Reducing Fear and Enhancing Aesthetics: Orthodontic Management with Video Self-Modeling in an Adolescent with Autism Spectrum Disorder

Introduction

Autism spectrum disorder (ASD), characterized by challenges in social interaction, communication, and repetitive behaviors,¹ affects approximately 1 in 100 children globally.² This condition poses unique challenges in various settings, with dental care being a notable concern.³ The experiences of children with ASD are further complicated by sensory overload, exposure to unfamiliar stimuli, and communication difficulties, all of which contribute to their increased anxiety and fear.⁴

In response to these complexities, there is a critical need for tailored behavior-guidance techniques that extend beyond traditional approaches. Current research emphasizes the shortcomings of conventional methods and highlights the importance of innovative and personalized strategies. Within this context, video self-modeling (VSM) has emerged as a promising, yet underexplored tool that presents an innovative approach to effectively manage fear and anxiety in individuals with ASD.

Case Report

An 11-year-old girl diagnosed with ASD visited the dental outpatient department with concerns regarding forward positioning of her upper front teeth. During her first visit, she exhibited signs of photophobia and was reluctant to undergo dental care. To assess anxiety and behavior, we used the Facial Image Scale, Venham's picture test, and Frankel's behavior rating scale. Venham's picture test helps children express their dental anxiety by choosing images that resemble their feelings. It generates scores ranging from 0 (no anxiety) to 5 (extreme anxiety). Simultaneously, we assessed her behavior using Frankel's behavior rating scale, categorizing it from definitely positive (score = 4) to definitely negative (score = 1). Parental assistance was crucial for these assessments.

Following an unsuccessful initial dental visit with conventional behavioral guidance techniques, we prepared a video in which the child's face was incorporated into the footage of an ideal dental visit (Fig. 1). This video was shown to her for 2 weeks prior to her next appointment. The subsequent dental visits showed significant improvements in both assessments (Table 1).

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Fig. 1 Insights from video self-modeling: a child's first dental visit.

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Inspired by this progress, we created more self-modeling videos for each subsequent treatment, reinforcing positive changes, encouraging repetition, and building trust. The treatment plan involved 6 months of twin-block therapy followed by fixed orthodontic therapy (Fig. 2). The treatment spanned 5 years. The results were very promising and met the aesthetic demands of the patient and her family. After the completion of orthodontic treatment, individualized home care measures were established and further emphasized using VSM.

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Fig. 2 Cephalometric changes before (1) and after orthodontic intervention (2).

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Discussion

Autism, originally described by Kanner in 1943, is a pervasive developmental disorder characterized by difficulties in social interactions, communication, and repetitive behaviors. Beyond these core characteristics, individuals with autism may be prone to phobias, sleep disturbances, eating difficulties, temper tantrums, and self-directed aggression.¹⁵ In dental settings, children with ASD often struggle with sensory-induced fear, leading to the avoidance of care. Pediatric dentists use techniques, such as systematic desensitization and visual pedagogy, to help children with ASD adapt. However, traditional methods face challenges owing to their sensory sensitivity, communication issues, and limited generalization. Recognizing individuals with ASD as visual learners, VSM has emerged as a powerful tool to aid in adaptation and improve general well-being, particularly in dental care.

Conclusion

Pediatric dentists face unique challenges when providing dental care to children with ASD, including increased anxiety and fear due to sensory overload, unfamiliar stimuli, and communication difficulties. Innovative behavioral guidance techniques are crucial for addressing the diverse needs of individuals with ASD, highlighting the importance of reducing anxiety, facilitating communication, and building trust between dental care providers and children with ASD. VSM has been introduced as an effective and underexplored tool for managing dental treatment in children with ASD, offering a promising approach to alleviate anxiety and enhance dental care experiences, and emphasizing its importance in the field of pediatric dentistry.