding of its diverse manifestations and associated difficulties. Despite the absence of specific oral peculiarities directly linked to ASD, individuals diagnosed with ASD often experience poorer oral health outcomes compared to the general population. Factors such as sensory sensitivities, communication barriers, and behavioral challenges contribute to difficulties in maintaining optimal oral hygiene, resulting in a higher prevalence of teeth decay. Furthermore, children with ASD exhibit unique challenges during dental visits, including sensory aversions, communication difficulties, and behavioral issues, necessitating tailored interventions and accommodations by dental professionals. The collaboration between parents, dentists, and other healthcare providers is essential in addressing the oral health needs of individuals with ASD, emphasizing the importance of a multidisciplinary approach. Despite ongoing research efforts to elucidate the intricacies of oral health in ASD, conflicting findings underscore the complexity of the topic and highlight the need for further investigation. By prioritizing oral and dental health management and fostering collaborative partnerships between caregivers and healthcare professionals, it is possible to enhance the quality of life and well-being of individuals with ASD. To achieve this, targeted interventions should be developed to address the unique challenges faced by individuals with ASD in oral hygiene practices and dental care settings. Ultimately, raising awareness among parents and healthcare providers about the significance of oral health in individuals with ASD is crucial for promoting preventive measures and ensuring access to appropriate dental care services.

Introduction/BackgroundTo review the literature on chronic pain and autism spectrum disorder (ASD). A key aim is to explore the prevalence of chronic pain in children with ASD and the impact that ASD could have on the experience of chronic pain.Description/MethodAfter reviewing the literature, a thematic analysis was completed in order to identify key patterns. The thematic analysis identified four key topics: Prevalence of chronic pain in ASD; Impact of comorbid ASD and chronic pain; Psychological flexibility; Sensory sensitivities.Discussion/ResultsThe literature demonstrates that the prevalence of chronic pain is higher in children with ASD than the general population; studies show the prevalence of pain to be almost doubled in children with ASD (ASD = 15.6%; without ASD = 8.2%). Chronic pain can also have a more significant impact on functioning in children who exhibit ASD traits, shown through higher pain interference, higher depression levels and lower health related quality of life. This greater functional impairment means interventions are particularly important, however, challenges are highlighted by the literature; ASD traits may affect the efficacy of talking therapies and treatment guidelines are not specific, such as those for comorbid ASD and anxiety not being intended for use with physical health conditions.An important protective factor identified in comorbid chronic pain and ASD is psychological flexibility; acting on long-term values rather than current thoughts and feelings. However, this is typically low in ASD thus highlighting a role for Acceptance and Commitment Therapy (ACT), which aims to increase psychological flexibility. This is supported in chronic pain research where ACT leads to improved functioning, particularly in those with higher ASD traits.A discrepancy exists in chronic pain literature as there is a higher prevalence of children with clinically significant ASD traits than with confirmed ASD diagnosis. It appears that medically unexplained pain can interfere with ASD diagnosis, with it often being the first presenting symptom in undiagnosed ASD, and oversensitivity to pain has been associated with delayed ASD diagnosis. Sensory and perceptual abnormalities are commonly seen in ASD, with research indicating an underlying link between hypersensitivity and pain. However, current pain sensitivity findings can often not be generalised to children with comorbid chronic pain and ASD; studies tend to exclude those with such physical health conditions and investigate only acute pain sensitivity in ASD.Key learning points/ConclusionThere is a link between chronic pain and ASD evident in the literature as children with ASD are at a higher risk of developing chronic pain than the general population, particularly if they also experience abnormal or hypersensitivities.Chronic pain is likely to have a greater impact on children with ASD, including higher depression levels and lower quality of life.Due to the risk for greater functional impairment, it is particularly important to manage chronic pain in children with ASD, however common ASD traits and a lack of specific guidelines pose challenges in doing so.Due to a lack of existing research, further research is required to gain understanding of the link between chronic pain and ASD, including exploring sensory abnormalities in chronic pain and the management of comorbid chronic pain and ASD.It is important raise awareness of this association amongst clinicians, particularly due to the prevalence of undiagnosed ASD, the impact on intervention, and the risk for more severe functional impairment in paediatric chronic pain.

