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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM

ARTICLE

ABSTRACT Oral care and sensory sensitivities

Children with autism spectrum disorders
(ASD) are at high risk for oral disease.
The aim of this study was to examine the
in children with autism spectrum
contribution of sensory processing prob-
lems to challenges in receiving oral care disorders
for children with ASD.
A questionnaire was sent to the par-
ents of 206 children with disabilities to Leah I. Stein, MA, OTR/L;1* José C. Polido, DDS, MS;2 Zoe Mailloux, MA,
test the hypotheses that children with OTR/L, FAOTA;3 Gina G. Coleman, MA, OTR/L;4 Sharon A. Cermak, Ed.D.,
ASD, relative to children with other dis-
abilities, experience greater difficulty
OTR, FAOTA5
with home-based and professional oral 1
Doctoral Student, Division of Occupational Science and Occupational Therapy at the Herman Ostrow
care, and that these difficulties may
School of Dentistry, University of Southern California, Los Angeles, California; 2Board Certified
relate in part to sensory processing
Pediatric Dentist, Head-–Division of Dentistry, Children’s Hospital Los Angeles, Los Angeles, California,
problems. The results partially sup-
and Associate Professor of Clinical Dentistry, School of Dentistry, University of Southern California, Los
ported these hypotheses. Compared to
Angeles, California; 3Executive Director of Administration and Research, Pediatric Therapy Network,
children with other disabilities, those
Torrance, California; 4Executive Director of Practice and Education, Pediatric Therapy Network,
with ASD had greater behavioral difficul-
Torrance, California; 5Professor of Occupational Science and Occupational Therapy, Division of
ties and sensory sensitivities that
Occupational Science and Occupational Therapy at the Herman Ostrow School of Dentistry, University
parents believed interfered with their
of Southern California, Los Angeles, California.
child’s oral care. Among children with
*Corresponding author e-mail: lstein@usc.edu
ASD, sensory sensitivities were associ-
ated with oral care difficulties in the
Spec Care Dentist 31(3): 102-110, 2011
home and dental office, and with behav-
ioral difficulties in the dental office.
Utilizing strategies to modify the sen-
sory environment may help facilitate oral
care in children with ASD. Introduction
Oral health is integral to both physical and psychological well-being.1 Unfortunately,
children with disabilities are almost twice as likely to have unmet oral health care
KEY WORDS: ASD, sensory
needs than their peers without disabilities,2 and consequently have an increased preva-
processing, dental care, behavior
lence of dental disease.3
difficulties, sensory integration, occupa-
Children with autism spectrum disorders (ASD), a condition characterized by
tional therapy
impaired social interaction, abnormalities in communication, restricted interests, and
repetitive and obsessive behaviors,4 represent one such population at high risk for poor
oral health.5,6 The prevalence of autism in the U.S. in 2010 was estimated to be approx-
imately 1 in 110 children.7 Therefore, dentists are likely to encounter children with
ASD in their practices.8

Among this population, co-occurring
disorders, the effects of prescribed med-
ications, increased or reduced saliva in
the mouth, poor dietary habits, damag-
ing oral habits such as bruxism or pica,
and poor oral self-care can impede ade-
quate oral care and increase the risk of
developing caries and periodontal dis-
ease.6,9 Children with ASD often face
significant hardships in accessing dental
care, due to difficulty locating a dentist
as well as difficulty tolerating treat-
ment.3,9,10 Difficulty tolerating treatment
may be due to many factors, including
but not limited to: appointment type, life
skills, a child’s participation with brush-
ing their teeth, and difficulty adjusting to
changes in routine.6,9,11 Other factors,
which have the potential to impede oral
care, can include the child’s communica-
tion difficulties, cognitive impairments,
and dental fear and anxiety.11,12
Sensory processing difficulties, which
are well-documented in children with
ASD,13-15 may also contribute to poor oral
care in the home and dental office. When
such problems are present, responses to
incoming sensory stimuli are not graded

