Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.
Faculty of Health, Child and Adolescent Psychiatry, Witten/Herdecke University, Witten, Germany.
PLoS One. 2022 Aug 3;17(8):e0271406. doi: 10.1371/journal.pone.0271406. eCollection 2022.
This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists.
An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales.
Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists.
Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.
本基于问卷的验证研究旨在根据交易应激理论，调查儿童和青少年自闭症谱系障碍的口腔检查是否被具有儿科牙科专业知识的牙医视为一种挑战或威胁。为此，使用了应激评估量表（SAM），并在德国牙医的多阶段验证过程中，首先对其可行性和有效性进行了检查。几乎没有研究过自闭症谱系障碍儿童的治疗是如何被牙医感知的。
开发了基于在线的调查（39 个问题），外加 SAM 作为附加项，以及之前关于该主题的想象短篇小说（在特殊学校进行牙科检查预约）。通过电子邮件，德国儿童牙科协会（DGKiZ）的成员收到了一个链接，有兴趣的成员可以通过该链接参与。DGKiZ 的大多数成员都具有治疗儿童和青少年的额外资格，并在牙科特殊需求护理领域接受过进一步的培训。数据分析基于 SAM 及其子量表。
在 DGKiZ 的 1725 名成员中，有 92 名参与者（11 名男性，81 名女性）完整地完成了问卷和 SAM。总的来说，牙医在治疗自闭症谱系障碍儿童和青少年时，将自己的心理和身体压力评为轻度到中度压力。尽管通过因子分析无法完全映射 SAM 的结构，但在阅读完故事后，可以对不同的“挑战”或“威胁”评分进行全面评估。参与者普遍将故事中的情况评估为具有挑战性，但并非威胁性。SAM 的子量表之间的相关性（例如威胁和中心性）为 r =.56，表明这些量表彼此之间并非完全独立。根据交易应激模型，SAM 基于评估过程（例如威胁、自我可控性）产生的感知应激，这些过程将描述情况的要求与一个人在人与环境匹配方面的自身可能性进行比较。在分层回归中，使用六个子量表（评估过程）可以解释 R2 的方差为.48，从而可以预测 SAM 在牙医样本中的感知应激。
由于回复率，SAM 的结果不能代表所有德国牙医，但它提供了对德国特殊需求牙科领域尚未研究的主题的深入了解。总体而言，SAM 在映射认知评估过程和应激方面的可行性和有效性得到了证实。考虑到治疗自闭症谱系障碍儿童和青少年被视为挑战的结果，可以得出结论，德国需要在牙科学生和毕业牙医的特殊需求牙科教育方面进行改进。