This study aimed to assess oral hygiene practices, dental conditions, and access to dental care among children with autism spectrum disorder (ASD) in Tunisia. This descriptive cross-sectional study included 48 children diagnosed with ASD. Data were obtained through a structured questionnaire completed by caregivers and a clinical oral examination. The questionnaire comprised 25 items divided into three domains: (1) Knowledge (awareness of oral hygiene importance, fluoride use, recognition of dental caries, and regular dental checkups); (2) Attitude (motivation for oral care, caregiver perception of dental visits, and beliefs about prevention); (3) Practices (tooth brushing frequency, technique, use of toothpaste, dental attendance, and dietary habits). The clinical examination assessed oral hygiene status, presence of untreated caries, gingival condition, and parafunctional oral habits. Descriptive statistics were used to analyze the data. Of the 48 children included in the study, 23% (n = 11) were classified at the severe end of the autism spectrum, while the remaining 77% (n = 37) presented with mild to moderate forms of ASD. Poor oral hygiene was observed in 46.6% (n = 14) of the children, untreated dental caries were present in 36.6% (n = 11), and 60% (n = 18) had never visited a dentist. Additionally, 33.3% (n = 10) of the children did not brush their teeth regularly. The presence of gingival inflammation and parafunctional habits was also noted but varied across severity levels of ASD. The study reveals considerable challenges regarding oral hygiene behaviors, dental health status, and access to dental care among children with ASD in Tunisia. These findings underscore the necessity for targeted oral health education programs and enhanced caregiver involvement to improve oral health outcomes in this population. A better understanding of the specific oral health needs of children with ASD is essential for tailoring dental care protocols. Focused caregiver training and adapted dental approaches are recommended to promote improved oral hygiene practices and overall oral health in children with ASD. How to cite this article: Ben Hadj Khalfa A, Boukhris H, Ayari G, et al. Oral Health Challenges and Hygiene Practices in Children with Autism Spectrum Disorder: A Cross-sectional Study from Tunisia. J Contemp Dent Pract 2025;26(6):581-586.

Sensory symptoms were recently added to the diagnostic criteria of autism spectrum disorder and may be a mechanism underlying the broad phenotype of autism spectrum disorder. To measure sensory symptoms based on perceptual rather than affective, regulative, or attention components, the Sensory Perception Quotient (SPQ) measuring five modalities of sensory sensitivity has been developed. In this study, the Dutch translation of the abridged SPQ-Short was investigated in a large sample of adults with (n = 657) and without autism spectrum disorder (n = 585). Its hypothesized factor structure, combining modality specific and one modality-independent factor, was assessed in a hierarchical model. Results show that modality-specific subscales are indeed present in the short version. Furthermore, its reliability is high and comparable to the original English version. The autism spectrum disorder group reported higher sensory sensitivities than the comparison group, and women with autism spectrum disorder reported higher sensitivities compared with men with autism spectrum disorder. The SPQ-Short correlates with all Autism Quotient (AQ)-Short subscales, except for the “imagination” subscale. The SPQ-Short seems suitable to further explore the relationship between basic sensory sensitivities in autism spectrum disorder and their related symptoms such as over- and under-responsivity to sensory stimulation.Lay Individuals on the autism spectrum often experience heightened or reduced sensory sensitivities. This feature was recently added to the diagnostic manual for autism (Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5)). To measure sensory sensitivities, the Sensory Perception Quotient (SPQ) has been developed. In this study, we tested whether a Dutch translation of the abridged SPQ-Short yields similar results as the original English version. We also tested whether this questionnaire can measure modality specific sensitivities. To this end, 657 adults with autism spectrum disorder and 585 adults without an autism spectrum disorder diagnosis filled out the Dutch SPQ-Short. The Dutch questionnaire data were very similar to the original English version: adults with autism spectrum disorder were more sensitive compared with adults without autism spectrum disorder. Women with autism spectrum disorder are more sensitive compared with men with autism spectrum disorder. Gender did not have an effect in the group without autism spectrum disorder. Individuals reporting higher sensory sensitivities also reported more autistic traits (such as lower social interests, or increased fascination for patterns). Finally, we found that the Dutch SPQ-Short is suited to measure modality-specific sensitivities. We conclude that the Dutch translation is a viable tool to measure sensory sensitivities in adults with and without autism spectrum disorder and can be used to further our understanding of differences in perception in people with or without autism spectrum disorder.

