Healing Spaces: Feasibility of a Multisensory Experience for Older Adults with Advanced Dementia and their Caregivers

Healing Spaces proposes a new approach to multisensory interventions that show potential in ameliorating the behavioral and psychological symptoms of advanced dementia in older adults. Using smart technology, the project combines both digital and physical components to transform spaces and create unified, curated sensory experiences that provide meaningful context for interaction, and are easy for caregivers to deliver. A usability study was conducted for the Healing Spaces app followed by a feasibility evaluation of the full experience in a memory care facility recruiting caregivers, and residents in advanced stages of dementia. The feasibility evaluation successfully illuminated strengths as well as areas for improvement for the Healing Spaces experience in a memory care setting with older adults with advanced dementia. Caregivers and facility managers expressed interest in continuing to use Healing Spaces with the residents of the facility. Lessons learned about the technical and logistical implementation of Healing Spaces are discussed, as well as future directions for study design and potential therapeutic value of the experience.Comment: PETRA 20: Proceedings of the 13th ACM International Conference on PErvasive Technologies Related to Assistive Environments. June 2020. Article No 24. Pages 1 to

The Persistence of Oral Health Disparities for African American Children: A Scoping Review

Oral health is an important yet often neglected component of overall health, linked to heart disease, stroke, and diabetic complications. Disparities exist for many groups, including racial and ethnic minorities such as African Americans. The purpose of this study was to examine the potential factors that perpetuate oral health care disparities in African American children in the United States. A systematic search of three literature databases produced 795 articles; 23 articles were included in the final review. Articles were analyzed using a template coding approach based on the social ecological model. The review identified structural, sociocultural, and familial factors that impact the ability of African Americans to utilize oral care services, highlighting the importance of the parent/caregiver role and the patient⁻provider relationship; policy-level processes that impact access to quality care; the value of autonomy in treatment and prevention options; and the impact of sociocultural factors on food choices (e.g., food deserts, gestures of affection). In conclusion, oral health care remains an underutilized service by African American children, despite increasing access to oral care secondary to improvements in insurance coverage and community-based programs

Oral Health Barriers for African American Caregivers of Autistic Children

The most persistent oral health disparities in the United States impact children from racial and ethnic minoritized groups and children diagnosed as autistic. This paper aims to describe barriers to oral care as depicted by Black/African American (B/AA) parents of autistic children to further explore how and why oral health disparities persist in this population. A purposeful sample of eleven caregivers of autistic children, ages 4 to 14 years, who identified as B/AA were interviewed twice for approximately 60–90 min each. Thematic analysis utilizing a narrative approach was employed. Three themes emerged from the data concerning the barriers that affect oral health experiences: (a) difficulty in maintaining good oral health practices, (b) challenges with access to care and resources, and (c) poor patient-provider relationships. Due to the limited research that examines the intersection of autism, B/AA culture, and oral health practices, this study provides a rich picture of the barriers families face when obtaining oral care. Many families raised issues that other parents of autistic children also identified. B/AA caregivers have demonstrated that despite their own negative dental experiences, they understand the value of good oral care practices and are willing to pursue oral care for their children

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA

Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy

Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments

Language matters: Hidden assumptions of health care professionals caring for children with Autism

Background: (395 words, excluding headings) Children with autism spectrum disorders (cASD) experience challenges when receiving medical care1 due to their sensory sensitivities and unique sets of occupational needs. Health care providers (HCPs) have direct contact with cASD and their families, and rely on communication to build relationships and create rapport.2 Language used by HCPs can influence provider-patient encounters, impact the stigma associated with being diagnosed with a disability, and change the way cASD experience health. Statement of Purpose: This paper will explore hidden assumptions held by some HCPs toward their patients with ASD, and how those beliefs are expressed in their language and actions. Methods: Two focus groups of 9 dental practitioners treating cASD were conducted to describe oral care related challenges experienced by cASD and identify strategies to address them. Each session lasted 2.5-3 hours and was transcribed verbatim. Thematic analysis and grounded theory were used to describe strategies to improve care, with codes developed inductively from the data and informed by sensitizing concepts from the literature. Having completed the analysis focused on strategies, it was clear that there were important aspects of the data that were not accounted for by the initial coding scheme. Additional codes driven by the data emerged related to the hidden biases of dentists when discussing children with ASD and their families. Results: Three themes were identified. The first, Healthcare Microaggressions, described instances when HCPs described their patients in a manner that communicated subtle negative opinions. The second theme, Marginalization, denoted the use of exclusionary language, such as “those kids,” which created a sense of otherness, specifically identifying children with ASD as different from “normal” patients. The last theme, Preconceptions, focused on HCPs comments that illuminated subtle biases and opinions they had about their patients, including assumptions about their patients’ cultural backgrounds. Conclusions: Focus group findings provide insight into the implicit biases held by HCPs, and how they manifest in their language and interactions with patients. Further research is necessary to understand how these assumptions relate to quality of care. Relationship to Occupational Science From an occupational justice perspective, everyone has a right to engage in meaningful occupations3 and be treated with respect. The lives of cASD are affected by the stigma they experience in health care settings. In presenting examples of assumptions embedded in HCPs language, we aim to raise awareness about the significance and consequences of biased communication in the patient-provider relationship, and how to decrease stigma in marginalized populations. Key Words: Autism, health care provider, children, stigma Discussion Questions: How does HCPs language impact how cASD experience health occupations? How does biased language with marginalized populations fit into our current approach to occupational justice? How do we reduce stigma in health encounters for cASD