102 S p e c C a re D e n t i s t 3 1 ( 3 ) 2 0 1 1 ©2011 Special Care Dentistry Association and Wiley Periodicals, Inc.
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
appropriately, leading to an over- or
underreaction to stimulation,13,14 which
can be detected physiologically or behav-
iorally.16,17 As a result of these difficulties
in modulating sensory input, children
with ASD often respond atypically to
visual, auditory, tactile, olfactory, or gus-
tatory stimuli. In a study based on
responses to caregiver questionnaires,
Baranek et al.13 found that responses to
sensory stimuli significantly affected 69%
of children who have autism. In another
caregiver report study, 58% of children
with ASD were distracted by or had trou-
ble functioning in the presence of
surrounding noise, 51% responded nega-
tively to unexpected loud noises, 24%
covered their eyes or squinted to protect
their eyes from light, and 46% avoided
certain tastes or food smells.18 Of particu-
lar relevance to oral care, children with
autism may also flinch or withdraw from
tactile stimuli (particularly light touch)
and be uncomfortable being touched by
people or objects.19 Children commonly
display hypersensitivity in and around
the mouth, leading to extreme aversive
responses to touch or to different textures
of food or objects placed in this area.20-22
Consistent with the above findings,
the National Institute of Dental and
Craniofacial Research9 has indicated that
responses to tactile, auditory, visual, or
olfactory stimuli have the potential to
impede oral care for children with
autism. When a child with hypersensitiv-
ities is introduced to these sensory
stimuli, such as in a dental office, “fight,
fright or flight” reactions may occur,
including physical withdrawal, vocal out-
bursts, aggressive behaviors, tantrums, or
attempts to block the stimuli.23,24
Dentists have indicated that behavior
problems such as these are the greatest
barrier to their willingness to treat chil-
dren with disabilities.25 These
uncooperative behaviors, which may in
part relate to or be exacerbated by sen-
sory sensitivities in addition to other
factors noted previously, make maintain-
ing adequate oral care especially difficult
in children with ASD.
Despite the high prevalence of sen-
sory sensitivities in the population with
ASD and their potential to impede effec-
Stein et al.
tive oral care in the home and dental
office, there is little empirical evidence
regarding the relationship of such prob-
lems to oral care. Therefore, the purpose
of this study was to examine oral care
difficulties and sensory sensitivities in
children with ASD and other disabilities.
Methods
Design and hypotheses
The research design consisted of a corre-
lational assessment of the relationship
between sensory processing difficulties
and oral care problems. Data were based
on parental responses to questions that
were included as part of a clinic-based
evaluation survey conducted both online
and via mail between April and August
of 2009.
Using data from this parental ques-
tionnaire, three sets of hypotheses were
investigated. The first set of hypotheses
examined whether children with ASD,
relative to children with other disabili-
ties, would have a greater prevalence of:
oral care difficulty on a daily basis, dis-
like of toothpaste’s taste, and dislike of
the feeling of the toothbrush in the
mouth. The second set of hypotheses
examined whether there was a greater
prevalence of parents of children with
ASD, relative to parents of children with
other disabilities, reporting: difficulty
getting their child’s teeth cleaned at the
dental office, behavior difficulties that
parents believed interfered with care at
the dental office, and sensory sensitivities
that parents believed interfered with care
at the dental office. The third set of
hypotheses examined whether sensory
processing difficulties in children with
ASD were associated with behavioral
problems in the dental office, as well as
with oral care difficulties in the home
and the dental office.
Participants
The study respondents were 210 parents
of children who received services from
Pediatric Therapy Network (PTN), a
nonprofit organization offering physical,
occupational, and speech-language thera-
pies for children and adolescents with
special needs. This represents an approx-
imate 20% return rate. Of the
respondents, approximately 66% were
receiving occupational therapy, 42%
physical therapy, 33% speech and lan-
guage therapy, and 24% early
intervention services. Data from four
respondents were excluded due to incon-
sistent information provided about
diagnosis. Therefore, 206 surveys were
included in the final analysis.
Instruments
Data were based on a series of items that
were included at the end of PTN’s
Annual Survey, a 29-item questionnaire
designed to evaluate consumer satisfac-
tion with services received from the
clinic. Within the survey, parents were
asked to provide their child’s age and
mark all applicable diagnoses, including
but not limited to: ASD, speech and lan-
guage delay/disorder, attention-deficit
disorder or attention-deficit/hyperactivity
disorder, and learning disability.
The survey included eight oral care
questions, seven of which consisted of
dichotomous yes/no questions pertaining
to oral care in the home and dental
office, behavioral difficulties, and sensory
sensitivities. The eighth item required
the respondents to indicate the number
of times the child had been to the dentist
in the past year for the purpose of teeth
cleaning, and was transformed into a
dichotomous variable (0 to 1 vs. 2 or
more visits).
Descriptions of sensory sensitivities
and behavioral difficulties were included
in the survey questions to enhance under-
standing of the terms. Examples of
sensory sensitivities included: child has
difficulty with bright lights, loud waiting
room, loud instruments for cleaning teeth,
new touch/taste/smell sensations, and
leaning back in the dentist’s chair.
Examples of behavioral difficulties
included: refusal to open mouth, scream-
ing, and not cooperating at dentist’s office.
Data analysis
Children were grouped into three diag-
nostic categories to facilitate analysis of
the link between ASD and oral care prob-
lems. An ASD Only group consisted of
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM

