Structured-Visual Model for Dental Examination in Autism Spectrum Disorder Children: Cooperation and Compliance
Open accessAbstract
INTRODUCTION: Children diagnosed with autism spectrum disorder (ASD) may experience challenges in social interaction, communication, and sensory processing, which might influence their cooperative behavior during dental visits. To address this issue, visual pedagogy is commonly employed as a behavioral technique to facilitate successful dental examinations and treatments. OBJECTIVES: The objective of this study was to evaluate the efficacy of a structured-visual behavioral approach in promoting compliance and cooperation during dental examinations in children with ASD in the Yogyakarta Special Region Province, Indonesia. METHODS: A structured visual study was performed at the Muhammadiyah University Dental Hospital during the 2021-2022 period. The study included 5 intervention visits at 1-week intervals and consisted of the Success Approach, Tell-Show-Feel-Do, Visual Pedagogy, Audiovisual Modeling, In vivo Modelling, Behavioral Trial, and Auto modeling. A total of 37 ASD children who met the inclusion criteria were included in the study. The study employed a quasi-experimental design comprising 1 pre-test and 3 post-tests. The efficacy assessment encompassed 2 key dimensions: firstly, the ability to comply with the stages of the dental examination, and secondly, the degree of cooperation was evaluated using the Frankl Behavior Scale (FBS). RESULTS: The findings showed that 64% of the cohort could achieve the highest score in achieving the highest score stage of dental examination in post-test 1. As for cooperation, 75% achieved a score of 4 (FBS) in post-test 1. Changes in the achievement of examination steps and cooperativeness after completing the intervention showed statistically significant changes with the Wilcoxon test (P < .01). CONCLUSION: The structured-visual behavioral model approach was found to be effective in improving compliance and cooperation during dental examination in children with ASD in Yogyakarta Special Region Province, Indonesia. CLINICAL RELEVANCE: These findings highlight the important point that the use of a structured-visual model in daily practice can be beneficial for children with ASD.
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Children with disabilities face persistent barriers to oral health services, including limited availability of trained providers, environmental challenges within clinics, and complexity of delivering care when cooperation is reduced.
“Children with disabilities also face persistent barriers to oral health services. These barriers include limited availability of trained providers, environmental challenges within clinics, and the complexity of delivering care when cooperation is reduced.4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Introduction describes sensory challenges in dental settings and says that reduced cooperation can delay essential dental care for children with ASD. The Discussion also describes examinations disrupted by communication difficulties and uncooperative behavior. The paper does not establish limited availability of trained providers, and its evidence concerns children with ASD rather than children with disabilities generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe available evidence suggests that non-pharmacological chairside management in neurodevelopmental disorders may be most useful when implemented as a stepwise, patient-centered approach.
“The available evidence suggests that non-pharmacological chairside management in NDD may be most useful when implemented as a stepwise, patient-centered approach.2,4–7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods describe a staged, non-pharmacological dental-examination intervention, and the Results report improved cooperation among children with autism spectrum disorder (ASD). The Discussion also emphasizes preparing for each child’s needs with input from parents. The study does not establish that this approach is most useful relative to other approaches or that its findings extend to neurodevelopmental disorders beyond ASD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThis review highlights an autism spectrum disorder-dominant evidence base, with limited representation of other neurodevelopmental disorder profiles such as tic disorders, dyslexia, and speech-language delay.
“This review also highlights an ASD-dominant evidence based, with limited representation of other NDD profiles, such as tic disorders, dyslexia, and speech-language delay, in recent chairside management research.2,4,5,7,9”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Introduction and Discussion describe a dental-examination study focused on children with ASD, so this paper is an example of ASD-focused chairside research. It does not assess the balance of the wider evidence base or establish limited representation of tic disorders, dyslexia, or speech-language delay. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAcross the included studies, outcomes included cooperation scales such as the Frankl scale, procedural tolerance or step completion, observed distress coding, and physiological markers including vital signs or electrodermal activity.
“Across the included studies, outcomes included cooperation scales, such as the Frankl scale, procedural tolerance or step completion, observed distress coding, and physiological markers, including vital signs or electrodermal activity.4–7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods sections on Cooperation and Compliance with the dental examination report use of the Frankl Behavior Scale and scoring of completed examination steps. The paper does not report observed distress coding or physiological outcomes such as vital signs or electrodermal activity; those parts of the multi-citation sentence are not supported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWithin the recent evidence base, the literature was limited, predominantly focused on autism spectrum disorder, and highly heterogeneous in interventions and outcome measures.
“Within this recent evidence base, the literature was limited, predominantly focused on ASD, and highly heterogeneous in terms of interventions and outcome measures.2,4–7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods (page unavailable) describe an intervention study in children with ASD, so this paper supports the ASD-focus part of the sentence as an example. Its Discussion (page unavailable) identifies limitations of this individual study, but does not assess whether the wider literature is limited or highly heterogeneous in interventions and outcome measures. (LLM, conf=0.78)
Experimental — accuracy not yet measured
This review provides a systematic overview of recent chairside approach clusters, highlights measurement gaps, and identifies priorities for future work.
