Training children with autism spectrum disorder to undergo oral assessment using a digital iPad® application

  • G. Lefer
  • A. Rouches
  • P. Bourdon
  • S. Lopez CazauxEmail author
Original Scientific Article



To present a training programme for teaching children and adolescents with autism spectrum disorder (ASD), to be compliant with a dental examination.


Fifty-two children and adolescents with ASD (age range 3–19 years) with a parent-signed consent form were enrolled. Dental examinations were performed once a month in education centres by a paediatric dentist using a visual activity schedule on an iPad® that was created with a digital application, çATED. Achievement and anxiety were evaluated using scales and grids every 2 months for 8 months.


Showed an improvement in oral assessment; the children became compliant and less anxious. The percentage of individuals who underwent the entire dental exam process increased over time; it was 25% at the beginning of the study and 65.4% after 8 months. Only 7.7% of the sample was not anxious at the beginning, while 59.6% of the sample was not anxious after 8 months. Wilcoxon analysis also showed significant improvement in the studied variables.


Training children and adolescents with ASD to undergo dental examination was efficient. The use of the iPad® is attractive and easy for practitioners and people with ASD.


Autism Oral health Dental examination iPad® Training program 



This study was supported by grants from the International Foundation of Applied Disability Research (FIRAH). We would like to express our gratitude to the çATED-autisme team. The authors would like to thank children, parents and professionals who participated to the “çATED pour tes dents” program.