Table 1. Percentage of yes responses on dichotomous items by ASD groupings.

ASD Only ASD Plus Other ORa: ASD Only OR:a ASD Plus
Oral care variable
(n ⫽ 32) (n ⫽ 79) (n ⫽ 127) vs. Other vs. Other

1. Difficulty with oral care on a daily basis 41.94% 48.00% 38.98% 1.13 (0.46) 1.44 (0.14)

2. Dislikes taste of toothpaste 6.25% 12.66% 12.60% 0.46 (0.92) 1.01 (0.58)

3. Dislikes feeling of toothbrush in mouth 31.25% 34.18% 16.54% 2.29 (0.056) 2.62 (0.003)

4. Difficulty getting teeth cleaned at dentist 46.43% 42.62% 32.08% 1.84 (0.12) 1.57 (0.12)

5. At dentist, behavior difficulties interfere with dental care 48.28% 44.44% 28.85% 2.30 (0.042) 1.97 (0.03)

6. At dentist, sensory sensitivities interfere with dental care 62.96% 49.21% 30.77% 3.83 (0.002) 2.18 (0.014)

7. Difficulty finding dentist with knowledge and skill required

16.67% 20.55% 18.33% 0.89 (0.67) 1.15 (0.42)
to work with child

8. Recommended number of visits to dentist in previous year 56.25% 55.70% 49.23% 1.33 (0.30) 1.30 (0.22)

OR ⫽ odds ratio; Probability values (in parentheses) are based on Fisher’s Exact probability tests.
a