“Nevertheless, this review provides a systematic overview of recent chairside approach clusters, highlights measurement gaps, and identifies priorities for future work.1–5,7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods describe several chairside approaches, including visual pedagogy and modeling, and the Discussion identifies study limitations and recommends control groups and randomization in future work (no page numbers supplied). The cited paper is a single intervention study, however; it does not provide the review’s systematic overview or identify review-wide measurement gaps. (LLM, conf=0.82)
Experimental — accuracy not yet measuredFor children with high avoidance or low tolerance, structured preparation through graded exposure or desensitization combined with modeling may improve tolerance of examinations and preventive care over repeated visits.
“Second, for children with high avoidance or low tolerance, structured preparation through graded exposure or desensitization combined with modeling may improve tolerance of examinations and preventive care over repeated visits.1,4,7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods (Auto-modeling; page unavailable) describe successive introduction to dental procedures combined with video, peer, and self-modeling across visits. The Discussion reports improved cooperation and compliance with dental examinations in children with autism spectrum disorder. The paper does not establish improved tolerance of preventive care, and it does not report a separate outcome for children selected for high avoidance or low tolerance. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe structured visual model reported in the Indonesian study operationalized a successive approach through multiple visits and included Tell-Show-Feel-Do, visual pedagogy, audiovisual modeling, in vivo modeling, and behavioral trials.
“The structured visual model reported in the Indonesian study operationalized this concept through multiple visits using a successive approach. The intervention included Tell-Show-Feel-Do, visual pedagogy, audiovisual modeling, in vivo modeling, and behavioral trials.4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
Preparation-based strategies may be especially important in autism spectrum disorder because sensory unpredictability and unfamiliar routines can lead to avoidance and agitation during dental treatment.
“Preparation-based strategies may be especially important in ASD because sensory unpredictability and unfamiliar routines can lead to avoidance and agitation during dental treatment.2,4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
Across the included evidence, graded exposure, desensitization, and modeling were described as approaches that may reduce novelty and increase procedural tolerance.
“Across the included evidence, graded exposure, desensitization, and modeling were described as approaches that may reduce novelty and increase procedural tolerance.2,4,7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
This approach has clinical utility because it describes a replicable multicomponent trajectory that resembles real-world step-up acclimatization in pediatric dental care rather than a single-session intervention.
“This approach has clinical utility because it describes a replicable multicomponent trajectory that resembles real-world step-up acclimatization in pediatric dental care rather than a single-session intervention.4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Indonesian study reported statistically significant improvements in compliance with examination steps and cooperation, as measured by the Frankl Behavior Scale.
“The study reported statistically significant improvements in compliance with examination steps and cooperation, as measured by the Frankl Behavior Scale.4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The literature continues to be dominated by autism spectrum disorder, with limited mapping of non-autism neurodevelopmental disorder profiles and fewer studies emphasizing standardized, child-centered outcomes.
“In addition, the literature continues to be dominated by ASD, with limited mapping of non-ASD NDD profiles and fewer studies emphasizing standardized, child-centered outcomes.2,4”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Introduction and Results describe a study of children with ASD, but an ASD-focused study alone does not establish that ASD dominates the literature. The Discussion mentions standardized measurement outcomes in this study; it does not assess how often other studies use standardized, child-centered outcomes. Searches for non-ASD neurodevelopmental disorders and comparative research gaps found no passage addressing the remaining claims. (LLM, conf=0.76)
Experimental — accuracy not yet measuredProtective stabilization was discussed or employed in selected circumstances during treatment.
“Protective stabilization was also discussed or employed in selected circumstances during treatment.2,4–7”
From Adapting the Chairside: Pediatric Dental Management for Children with Neurodevelopmental Disorders – A Scoping Review (2026) · cites this paper as [4]
The Methods describe a structured-visual dental examination, and the Discussion describes parents encouraging children to continue or rescheduling visits. Neither section says protective stabilization was discussed or used. Searches for protective stabilization, physical restraint, and immobilization found no passage addressing that practice; the Discussion’s reference to restraining parents’ desires is not physical restraint of a child. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Octavia, A., Sitthisettapong, T., Kettaratad-Pruksapong, M., & Dewanto, I.
- Affiliations
- Thammasat University (TH)
- Muhammadiyah University of Yogyakarta (ID)
- Corresponding author
- Sitthisettapong, Thanya
- Venue
- International Dental Journal
- Publisher
- Elsevier BV
- Published
- 2025-06
- Volume
- 75
- Issue
- 3
- Pages
- 2182-2193
- ISSN
- 0020-6539 (ISSN-L)
- PMC
- PMC12142754
- OpenAlex
- W4406380852
- Semantic Scholar
- e0eb6f1d5e4e083592ed0f36afa3c2e575b5133d
- Cited by
- 6
- References
- 35
- Citations by year
- 2026: 5 · 2025: 1
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Dental Journal (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Universitas Muhammadiyah Yogyakarta
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- autism spectrum disorder, dental examination, pediatric dental care, visual pedagogy, behavioral interventions, medication adherence, patient cooperation, in vivo models
- MeSH terms
- Autism Spectrum Disorder, Child, Child, Preschool, Cooperative Behavior, Female, Humans, Indonesia, Male, Patient Compliance, Dental Care for Children
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