Background/Objectives: Children with autism spectrum disorder (ASD) often face challenges in maintaining oral hygiene due to sensory sensitivities, behavioral difficulties, and limited access to specialized dental care. This study aimed to assess the oral hygiene status of children with ASD and compare it with neurotypical peers. Methods: A cross-sectional study was conducted with 74 children with ASD and 74 neurotypical children. Dental exams measured oral hygiene and caries prevalence using the DMFT/dmft, Oral Hygiene Index (OHI), and Sulcus Bleeding Index (SBI). Tooth brushing frequency and dental visits were also recorded. Statistical analysis was performed using the Mann-Whitney U test and Fisher's exact test. Results: Children with ASD had significantly poorer oral hygiene and higher caries rates compared to controls. Boys with ASD had higher DMFT scores, indicating more caries. Additionally, ASD children brushed their teeth less often and had fewer dental visits. Preventive treatments were underutilized in this group despite a higher need. Conclusions: Children with ASD face notable oral health challenges, including poor hygiene, higher caries prevalence, and limited preventive care. These findings highlight the need for tailored interventions, improved parental education, and specialized dental care strategies for this population.

Autism Spectrum Disorder (ASD) presents unique challenges in behaviour management, requiring tailored approaches. This paper explores the impediments academic psychologists face in administering Behavior Management Techniques (BMTs) for children and adults diagnosed with ASD. Qualitative research was employed to discover the views of academic psychologists. The investigator selected the participants through a purposive sampling technique and performed semi-structured interviews to accumulate the views. Academic psychologists within the Punjab province, Pakistan, were taken as the population of the study. The group of five academic psychologists was selected purposefully to discover the phenomenon. Academic psychologists were recruited from the Govt. Special Education Centers, along with the experience of diverse clinical settings, hospital practices and clinical sessions with children and adults diagnosed with ASD. Twelve open-ended questions were designed to inquire from the respondents and to facilitate a deeper dialogue about the phenomenon of the study. Reflexive thematic analysis was employed over the views of academic psychologists. The analysis process involved coding the data to perceive the patterns of the data. Patterns were prepared into broader themes and then sub-themes to increase the complete understanding of the statistics. Key impediments were identified, including communication challenges, sensory sensitivities, individualized needs, and lack of parental involvement. Understanding these impediments is crucial for developing effective interventions and improving outcomes for children and adults diagnosed with ASD.

