A Study of The Challenge and Instructional Approaches in Teaching Toothbrushing Skills to Children with Autism
DOI:
https://doi.org/10.14456/psruhss.2025.24Keywords:
Teaching toothbrushing skills, Autism, Life skills, Parental involvementAbstract
This study aimed to investigate the problems and instructional approaches related to toothbrushing for children with autism. The population consisted of 73 parents of children with autism aged 3–12 years who had successfully taught their children to brush their teeth and were receiving services at Special Education Centers in the Lower Northern Region. The research instrument was a questionnaire on problems and instructional approaches for teaching toothbrushing to children with autism, developed from an analysis of interview data obtained from parents. The questionnaire was then used to collect quantitative data. Statistical analyses included the mean (μ) and standard deviation (σ). The findings revealed that the overall problems in toothbrushing among children with autism were at a moderate level. The most significant problem was sensory processing dysfunction in response to oral stimuli, followed by resistant or aggressive behaviors during toothbrushing, while the least reported problem was poor motor coordination of the arms and hands in handling a toothbrush. In terms of instructional approaches, the overall level was high. The most important approach was consistent support from parents or caregivers in daily routines, followed by the use of stimulus fading techniques to gradually reduce oral sensitivity, while the least emphasized approach was the development of language comprehension and communication skills to help children understand instructions and perform toothbrushing step by step.
References
จินตนา ประดุจพงษ์เพ็ชร์, ศิริวิมล ใจงาม, สลักจิต ตรีรณโอภาส, สุวพัชร์ ช่างพินิจ และอนุชา ภูมิสิทธิพร. (2566). การศึกษาสภาพปัญหาพฤติกรรมของเด็กออทิสติก รูปแบบการอบรมเลี้ยงดูแลความต้องการของผู้ปกครองในการจัดการพฤติกรรมของเด็กออทิสติกในเขตภาคเหนือตอนล่าง. วารสารมนุษยศาสตร์และสังคมศาสตร์ มหาวิทยาลัยราชภัฏพิบูลสงคราม, 17(2), 622–637. https://doi.org/10.14456/psruhss.2023.44
เจริญชัย ศรีพันธ์ชาติ. (2567). การฝึกแปรงฟันโดยใช้ภาพนิทานสำหรับนักเรียนที่มีภาวะออทิซึม. วารสารวิชาการและวิจัย มหาวิทยาลัยภาคตะวันออกเฉียงเหนือ, 14(1), 286–294. https://so04.tci-thaijo.org/index.php/neuarj/article/view/267861
ทัศนา ฤทธิกุล, พัชราภรณ์ กาวิละ, น้ำผึ้ง รัตนพิบูลย์, กรวิภา วุฒิจูรีพันธุ์, วิสเพ็ญ กิจธเนศ, สุทธิกานต์ กันตี, ภาวิณี วรรณศรี และเดชา ทําดี. (2564). การศึกษาผลการใช้สื่อภาพกระบวนการแปรงฟันในการช่วยสื่อสารกระบวนการแปรงฟันแก่เด็กที่มีความต้องการพิเศษโดยผู้ปกครองที่บ้านโรงเรียนวัดช่างเคี่ยน จ.เชียงใหม่. วารสารวิชาการสุขภาพภาคเหนือ, 9(1), 161-175.
บุญชม ศรีสะอาด. (2554). การวิจัยเบื้องต้น (พิมพ์ครั้งที่ 9). กรุงเทพฯ: สุวีริยาสาส์น.