Compliance with ethical standards

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this study, written informed consent was obtained from all parents of children and adolescents included in the study.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent. 2016;38 (6):185–98.Google Scholar
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric; 2013.CrossRefGoogle Scholar
  3. Ash ES. Forming impressions of personality. J Abnorm Soc Psychol. 1946;41:258–90.CrossRefGoogle Scholar
  4. Bäckman B, Pilebro C. Visual pedagogy in dentistry for children with autism. ASDC J Dent Child. 1999;66 (5):325–31.PubMedGoogle Scholar
  5. Barry S, O’Sullivan EA, Toumba KJ. Barriers to dental care for children with autism spectrum disorder. Eur Arch Paediatr Dent. 2014;15:127–34.CrossRefGoogle Scholar
  6. Bishop MR, Kenzer AL, Coffman CM, et al. Using stimulus fading without escape extinction to increase compliance with toothbrushing in children with autism. Res Autism Spec Disord. 2013;7:680–6.CrossRefGoogle Scholar
  7. Brickhouse TH, Farrington FH, Best AM, Ellsworth CW. Barriers to dental care for children in Virginia with autism spectrum disorders. J Dent Child (Chic). 2009;76:188–93.Google Scholar
  8. Cagetti MG, Mastroberardino S, Campus S, et al. Dental care protocol based on visual supports for children with autism spectrum disorders. Med Oral Patol Cir Bucal. 2015;20 (5):e598–604.CrossRefGoogle Scholar
  9. Cermak SA, Stein Duker LI, Williams ME, et al. Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: a randomized controlled pilot study. J Autism Dev Disord. 2015;45 (9):2876–88.CrossRefGoogle Scholar
  10. Conyers C, Miltenberger RG, Peterson B, et al. An evaluation of in vivo desensitization and video modeling to increase compliance with dental procedures in persons with mental retardation. J Appl Behav Anal. 2004;37 (2):233–8.CrossRefGoogle Scholar
  11. Cuvo AJ, Godard A, Huckfeldt R, Demattei R. Training children with autism spectrum disorders to be compliant with an oral assessment. Res Autism Spect Disord. 2010;4 (4):681–96.CrossRefGoogle Scholar
  12. Dancey C, Reidy J. Statistics without math for psychologists. Paris: De Boeck; 2007 (French).Google Scholar
  13. Delli K, Reichart PA, Bornstein MM, Livas C. Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal. 2013;18:e862.CrossRefGoogle Scholar
  14. Gandhi RP, Klein U. Autism spectrum disorders: an update on oral health management. J Evid Based Dent Pract. 2014;14:115–26.CrossRefGoogle Scholar
  15. Heitz MH. Clis’Tab: first results of an innovative project. La nouvelle revue de l’adaptation et de la scolarisation. 2015;69 (1):191–206 (French).CrossRefGoogle Scholar
  16. Hernandez P, Ikkanda Z. Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments. J Am Dent Assoc. 2011;142:281–7.CrossRefGoogle Scholar
  17. Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Applied Oral Sci. 2011;19:212–7.CrossRefGoogle Scholar
  18. Kagohara DM, van der Meer L, Ramdoss, et al. Using iPods® and iPads® in teaching programs for individuals with developmental disabilities: a systematic review. Res Dev Disabil. 2013;34:147–56.CrossRefGoogle Scholar
  19. Karsenti T, Fievez AN. The iPad in education: uses, benefits, and challenges—a survey of 6,057 students and 302 teachers in Quebec, Canada. Montreal, QC: CRIFPE; 2013. p. 56 (report no: 978-2-923808-34-5$4).Google Scholar
  20. Kemp F. Alternatives: a review of non-pharmacologic approaches to increasing the cooperation of patients with special needs to inherently unpleasant dental procedures. Behav Anal Today. 2005;6:88.CrossRefGoogle Scholar
  21. Knight V, Sartini E, Spriggs AD. Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders. J Autism Dev Disordr. 2015;45:157–78.CrossRefGoogle Scholar
  22. Koyama T, Wang HT. Use of activity schedule to promote independent performance of individuals with autism and other intellectual disabilities: a review. Res Dev Disabil. 2011;32:2235–42.CrossRefGoogle Scholar
  23. Lai B, Milano M, Roberts MW, Hooper SR. Unmet dental needs and barriers to dental care among children with autism spectrum disorders. J Autism Dev Disord. 2012;42:1294–303.CrossRefGoogle Scholar
  24. Lewis C, Vigo L, Novak L, Klein EJ. Listening to parents: a qualitative look at the dental and oral care experiences of children with autism spectrum disorder. Pediatr Dent. 2015;37 (7):98E–104E.Google Scholar
  25. Loo CY, Graham RM, Hughes CV. Behaviour guidance in dental treatment of patients with autism spectrum disorder. Int J Paediatr Dent. 2009;19:390–8.CrossRefGoogle Scholar
  26. Luscre DM, Center DB. Procedures for reducing dental fear in children with autism. J Autism Dev Disord. 1996;26 (5):547–56.CrossRefGoogle Scholar
  27. Marion IW, Nelson TM, Sheller B, et al. Dental stories for children with autism. Spec Care Dent. 2016;36 (4):181–6.CrossRefGoogle Scholar
  28. Marshall J, Sheller B, Mancl L. Caries-risk assessment and caries status of children with autism. Pediatr Dent. 2010;32:69–75.PubMedGoogle Scholar
  29. Mercier C, Bourdon P, Bourdet JF. The time of the child with autism and the time of the professional: adopt the rhythm of the learner in order to facilitate the access to new learning. Distances et médiations des savoirs Distance Med Knowl. 2016;16 (French).Google Scholar
  30. Nelson TM, Sheller B, Friedman CS, et al. Educational and therapeutic behavioral approaches to providing dental care for patients with autism spectrum disorder. Spec Care Dent. 2015;35:105–13.CrossRefGoogle Scholar
  31. Orellana LM, Martinez-Sanchis S, Silvestre FJ. Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach. J Autism Dev Disord. 2014;44 (4):776–85.CrossRefGoogle Scholar
  32. Pilebro C, Bäckman B. Teaching oral hygiene to children with autism. Int J Paediatr Dent. 2005;15:1–9.CrossRefGoogle Scholar
  33. Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;10:CD009260.PubMedGoogle Scholar
  34. Stein LI, Polido JC, Mailloux Z, et al. Oral care and sensory sensitivities in children with autism spectrum disorders. Spec Care Dent. 2011;31 (3):102–10.CrossRefGoogle Scholar
  35. Stein LI, Polido JC, Najera SOL, Cermak SA. Oral care experiences and challenges in children with autism spectrum disorders. Pediatr Dent. 2012;34:387–91.PubMedGoogle Scholar
  36. Stein LI, Polido JC, Cermak SA. Oral care and sensory over-responsivity in children with autism spectrum disorders. Pediatr Dent. 2013;35:230–5.PubMedGoogle Scholar
  37. Udhya J, Varadharaja MM, Parthiban J. Autism disorder (AD): an updated review for paediatric dentists. J Clin Diagn Res. 2014;8 (2):275–9.Google Scholar
  38. Weil TN, Inglehart MR. Three-to 21-year-old patients with autism spectrum disorders: parents’ perceptions of severity of symptoms, oral health and oral health-related behavior. Pediatr Dent. 2012;34:473–9.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2018

Authors and Affiliations

  • G. Lefer
    • 1
  • A. Rouches
    • 2
  • P. Bourdon
    • 1
    • 3
  • S. Lopez Cazaux
    • 1
    • 2
    • 4
    Email author
  1. 1.Centre de Recherche en Education de Nantes, EA2661Nantes Cedex 3France
  2. 2.Faculté de Chirurgie DentaireNantes Cedex 1France
  3. 3.Ecole Supérieure du Professorat et de l’EducationNantesFrance
  4. 4.Centre Hospitalo-Universitaire de NantesNantes Cedex 1France

Personalised recommendations