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAs Number of Adults With Autism Rise, Need For Better Services ApparentNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:25 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.12AbstractWhile there is a growing recognition of the health risks adults with autism face, much remains unknown about how best to effectively care for this population.iStock/scyther5Recent data from the Centers for Disease Control and Prevention (CDC) suggest that the prevalence of autism spectrum disorder (ASD) among U.S. children is on the rise. An estimated 1 in 54 8-year-olds was identified as having ASD in 2016, up from 1 in 150 when the CDC began national tracking in 2000.While early recognition of ASD in children and wraparound services such as speech and behavioral therapy have helped many, most people with ASD will continue to experience challenges well into adulthood.“This is a problem at a societal level, since these new adults are transitioning to a world that wasn’t set up for them,” said Brittany Hand, Ph.D., an assistant professor of health and rehabilitation science at the Ohio State University and occupational therapist.How big is the problem? According to data released by the CDC in 2020, autism effects just over 2%—or about 5.5 million—of adults aged 18 to 84 nationwide.This estimate, based on historic ASD prevalence rates in children and state-by-state mortality data, is likely an underestimate, explained psychiatrist Robert Wisner-Carlson, M.D., chief of the Autism and Neurodevelopmental Outpatient Program at Sheppard Pratt in Towson, M.D.Though child psychiatrist Leo Kanner, M.D., first described autism in 1943, the diagnosis was likely missed in children for several decades. “Many children with ASD who grew up in the 1940s, 50s, or 60s probably never got evaluated,” he said.This hidden population could present challenges, added Hand, who works with people with ASD. “I’m not sure if our health system is prepared to meet the needs of this vulnerable population as they age,” she said.Much Unknown About ASD in AdultsExperts interviewed by Psychiatric News noted that there are few data to help guide clinical and supportive care of adults with autism. Historically, only 1% to 2% of federal funding for ASD research has supported the study of adults.Wisner-Carlson believes multiple factors over the years created this widening knowledge gap, but the seeds can be traced to Kanner’s pioneering work. “This disorder was first identified by a child psychiatrist, and that set the path for future research to be child-centric,” he said. As still holds true today, researchers first diagnosing ASD in children lacked the time and resources to follow the patients over long periods of time, so they were not studied into adulthood.Additionally, adults with ASD were not likely recognized by physicians in those early years, noted Elizabeth Wise, M.D., a geriatric psychiatrist at the Johns Hopkins Adult Autism and Developmental Disorders Center. High-functioning adults received no diagnoses, while those with more severe ASD were typically misdiagnosed with schizophrenia.There is increasing awareness today of the impact that ASD has on adults, Wise said. Patients at her center have been referred by psychiatrists, neurologists, and primary care physicians. “Even patients come to us themselves sometimes, typically after they have a child who gets diagnosed and they reflect on their own condition.”As is the case with children with the disorder, adults with ASD often have difficulties communicating and recognizing socially unacceptable behaviors, and they can be prone to outbursts. Adults with ASD typically have less social anxiety than children, as they have slowly adapted to their surroundings with age.“A definitive ASD diagnosis can only be made if you know the symptoms started in early childhood,” Wisner-Carlson said. For older adults without parents or siblings who can be informants, it may not be possible to confirm symptom onset.Despite Need, Few Services AvailableAs with research funding, policy decisions funding ASD services have focused predominantly on children. Laws such as the 1975 Individuals with Disabilities Education Act—which mandates special education and wraparound services to children with ASD and other intellectual disabilities—expire at age 21.“For many children with disabilities, that’s enough time to give them a chance at success in adulthood,” said Christopher Manente, Ph.D., the executive director of Rutgers Center for Adult Autism Services in New Jersey. “But the nature of autism makes it different from every other disability and points to why we need more support.”Manente told Psychiatric News that common ASD behaviors, such as difficulties communicating and understanding social norms, hinder people’s ability to integrate into society.“Being able to connect with other humans lets them know you have value to add,” Manente explained. “But many individuals with ASD have an inherent inability to do that.”Given these social difficulties—and the limited availability of ASD services for adults, such as skills or job training—many adults with ASD are unemployed, living at home, and socially isolated.