สมบัติ ลำคำ, สุวพัชร์ ช่างพินิจ, ไพวรรณ สุดวรรค์, อนุชา ภูมิสิทธิพร และศิริวิมล ใจงาม. (2566). การศึกษาสภาพปัญหา แนวทาง และความต้องการจัดการปัญหาพฤติกรรมซ้ำ ๆ ของเด็กออทิสติก. วารสารมนุษยศาสตร์และสังคมศาสตร์ มหาวิทยาลัยราชภัฏพิบูลสงคราม, 17(2), 604–621. https://doi.org/10.14456/psruhss.2023.43
Al-Batayneh, O. B., Nazer, T. S., Khader, Y. S., & Owais, A. I. (2020). Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders. European archives of paediatric dentistry, 21(2), 277-283. https://doi.org/10.1007/s40368-019-00485-x
AlHammad, K. A. S., Hesham, A. M., Zakria, M., Alghazi, M., Jobeir, A., AlDhalaan, R. M., ... & Mosadomi, H. (2020). Challenges of autism spectrum disorders families towards oral health care in Kingdom of Saudi Arabia. Pesquisa Brasileira em Odontopediatria e Clínica Integrada, 20, e5178. https://doi.org/10.1590/pboci.2020.046
Bishop, M. R., Kenzer, A. L., Coffman, C. M., Tarbox, C. M., Tarbox, J., & Lanagan, T. M. (2013). Using stimulus fading without escape extinction to increase compliance with toothbrushing in children with autism. Research in autism spectrum disorders, 7(6), 680-686. https://doi.org/10.1016/j.rasd.2013.02.004
DeVon, H. A., Block, M. E., Moyle‐Wright, P., Ernst, D. M., Hayden, S. J., Lazzara, D. J., ... & Kostas‐Polston, E. (2007). A psychometric toolbox for testing validity and reliability. Journal of Nursing scholarship, 39(2), 155-164. https://doi.org/10.1111/j.1547-5069.2007.00161.x
Doichinova, L., Gateva, N., & Hristov, K. (2019). Oral hygiene education of special needs children. Part 1: children with autism spectrum disorder. Biotechnology & Biotechnological Equipment, 33(1), 748-755. https://doi.org/10.1080/13102818.2019.1615846
Floríndez, L. I., Como, D. H., Floríndez, D. C., Floríndez, F. M., Law, E., Polido, J. C., & Cermak, S. A. (2022). Toothbrushing and oral care activities of autistic and non-autistic latino children. Children, 9(5), 741. https://doi.org/10.3390/children9050741
France, K., Urquhart, O., Ko, E., Gomez, J., Ryan, M., Hernandez, M., ... & Wolff, M. S. (2024). A pilot study exploring caregivers’ experiences related to the use of a smart toothbrush by children with autism spectrum disorder. Children, 11(4), 460. https://doi.org/10.3390/children11040460
Hadi, S., Djuliawanti, M., Marjianto, A., & Jumriani, J. (2022). Appropriate learning methods for autistic children in improving tooth brushing skills: A review. International Journal of Advanced Health Science and Technology, 2(2), 122-129. https://doi.org/10.35882/ijahst.v2i2.12
Hannant, P., Tavassoli, T. & Cassidy, S. (2016). The role of sensorimotor difficulties in autism spectrum conditions. Frontiers in Neurology, 7(124), 1-11. https://doi.org/10.3389/fneur.2016.00124
Huang, J., Du, C., Liu, J., & Tan, G. (2020). Meta-analysis on intervention effects of physical activities on children and adolescents with autism. International journal of environmental research and public health, 17(6), 1950. https://doi.org/10.3390/ijerph17061950
Khrautieo, T., Srimaneekarn, N., Rirattanapong, P., & Smutkeeree, A. (2020). Association of sensory sensitivities and toothbrushing cooperation in autism spectrum disorder. International journal of paediatric dentistry, 30(4), 505-513. https://doi.org/10.1111/ipd.12623
King’s College Hospital. (2022). Mouth care for people with autism. http://www.kch.nhs.uk
Larasati, R., Kusuma, I. G. A., & Ahmad, A. B. (2022). Oral Health Assessment of Children with Autism Spectrum Disorder: Literature Review. International Journal of Advanced Health Science and Technology, 2(3), 175-182. https://doi.org/10.35882/ijahst.v2i3.8
Lopez Cazaux, S., Lefer, G., Rouches, A., & Bourdon, P. (2019). Toothbrushing training programme using an iPad® for children and adolescents with autism. European Archives of Paediatric Dentistry, 20(3), 277-284.
Mah, R. M. F., Rahman, N. A., Adnan, M. M., & Zakaria, N. (2023). Effectiveness of" Oral Health Care for Children with Autism Spectrum Disorder Module" in Improving Tooth-Brushing Practice among Children with Autism Spectrum Disorder in Hospital Universiti Sains Malaysia. Malaysian Journal of Medicine & Health Sciences, 19(1), 71-79.
Mahajan, A., Anand, S., Awinashe, V., Devanna, R., Alessa, N., & Babaji, P. (2023). Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study. Journal of Education and Health Promotion, 12(1), 223. 10.4103/jehp.jehp_259_23
Neff, A. M. (2024). Sensory Overload & Tooth Brushing: 15+ of the Best Tips. Neurodivergent insights. https://neurodivergentinsights.com/blog/category
Othman, A., & Kamarudin, F. N. (2011). Disability learning tool: Brushing-teeth using music for autism. In EDULEARN11 Proceedings (pp. 354-363). IATED. Barcelona: Universiti Teknikal Melaka Malaysia.
