Discussion
distress behavior, Anxiety, anxiety, behavioral distress, autistic
This randomized crossover study found that dental cleanings performed in SADE elicited significantly lower sympathetic activation, as measured by SCL, compared with RDE throughout the entirety of the dental encounter, suggesting that children were more relaxed and less physiologically anxious during care in SADE. This finding supports previous studies reporting the efficacy of SADE to decrease a variety of physiological measures of stress and anxiety in smaller sample sizes of autistic children,Although SCL and NS-SCRs are widely used in research as indicators of sympathetic activation, it should be noted that they are only moderately positively correlatedChildren in this study also exhibited significantly decreased overt behavioral distress indicators, as measured by frequency and duration of distress behavior, in SADE compared with RDE. This finding supports previous research indicating a positive behavioral impact of SADE.Although we found significant improvements in frequency and duration of distress behavior, there were no significant changes in the CDBRS, Frankl Scale, or Anxiety and Cooperation Scale. We hypothesize this may be due to a lack of sensitivity of these measures to assess change. A random measurement error can cause results that cluster around the true value but which are imprecise. For example, the Frankl and Anxiety and Cooperation scales are 4- and 6-point Likert Scales, respectively, and the CDBRS codes only a dichotomous presence or absence for distress variables. Although Kim et alEDA was significantly lower at baseline in SADE vs RDE, suggesting that simply lying in the sensory-adapted room prior to treatment elicited relaxation. EDA at baseline was also significantly associated with future sympathetic activation during the cleaning, overt distress behavior, and child-report of sensory discomfort. Therefore, these results support the potential impact of environmental factors on stress and relaxation immediately on entering the dental operatory and extending throughout the duration of the dental encounter.Similar to the findings of Kim et al,The SADE approach is highly scalable, as it requires minimal training to implement, is easily portable, does not involve renovations, requires only 5 to 10 minutes to set up or remove, and incurs a 1-time cost of less than $6000. In practice settings, this equipment could remain set up indefinitely, with clinicians able to use (or not use) SADE adaptations for any given patient. One of the greatest challenges with implementation of newly developed interventions is the translation of research into practice. Due to the simplicity and high scalability of SADE, it has outstanding potential to be readily implemented into dental clinics nationwide. In fact, SADE has recently been added to the American Academy of Pediatric Dentistry’s best practices for behavioral guidance as a potential technique for dental patients with anxiety or special health care needs.