“A common thread of people with autism is that they do not handle transitions well,” Wisner-Carlson said. Even small transitions—such as a schedule change in a daily bus route—can affect the well-being of people with ASD, who are comfortable with routines. Major life transitions, such as entering a nursing home and/or the death of a caregiver, can completely derail a person with ASD emotionally.Hand has combed data from hospital records and Medicare claims to tease out some details about the health challenges adults with ASD face as they grow older. Her analyses have shown that older adults with ASD are more likely than the general Medicare population to have hypertension, diabetes, mood disorders, osteoporosis, arthritis, heart problems, and cognitive impairment.The ASD literature on children indicates that they often have comorbid attention-deficit/hyperactivity disorder, personality disorders, epilepsy, and/or gastrointestinal issues. Hand’s research has found that these problems are also prevalent among older adults with ASD. The risks of these various comorbidities may be even higher in adults who are minorities and of lower socioeconomic status, she noted.When you factor in the risks for mood problems, impulsivity problems, and social difficulties, it is no surprise that self-harm and suicide are more common in adults with ASD compared with the general population, Wisner-Carlson continued, though this connection is underappreciated. One 2017 study of 42 adults with ASD found that 50% had injured themselves, while Hand’s analysis of Medicare recipients with ASD found an 11-fold increased risk of self-harm or suicidal ideation compared with Medicare enrollees without ASD.Factors to Consider When Working With Adults With ASDEven though adults with ASD are at greater risk of health problems than those without ASD, they often have less access to specialist care and are more likely to seek care in the emergency room, Hand said. She noted that this disparity may be driven in part by health professionals who lack training in how to treat adults with ASD and may feel uncomfortable doing so, she said.This discomfort exists even among some mental health professionals, Wisner-Carlson noted. “ASD is more common than schizophrenia, which [adult] psychiatrists train for,” he said. “But we draw a lot of our clinic patients from psychiatric hospitals in the region, because they tell us they don’t have the tools to care for them.”That’s why education and training for medical residents, nurses, and social workers is an important component of the services offered at places like Sheppard Pratt, Johns Hopkins, Rutgers, and Ohio State (which recently established a Center for Autism Services and Transition to provide tailored primary care for young adults with ASD).“We need to professionalize adult autism services in the same manner they are for children,” Manente said. “We know that adults with ASD need a lot of support at any age.”In the short term, Manente implored psychiatrists to be confident when treating patients with ASD.“Many psychiatrists may get their first experience of adult ASD in the emergency room with an agitated patient, but such cases reflect a small proportion of this community,” Wise added.Wise said psychiatrists should be mindful that a common symptom of ASD is sensory sensitivity, so they should make sure to ask patients about light and sound levels and be cognizant about physical procedures, including taking blood pressure.“The presence of a mood disorder can be difficult to tease out, since many people with ASD, including high-functioning individuals, cannot tell you how they feel emotionally,” noted Wisner-Carlson, who has extensive experience managing a comprehensive outpatient program for over 600 adults with ASD and other neurodevelopmental disorders.“Communication can be difficult, but most talk-based therapies can be effective for people with autism,” Manente added. “An ASD diagnosis should not be an exclusion for behavioral therapy.” ■“National and State Estimates of Adults With Autism Spectrum Disorder” is posted here.“Prevalence of Physical and Mental Health Conditions in Medicare-Enrolled, Autistic Older Adults” is posted here.“Untended Wounds: Non-Suicidal Self-Injury in Adults With Autism Spectrum Disorder” is posted here. 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Atypical responses to sensory stimuli, termed sensory sensitivities, are a commonly reported symptom for individuals diagnosed with Autism Spectrum Disorder (ASD). In this community-based study of 604 adults, the correlation between sensory sensitivities and ASD symptoms was r = 0.23, p < .001, representing a smaller relation than estimates previously reported in the peer-reviewed research. Additionally, when examining only participants who met or exceeded the ASD screening cutoff score, the relation between sensory sensitivities and ASD symptoms was only slightly larger at r = 0.25, p < .001. Forty-four percentage who met the screening cutoff score for ASD also reported the lowest degree of sensory sensitivities. Finally, just over one-third who met the screening cutoff score for ASD had the highest sensory sensitivities. Sensory sensitivities did not appear to be a consistent feature across adults meeting the ASD screening cutoff score, but a proportion meeting the ASD screening cutoff score also exhibited the most extreme sensory sensitivities.