children whose parents reported ASD as
their child’s sole diagnosis. A second cat-
egory, ASD Plus, included all children in
the ASD Only group as well as children
diagnosed with both ASD and at least
one other condition, such as speech and
language disorder. The final group, Other
Disability/No ASD (referred to herein as
Other Disability), included children who
did not have a parent-reported diagnosis
of ASD, but had at least one other diag-
nosis. The decision to include an ASD
Only group was based on the intent to
statistically isolate ASD as a possible pre-
dictor of dental problems by removing
the potential influences of codiagnoses in
selected analysis.
Data were analyzed using the SAS
computing package (SAS v.9.2, SAS
Institute, Inc., Cary, NC, USA). For
descriptive purposes, frequencies and
percentages were calculated for diagnos-
tic categories as well as each of the oral
care variables. Fisher’s exact probability
tests (FEP)26 were performed to test for
associations between dichotomous diag-
nostic group variables (ASD Only vs.
Other Disability, and ASD Plus vs. Other
Disability) and the dichotomous oral care
variables. One-tailed statistical tests were
used, based on evidence indicating that
children with ASD exhibit atypical sen-
sory responses at a much higher rate
than children with other types of devel-
opmental disabilities,14,18,27 an outcome
that suggests that dental care is poten-
tially more noxious to the groups with
ASD. One-tailed FEP tests26 were also
performed to test for positive associa-
tions, within the ASD Plus group,
between indicators of sensory sensitivi-
ties and (1) behavioral problems, (2) oral
care difficulties in the home, and (3) oral
care difficulties in the dental office. All
hypothesis tests were conducted at the
significance level of 0.05.
Results
For the 206 completed surveys, children
ranged in age from 1.1 years to 15.0
years (M ⫽ 7.3 ⫾ 3.1 years). Mean ages
for the three main study groups were:
ASD Only, 8.0 ⫾ 3.02 years; ASD Plus,
7.73 ⫾ 3.09 years; and Other Disability,
6.98 ⫾ 3.12 years. The mean age for the
Other Disability group was significantly
lower than the mean for each of the
other two groups (p ⬍ .05).
Frequencies for the three diagnostic
categories included in hypothesis tests
were ASD Only, n ⫽ 32 (15.5%); ASD
Plus, n ⫽ 79 (38.4%); and Other
Disability, n ⫽ 127 (61.7%). Almost
half (48.1%) of all the children in the
sample had multiple diagnoses. The
most common codiagnoses with ASD
were speech and language delay/disorder
(n ⫽ 17) and developmental delay
(n ⫽ 16).
Oral care in the home
Results of this study did not support our
hypothesis that a higher prevalence of
children with ASD would experience dif-
ficulty with daily oral care, compared to
children with other disabilities. Overall,
41.9% and 48.0% of parents reported that
children with ASD Only and ASD Plus,
respectively, had difficulty with oral care
at home. These percentages were higher
than, but did not statistically significantly
exceed, the 39.0% of children in the
Other Disability group (see Table 1).
We also examined whether children
with ASD, compared with children with
other disabilities, demonstrated statisti-
cally significantly greater dislike for the
taste of toothpaste as well as the feeling
of the toothbrush in their mouth. As
shown in Table 1, a statistically signifi-
cant between-group difference was found
only for dislike of the feeling of the
toothbrush in the child’s mouth when
comparing the ASD Plus group and the
Other Disability group, although the ASD
Only and Other Disability group compari-
son approached statistical significance.
Oral care in the dentist’s
office
We hypothesized that more children with
ASD would experience difficulty in the
dental office than children with other
non-ASD disabilities. The first tested
variable pertained to difficulty that