Pawar, M., Kasuhal, D., Kakti, A., Alshammari, F., Alshammari, M. F., Dixit, S., & Alibrahim, W. Y. (2022). Manual and powered toothbrushing effectiveness on autistic children's oral hygiene status. Journal of Pharmacy and Bioallied Sciences, 14(Suppl 1), S837-S840.
Piraneh, H., Gholami, M., Sargeran, K., & Shamshiri, A. R. (2023). Social story based toothbrushing education versus Video-Modeling based toothbrushing training on oral hygiene status among male students aged 7–15 years old with autism spectrum disorders in tehran, iran: A Quasi-Randomized controlled trial. Journal of autism and developmental disorders, 53(10), 3813-3824.
Raulston, T. J., & Machalicek, W. (2018). Early intervention for repetitive behavior in autism spectrum disorder: A conceptual model. Journal of Developmental and Physical Disabilities, 30(1), 89-109.
Sallam, M. S., Badr, S. B., & Rashed, M. A. (2013). Effectiveness of audiovisual modeling on the behavioral change toward oral and dental care in children with autism. Indian Journal of Dentistry, 4(4), 184-190. https://doi.org/10.1016/j.ijd.2013.02.002
Sami, W., Ahmad, M. S., Shaik, R. A., Miraj, M., Ahmad, S., & Molla, M. H. (2023). Oral health statuses of children and young adults with autism spectrum disorder: an umbrella review. Journal of Clinical Medicine, 13(1), 59. https://doi.org/10.3390/jcm13010059
Santosh, A., Kakade, A., Mali, S., Takate, V., Deshmukh, B., & Juneja, A. (2021). Oral health assessment of children with autism spectrum disorder in special schools. International journal of clinical pediatric dentistry, 14(4), 548–553. https://doi.org/10.5005/jp-journals-10005-1972
Stein, L. I., Polido, J. C., & Cermak, S. A. (2012). Oral care and sensory concerns in autism. The American Journal of Occupational Therapy, 66(5), e73-e76. https://doi.org/10.5014/ajot.2012.004085
Sullivan, M. O., Gallagher, L., & Heron, E. A. (2019). Gaining insights into aggressive behaviour in autism spectrum disorder using latent profile analysis. Journal of Autism and Developmental Disorders, 49(10), 4209-4218.
Weitlauf, A. S., Sathe, N., McPheeters, M. L., & Warren, Z. E. (2017). Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics, 139(6), e20170347.
Welsh, P., Rodgers, J., & Honey, E. (2019). Teachers' perceptions of Restricted and Repetitive Behaviours (RRBs) in children with ASD: Attributions, confidence and emotional response. Research in developmental disabilities, 89, 29-40. https://doi.org/10.1016/j.ridd.2019.01.009
Wuang, Y. P., Huang, C. L., & Tsai, H. Y. (2020). Sensory integration and perceptual-motor profiles in school-aged children with autistic spectrum disorder. Neuropsychiatric Disease and Treatment, 16, 1661–1673. https://doi.org/10.2147/NDT.S253337
Wuang, Y., Huang, C., & Tsai, H. (2020). Sensory integration and perceptual-motor profiles in school-aged children with autistic spectrum disorder. Neuropsychiatric Disease and Treatment, 16(1), 1661–1673.
Zarafshan, H., Salmanian, M., Aghamohammadi, S., Mohammadi, M. R., & Mostafavi, S. A. (2017). Effectiveness of non-pharmacological interventions on stereotyped and repetitive behaviors of preschool children with autism: a systematic review. Basic and Clinical Neuroscience, 8(2), 95-104.
Zarafshan, H., Salmanian, M., Aghamohammadi, S., Mohammadi, M. R., & Mostafavi, S. A. (2017). Effectiveness of non-pharmacological interventions on stereotyped and repetitive behaviors of pre-school children with autism: a systematic review. Basic and clinical neuroscience, 8(2), 95–103. https://doi.org/10.18869/nirp.bcn.8.2.95
Zhou, N., Wong, H. M., & McGrath, C. (2019). Oral health and associated factors among preschool children with special healthcare needs. Oral diseases, 25(4), 1221-1228. https://doi.org/10.1111/odi.13057
Zhou, N., Wong, H. M., & McGrath, C. (2020). Efficacy of social story intervention in training toothbrushing skills among special‐care children with and without autism. Autism Research, 13(4), 666-674. https://doi.org/10.1002/aur.2256
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