BACKGROUNDChildren with autism spectrum disorder (ASD) face unique challenges in maintaining oral health due to sensory sensitivities, communication difficulties, and behavioral barriers. These factors, along with limited access to ASD-trained dental professionals, increase their risk of dental caries, periodontal disease, bruxism, and other oral health issues. Despite growing awareness of these challenges, a comprehensive synthesis of evidence-based solutions remains lacking.AIMTo review synthesizes existing research on dental problems in ASD, barriers to care, management strategies, and future directions for improved oral health outcomes.METHODSA systematic search of PubMed, Cochrane Library, and Scopus was conducted using predefined search terms. Related to ASD, dental health, and management strategies. Inclusion criteria encompassed studies focusing on children with ASD, dental health issues, and interventions. Data extraction included study design, participant characteristics, key findings, and intervention outcomes. The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. A narrative synthesis approach, incorporating thematic analysis, was utilized to evaluate the findings.RESULTSA total of 165 studies met the inclusion criteria. Children with ASD exhibited a higher prevalence of dental caries, gingivitis, bruxism, and malocclusion compared to neurotypical peers. Barriers to dental care included sensory sensitivities, communication difficulties, financial constraints, and a shortage of ASD-trained dental professionals. Effective interventions included desensitization programs, behavioral therapy, digital applications, and interdisciplinary collaboration. Parental education and professional training were crucial for improving oral health outcomes.CONCLUSIONTailored dental care strategies, including sensory adaptations, behavioral interventions, and interdisciplinary collaboration, are essential for children with ASD. Standardized guidelines and long-term studies are needed to refine evidence-based protocols. Future research should explore digital interventions and probiotic applications in ASD dental care.

Purpose: This study aimed to evaluate the oral health status and hygiene practices of children with autism spectrum disorder (ASD) in Almaty, Kazakhstan, and to assess parental awareness regardingtheir children’s oral care. Methods: The study was conducted involving 53 children aged 3 - 18 years with a confirmed ASD diagnosis, recruited from the “Autism Pobedim” rehabilitation center in Almaty. Clinical examinations assessed caries using the DMFT/dmft, CAST indices, and oral hygiene using the OHI-S index. A 36-item parental questionnaire collected information on children’s oral hygiene routines, dental care experiences, and behavioral characteristics. Results: The study revealed inadequate oral hygiene practices, with only 24.5% of children brushing their teeth twice daily. Most children relied on parental assistance for brushing. Notably, 30.2% had never visited a dentist, and among those who had, 58.5% exhibited behavioral difficulties requiring sedation, restraint, or general anesthesia. Only 39.6% of dental visits resulted in completed treatment. Dietary habits were unfavorable, with 71.7% of children consuming sweets between meals and just17% rinsing their mouths after eating. While 75.5% of parents were aware of toothpaste composition, there was limited professional guidance and a lack of adapted dental services. Conclusion: Children with ASD in Almaty showed a high prevalence of dental caries, limited independent oral hygiene, and significant challenges accessing effective dental care. These findings highlight the urgent need for specialized dental care protocols and public health strategies tailored to the needs of children with ASD in Kazakhstan.

This study explored the role of special care dentistry (SCD) education in enhancing oral healthcare accessibility for people with disabilities and frail older adults. An online questionnaire about SCD was distributed among dentists and dental hygienists in Flanders (Belgium) in December 2020 and January 2021. Descriptive and bivariate analyses were performed to compare the responses of these two professional groups. Among dentists, adjusted binary logistic regression analyses were performed to study the relationship between prior education on SCD and the willingness to engage in future SCD initiatives. Furthermore, an open-ended question requesting suggestions about SCD was analysed using the principles of thematic analysis. In total, 51 dental hygienists and 308 dentists responded. Both groups reported treating SCD patients, mostly between a few times a year and monthly. A higher proportion of dental hygienists received prior education on SCD and exhibited openness to future SCD initiatives than dentists. Responding dentists with prior education on SCD had higher estimated odds for the willingness to receive future education. Analysing the open-ended question, dentists attributed their lower willingness to factors beyond their control and emphasised the need for an established role for dental hygienists in SCD. Most dental care providers deliver SCD infrequently. More than half of the dentists reported they never received SCD education. Dentists are less willing than dental hygienists to contribute to future SCD initiatives. To encourage dentists in future service provision, SCD educational initiatives could help, but must be supported by governmental actions and regulations.