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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
children experienced while getting their
teeth cleaned at the dentist. As reported
in Table 1, although a trend in the
hypothesized direction was present
(46.4% and 42.6% for ASD Only or ASD
Plus, respectively, vs. 32.1% for the Other
Disability group), these differences were
not statistically significant.
The second tested variable pertained
to behavior difficulties (e.g., refusal to
open mouth, screaming, not cooperating)
that interfered with office-based dental
care. The results supported the hypothe-
sis: 48.3% and 44.4% of ASD Only and
ASD Plus groups were rated as having
behavioral difficulties, compared to
28.9% in the Other Disability group.
These results were statistically signifi-
cantly different.
The third question examined
whether more parents of children with
ASD reported that sensory sensitivities
(e.g., child has difficulty with bright
lights, loud waiting room, loud instru-
ments for cleaning teeth, new
touch/taste/smell sensations, leaning
back in the dentist’s chair, etc.) interfered
with their child’s care at the dentist’s
office compared to children with other
disabilities. For both the ASD Only and
ASD Plus groups, the percentage of par-
ents reporting that they believed their
child’s sensory sensitivities interfered
with dental care in the clinic (63.0% and
49.2%) was statistically significantly
larger than for children with other dis-
abilities (30.8%).
The fourth variable tested pertained to
the number of times each child visited the
dentist in the previous year for the pur-
pose of cleaning. There were no
statistically significant between-group dif-
ferences when comparing the ASD groups
and Other Disability group. The results
indicated that 44%, 44%, and 51% of chil-
dren in the ASD Only, ASD Plus, and Other
Disability groups, respectively, did not
have the recommended number of annual
dental cleanings (i.e., two or more).28
Associations between sensory
sensitivities and oral care
within the ASD Plus group
The final hypotheses examined the rela-
tionship between sensory sensitivities,
Stein et al.
oral care difficulties in the home and the
dental office, and behavioral difficulties
in the dental office, recognizing that sen-
sory sensitivities may not be the only
factor contributing to these relationships
among subjects. As shown in Figures 1
to 3, almost all of the comparisons
yielded statistically significant associa-
tions. Dislike of the taste of toothpaste,
dislike of the feeling of the toothbrush in
the mouth, and sensory sensitivities in
the dental office were each statistically
significantly associated with difficulty
with home-based oral care (Figure 1), as
well as with behavior difficulties that
interfered with care in the dental office
(Figure 2). Dislike of the feeling of the
toothbrush and sensory sensitivities in
the dental office were also statistically
significantly associated with difficulty
with teeth cleaning in the dental office
(Figure 3).
Discussion
Overall, oral care was found to be chal-
lenging for children with ASD as well as
those with other disabilities, with
approximately 40% to 50% of parents of
children in all groups reporting difficulty
with oral care on a daily basis. The
results of this study indicate that, as
hypothesized, children with ASD, in
comparison to children with other dis-
abilities, were statistically significantly
more likely to dislike a toothbrush in the
mouth, have sensory sensitivities that
parents believed hindered dental care,
and exhibit behavior difficulties that
interfered with oral care in the dentist’s
office. In addition, among children with
ASD, variables indicative of sensory pro-
cessing problems were statistically
significantly associated with difficulty in
oral care in the home, difficulty with
teeth cleaning in the dental office, and
behavioral difficulties in the dental
office. This pattern of results was main-
tained in the ASD Only versus Other
Disability comparisons as well as the ASD
Plus versus Other Disability comparisons.
In the home, sensory sensitivities in
children with ASD may be one factor
that hinders the parent’s or child’s ability
to accomplish toothbrushing in an effec-
tive manner. Within the ASD Plus group,
both aversion to the taste of toothpaste
and dislike of the feeling of the tooth-
brush in the child’s mouth were
associated with oral care difficulty in the
home. Approximately 13% of parents of
children in the ASD Plus group reported
that their child disliked the taste of
toothpaste, and 34% reported that their
child disliked the feeling of the tooth-
brush in their mouth. Of this latter
group, more than 90% also reported diffi-
culty with home-based oral care. Among
parents who did not report that their
child disliked the feeling of the tooth-
brush in his/her mouth, only 22% also
reported difficulty with home-based oral
care. Since oral care at home is related to
a child’s overall oral health status,1 den-
tists may suggest using strategies to
adapt the sensory experience of tooth-
brushing in the home in order to
potentially make oral self-care easier for
