为自闭症贫困儿童提供牙科护理的家长培训：一项随机对照试验。
Parent Training for Dental Care in Underserved Children With Autism: A Randomized Controlled Trial.
作者信息
Fenning Rachel M, Butter Eric M, Macklin Eric A, Norris Megan, Hammersmith Kimberly J, McKinnon-Bermingham Kelly, Chan James, Stephenson Kevin G, Albright Charles, Scherr Jessica, Moffitt Jacquelyn M, Lu Frances, Spaulding Richard, Guijon John, Hess Amy, Coury Daniel L, Kuhlthau Karen A, Steinberg-Epstein Robin
机构信息
Department of Child and Adolescent Studies and Center for Autism, California State University, Fullerton, Fullerton, California.
The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.
出版信息
Pediatrics. 2022 May 1;149(5). doi: 10.1542/peds.2021-050691.
OBJECTIVE
Children with autism spectrum disorder (ASD) have difficulty participating in dental care and experience significant unmet dental needs. We examined the efficacy of parent training (PT) for improving oral hygiene and oral health in underserved children with ASD.
METHOD
Families of Medicaid-eligible children with ASD (ages 3-13 years, 85% boys, 62% with intellectual disability) reporting difficulty with dental care participated in a 6-month randomized controlled trial comparing PT (n = 60) with a psychoeducational dental toolkit (n = 59). Primary outcomes were parent-reported frequency of twice-daily toothbrushing and dentist-rated visible plaque. Secondary outcomes included parent-reported child behavior problems during home oral hygiene and dentist-rated caries. Dentists were blind to intervention assignment. Analyses were intention to treat.
RESULTS
Retention was high at posttreatment (3 months, 93%) and 6-month follow-up (90%). Compared with the toolkit intervention, PT was associated with increased twice-daily toothbrushing at 3 (78% vs 55%, respectively; P < .001) and 6 (78% vs 62%; P = .002) months and a reduction in plaque at 3 months (intervention effect, -0.19; 95% confidence interval [CI], -0.36 to -0.02; P = .03) and child problem behaviors at 3 (-0.90; 95% CI, -1.52 to -0.28; P = .005) and 6 (-0.77; 95% CI, -1.39 to -0.14; P = .02) months. Comparatively fewer caries developed in children receiving the PT intervention over 3 months (ratio of rate ratios, 0.73; 95% CI, 0.54 to 0.99; P = .04).
CONCLUSIONS
PT represents a promising approach for improving oral hygiene and oral health in underserved children with ASD at risk for dental problems.
目的
自闭症谱系障碍（ASD）儿童在接受牙科护理方面存在困难，并且有大量未满足的牙科需求。我们研究了家长培训（PT）对改善服务不足的ASD儿童口腔卫生和口腔健康的效果。
方法
报告在牙科护理方面存在困难的符合医疗补助条件的ASD儿童（3至13岁，85%为男孩，62%有智力障碍）家庭参与了一项为期6个月的随机对照试验，该试验将PT组（n = 60）与一个心理教育牙科工具包组（n = 59）进行比较。主要结局是家长报告的每日两次刷牙频率和牙医评定的可见牙菌斑。次要结局包括家长报告的家庭口腔卫生期间儿童的行为问题和牙医评定的龋齿情况。牙医对干预分配不知情。分析采用意向性分析。
结果
治疗后（3个月）和6个月随访时的保留率很高（分别为93%和90%）。与工具包干预相比，PT与3个月（分别为78%对55%；P <.001）和6个月（78%对62%；P =.002）时每日两次刷牙频率增加以及3个月时牙菌斑减少（干预效应，-0.19；95%置信区间[CI]，-0.36至-0.02；P =.03）和3个月（-0.90；95% CI，-1.52至-0.28；P =.005）及6个月（-0.77；95% CI，-1.39至-0.14；P =.02）时儿童问题行为减少相关。在接受PT干预的儿童中，3个月内发生龋齿的情况相对较少（率比之比，0.73；95% CI，0.54至0.99；P =.04）。
结论
PT是一种有前景的方法，可用于改善有牙科问题风险的服务不足的ASD儿童的口腔卫生和口腔健康。
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