Psychological behavioral therapies to improve autistic children’s behaviors during dental visits: A systematic review and meta-analysis

This systematic review aimed to evaluate the effectiveness of psychological behavioral therapies to improve behaviors of autistic children during dental visits. Screening, data extraction, risk-of-bias assessment, and evaluation of certainty of evidence were performed by two independent reviewers. Eighteen studies were ultimately included. On average 56% (95% confidence interval, 33.95–78.29) and 64% (95% confidence interval 47.24–81.80) of autistic children can cooperate with dental examination with an oral mirror in the first and second visits, respectively. Visual pedagogy did not improve the proportion of autistic children who can accept dental examinations. Inconsistent results were also identified for Treatment and Education of Autistic and related Communication-handicapped CHildren, Picture Exchange Communication System, Applied Behavior Analysis, video modeling, distractions, and other conventional behavioral management techniques. Many studies were of small sample size, lacked a control group, did not account for autism spectrum disorder severity, comorbidities, previous dental experience or other confounders, and had a high risk of bias. The evidence supporting the use of psychoeducation techniques to improve the dental experience of autistic children is limited and of very low certainty. Further research with larger scale studies and appropriate control groups is needed to enhance the certainty of evidence in this field. Lay abstract This research review looked at how well different psychological behavioral therapies help improve the behavior of autistic children during dental visits. The researchers studied 18 different studies and found that, on average, about 56% of autistic children were able to cooperate with a dental exam using an oral mirror during their first visit. The number increased to about 64% during their second visit. However, using visual pedagogies or teaching aids did not seem to make a big difference in how many children could accept the dental exams. The results for other psychological behavioral techniques were also inconsistent, including Treatment and Education of Autistic and related Communication-handicapped CHildren, Picture Exchange Communication System, Applied Behavior Analysis, video modeling, and distractions. Many of the studies were small and did not include a comparison group. They also did not consider factors like how severe the autism was, other conditions the children had, or their previous dental experiences. Because of these limitations, the evidence supporting the use of psychological behavioral techniques to improve dental visits for autistic children is limited and uncertain. More research with larger studies and proper control groups is needed to better understand this topic.