Objective: This review aimed to seek insights into the challenges faced by caregivers and children with autism spectrum disorder (ASD) when performing and accessing oral care and their recommendations to overcome the matter. Methods: Six electronic databases were used to search for published English full articles using a standardised strategy and grouped using thematic analysis as findings to the study’s goal. Results: The initial screening found 46 relevant articles, but 21 were deemed eligible. Studies were mostly observational (18 crosssectional surveys and 3 case-controls), retrieving data from online or face-to-face surveys and insurance health info. The perceptions and potential solutions made by parents, teachers, doctors, and individuals with ASD were diverse but mostly consistent in most studies with a focus on issues of oral health as low priority, incompetency in oral health care performance at home, children’s cooperation and involuntary behaviours in dental settings, and constraints in related resources. Conclusion: Carers’ lack of awareness and prioritisation of treatment for children with ASD, challenges in performing oral care at home, concerns over oral health care provided by caregivers in educational institutions and dental clinics, and challenges in accessing more supportive oral health care services were highlighted as barriers to oral care.

ABSTRACTObjective: Selective or “picky” eating (SE) refers to rejection of a wide range of familiar and unfamiliar foods based on aversions to their sensory properties. When severe, SE can cause symptoms of avoidant/restrictive food intake disorder (ARFID), including weight loss, nutritional deficiencies, and/or psychosocial impairment. SE is highly prevalent in autism spectrum disorder (ASD) compared to both typical development and other developmental disorders. A possible explanation for the high prevalence of SE in ASD is the effect of core ASD symptoms, repetitive/restrictive behaviors (e.g., rigidity), and sensory sensitivity on feeding behaviors. These traits are found not only in ASD but also in other clinical groups and the general population, albeit often at subclinical levels. Identifying mechanisms of SE across various populations is critical to inform intervention approaches.Methods: In 263 unselected children ages 5–17, 534 unselected college students ages 18–22, 179 children with anxiety/obsessive spectrum disorders ages 5–17, and 185 children with ASD ages 4–17, we explored the unique contributions of sensory (i.e., oral texture and olfactory) sensitivities and rigidity as predictors of self/parent-reported SE.Results: In each sample, rigidity and oral texture sensitivity, controlling for olfactory sensitivity, age, and gender, emerged as significant, independent predictors of SE.Conclusions: This is the first study to highlight the importance of cognitive/behavioral rigidity to SE, and one of the first to illustrate the domain-specificity of the relationship between sensory sensitivity and SE.

Autism spectrum disorder (ASD) is characterized by challenges in social interaction, communication, and stereotypical patterns of behavior. They are more likely to have tooth brushing issues and need help with routine dental care. Children with ASD could face difficulty in accessing dental care as the parents have a challenging task in finding a dentist that would treat the child with special needs. As a result, dental care is often neglected. The aims of this study are to evaluate oral hygiene practices and challenges in children with ASD and compare it with typically developing peers (TDP). The sample size of the study was 60. Parents of children aged 3-10 were recruited and divided in 2 groups with 30 in each group. Age and gender of children were matched. ASD group included children with medical diagnosis of ASD only and no other co-morbidities. Children in TDP group had no diagnosis of ASD, and reported no disability, or any other diagnosis. Parents were asked to complete the questionnaire which asked about their demographic information, child's oral care regimens, and their knowledge about dental care. Chi-squared tests and t-test were used for statistical analysis. A p-value of .05 was used for determining statistical significance. Many children with ASD (47%) had to travel more than 20 miles for their dental home compared to 13% with TDP (p<.05). Only 60% of children with ASD brushed twice a day with 70% of parents reporting that it is difficult to brush their child's teeth compared to TDP with 93% of children brush twice daily (p<.05). Significantly a smaller number of children with ASD (47%) allowed their parent to brush their teeth as compared to 93% of TSD children (p<.001). Parents of children with autism spectrum disorder travel longer distance to find a dental home and face more difficulty in maintaining their child's daily oral hygiene.