children with sensory sensitivities. For
example, starting with an oral massage,
using a washcloth on teeth before a
toothbrush, trying toothbrushes with
hard or soft bristles, allowing the child to
brush his or her face and lips with the
brush, or trying an electric toothbrush
(while being careful not to stimulate a
possibly oversensitive gag reflex), may
help lessen the child’s dislike of the feel-
ing of the toothbrush in his or her
mouth. Experimenting with different
toothpastes, such as those with a mild
taste or smell, may also minimize taste
and smell aversions.
Approximately 50% of parents of
children with ASD reported that they
believed sensory processing difficulties
interfered with their child’s oral care in
the dentist’s office. This high rate under-
scores the important need for dental
professionals to be aware of sensory
overresponsivity as one of the many pos-
sible factors contributing to challenges in
oral care. In the dental office, aggrava-
tion of sensory sensitivities can stem
either directly from the dental cleaning
and care provided or from the environ-
mental characteristics of the dental
operatory, which can be perceived by
some children as highly noxious. For
example, in the dental environment, the
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
Figure 1. Percentage of children with oral care difficulties in the home in relation to sensory sen-
sitivities within the ASD Plus diagnostic group.
Note: Bars are not meant to sum to 100% and are read as follows: for example, of parents who
responded that their child disliked the taste of toothpaste (“Yes” responses), 90.0% stated that
their child experienced oral care difficulty in the home. Of parents who responded that their child
did not dislike the taste of toothpaste (“No” responses), only 41.5% stated that their child experi-
enced oral care difficulty in the home.
child is exposed to: (1) bright fluorescent
lights; (2) high-pitched, loud, unfamiliar
noises, especially if a dental drill is
required; (3) repeated light touch in or
around the mouth by a dental profes-
sional attempting to hold it open or
manipulate it; and (4) the texture, taste,
and smell of various oral care products.
These stimuli may lead to hyperrespon-
sive reactions from children with ASD.
Utilizing strategies to adapt the sen-
sory environment in the dental office by
minimizing the effects of such possible
noxious stimuli may be highly beneficial
to children with sensory sensitivities. For
example, a room with dim lighting,12,29
provision of stimuli such as deep pres-
sure (firm tactile input applied uniformly
across the body),12,30 or use of calming
auditory stimulation12,31 may potentially
decrease maladaptive behaviors or anxi-
ety in children with sensitivities. In an
experimental study, Shapiro et al.12 modi-
fied the degree of visual, auditory, and
106 S p e c C a re D e n t i s t 3 1 ( 3 ) 2 0 1 1
tactile stimulation encountered by chil-
dren with developmental disabilities
undergoing dental cleaning and found a
significant reduction in both duration of
behavioral (anxious or negative behav-
iors) and physiological (electrodermal
activity) measures before, during, and
after treatment. These findings support
prior research, which suggests that chal-
lenging behaviors displayed by children
with sensory modulation difficulties may
be in part sensory driven, not only
behaviorally driven as commonly
believed.16,29 This result is consistent
with findings that children with ASD and
sensory processing difficulties, such as
tactile sensitivity, are more likely to
demonstrate oppositional, hyperactive,
and restless or impulsive behaviors in the
classroom than their typically developing
counterparts.32 However, we recognize
that sensory sensitivities alone are not
responsible for these behavior difficul-
ties, as other factors such as
O r a l c a re a n d s e n s o r y s e n s i t i v i t i e s i n a u t i s m
communication difficulties, IQ, and
dental fear and anxiety have also been
found to predict uncooperative behavior
in the dental office.11
As stated earlier, prior research indi-
cates that parents of children with special
needs have more difficulty in finding a
dentist.3,10 Surprisingly, only 21% of par-
ents in this study reported difficulty in
locating a dentist with the knowledge
and skill required to work with their
child. This may be due in part to a col-
laborative arrangement between PTN’s
early intervention program and a specific
dental care center (Children’s Dental
Center of Greater Los Angeles).
However, despite the small number
of parents noting difficulty in finding a
dentist for their child with ASD, almost
50% of all groups did not go to the den-
tist for a cleaning the recommended
number of times within the last year.
Thirty percent of parents of children with
ASD reported that their child had not
visited the dentist for a teeth cleaning in
the prior 12 months. This low percentage
of children with ASD visiting the dentist
may be due in part to the children’s fear
and anxiety surrounding dental visits,6
need for rigidity and routine,33 or behav-
ioral or sensory processing difficulties.9
Parents of children with ASD and other
disabilities may need further education
on the recommended frequency of visits
and importance of professional oral care.
Several limitations exist in this study.
The first limitation relates to the subject
population. Autism spectrum disorders
study groups were formed on the basis of
parent-report of diagnosis, and were not
confirmed by proven diagnostic tools
such as the Autism Diagnostic Interview
Revised34 or the Autism Diagnostic Obser-
vation Schedule.35 Due to the utilization
of a preexisting survey, information was
not obtained on variables such as socioe-
conomic status or ethnicity. Pediatric
Therapy Network staff estimated that the
clinic’s ethnic representation was 34%
Caucasian, 25% Asian, 22% Latino, 16%
African American, and 3% other,
although we do not know how represen-
tative the survey respondents were of the
population served at PTN. Also due to
the use of a preexisting clinic survey,
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
Figure 2. Percentage of children with behavior difficulties in the dental office in relation to sensory sensitivities within the ASD Plus diagnostic group.
information on children with no disabili-
ties was not available for comparison.
However, it is assumed that the group
differences would be greater if comparing
children with ASD to their typically
developing counterparts given that there
is a significantly higher level of sensory
aversion in children with autism than
control groups with no disabilities.14
Between-group age differences were also
present in the sample, with both ASD
groups approximately 1 year older than
the Other Disability group. However,
research suggests a trend that older chil-
dren may tolerate care better than
younger children;11,36 therefore, the age
Stein et al.
differences are likely to have led to a
conservative test of diagnosis-related
study hypotheses.
A second limitation relates to the
survey instrument. The survey utilized
dichotomous responses that may limit
the breadth of information obtained.
In addition, all terms were not opera-
tionally defined, although multiple
examples of “sensory sensitivities” and
“behavioral difficulties” were provided
in the survey and parents had received
education regarding these topics from
PTN. Furthermore, these findings are
based on parents’ reports. Certain
limitations of parent-report measures
exist, including: parents may not have a
normative framework in which to
interpret behaviors, they may exhibit
shared method variance such that they
are likely to report similarly on different
domains of child behavior (e.g., sensory
sensitivity and behavior problems), and
parent characteristics such as depression
may bias parent ratings.37 Nevertheless,
many human development researchers
rely on parent-report data for empirical
understanding of key phenomena.37
Parents are observers of their children’s
behavior and have a unique role in
children’s lives as they share daily
experiences. Specifically, when discussing
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
Figure 3. Percentage of children with oral care difficulties in the dental office in relation to sensory sensitivities within the ASD Plus diagnostic group.
sensory sensitivities, we were interested
in the broad influence that sensory
processing had on general patterns of
response to routines in daily activities.38
Parents are the best to comment on this
aspect of children’s behavior. Additionally,
much of the dental literature regarding
dental fear and anxiety is based on self-
or parental-report measures such as the
Children’s Fear Survey Schedule–Dental
Subscale.39,40 Ultimately, it will be
important to replicate this study with
dental professional reports as well as
direct observation and coding of
children’s behavior.
Lastly, due to the nonexperimental,
correlational nature of this study, causality
108 S p e c C a re D e n t i s t 3 1 ( 3 ) 2 0 1 1
of the relationship between sensory
sensitivities and difficulty with oral care
cannot be determined. Despite these
study limitations, the current findings
reveal an important area to consider
when providing dental services to chil-
dren with ASD.
Conclusion
This study provides insight into one
aspect of the unique problems regarding
oral care in children with ASD. It also
indicates that problems in processing
sensory input may be one variable that
may contribute to the difficulties with
oral care in children with this very
O r a l c a re a n d s e n s o r y s e n s i t i v i t i e s i n a u t i s m
complex disorder. This knowledge can
help both oral care professionals and
parents to recognize challenges related to
sensory processing that may occur during
dental care with children with ASD by
preparing them to manage frequently
encountered obstacles. If special adapta-
tions can be identified that minimize the
problems faced by children with sensory
sensitivities, effective oral care may be
enhanced.
Acknowledgement
This research was made possible by
Pediatric Therapy Network’s generous
sharing of data.
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ORAL CARE AND SENSORY SENSITIVITIES IN AUTISM
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