Oral Care Knowledge, Attitudes, and Practices of Black/African American Caregivers of Autistic Children and Non-Autistic Children

Oral health is a vital component of overall health. Children from underserved, minoritized populations (i.e., Black/African Americans, autistic children) are at even greater risk for experiencing oral health disparities. This study aims to illuminate the oral health knowledge, attitudes, and practices of Black/African American caregivers of autistic and non-autistic children. Black/African American caregivers of children (4-to-14 years) on the autism spectrum (n = 65) or not on the autism spectrum (n = 60), participated in a survey, with input from literature reviews, interviews, previous research, and reviews by experts. Caregivers demonstrated basic knowledge of oral health with significantly lower scores for caregivers of autistic children. Caregivers care about oral health and would like to increase their knowledge. Significant differences in oral care practices were found between the autistic and non-autistic groups. Caregivers reported they can access dental services with relative ease, including finding their child a dentist, scheduling a dental appointment, and accessing transportation (personal or public) to attend the visit. Black/African American caregivers of autistic children and children without autism seem to have foundational knowledge about oral health and basic practices; however, they are interested in learning more. Therefore, tailored oral health education programs may help mitigate oral health disparities for Black/African American families

Everyday occupations for children with Autism: Improving oral care

Background: (394 words, excluding headings) Oral health, an everyday occupation of daily living, is important to both physical and psychological health.1 Children with autism spectrum disorders (cASD) experience significant barriers to adequate oral care, including sensory processing concerns, impairments in communication, and ineffective techniques to alleviate fear and anxiety.2 However, little research on efficacious interventions to improve care for this population exists. Statement of Purpose: To gather information from caregivers and dental professionals on current strategies to facilitate successful oral care encounters for cASD. Methods: Two focus groups with parents of cASD (9 parents with children aged 5-18 years) and two focus groups with 7 dental practitioners who treat cASD were conducted. Semi-structured questions were asked about the oral care related challenges experienced by cASD and the strategies employed to address them. Each session lasted 2.5-3 hours in duration and was transcribed verbatim. Thematic analysis following a grounded theory approach was used to analyze the data by 3 independent coders. Results: Three themes emerged from the parent focus groups. The first theme, What Makes a Good Dentist, focused on the dentist’s knowledge, understanding, and experience. The second theme, Tricks, Tactics, and Diversions, described different techniques to improve dental visits. The last theme, Preparation, Preparation, Preparation, explored parent-implemented strategies. In the dentist focus groups, four themes emerged. The first theme, Parents Know Best, described how dentists often valued parental expertise regarding care techniques. The second theme, Desensitization, explored strategies for preparation in the home and at the dental office. The third theme, Network of Colleagues, referred to dentists seeking advice of other health care professionals regarding working with the ASD population, as well as mentoring new dentists. The last theme, Flexibility, focused on dentists doing “whatever it takes” to accommodate the needs of cASD. Conclusions: Focus group findings provide insight into the techniques perceived by parents and dental providers to lead to successful dental care encounters for cASD. This information has the potential to improve care for this population by identifying areas for modification to create the optimal experience for cASD and their parents. Relationship to Occupational Science Caring for a child with ASD is a unique and challenging experience.3 Better understanding of these strategies can help to improve oral care for cASD, and illuminate the particularities of how cASD engage in everyday occupations.3 Discussion about how to facilitate better experiences for cASD in dental settings also has potential to help mitigate the health disparities faced by this marginalized population. Key Words: Autism, oral care, children Discussion Questions: 1. How do these oral care strategies impact the experience of everyday occupations for cASD? 2. How is engagement and participation in oral health affected by a diagnosis of ASD

sj-docx-1-aut-10.1177_13623613231163056 – Supplemental material for Pediatricians’ role in healthcare for Latino autistic children: Shared decision-making versus “You’ve got to do everything on your own”

Supplemental material, sj-docx-1-aut-10.1177_13623613231163056 for Pediatricians’ role in healthcare for Latino autistic children: Shared decision-making versus “You’ve got to do everything on your own” by Amber M Angell, Olivia J Lindly, Daniella Floríndez, Lucía I Floríndez, Leah I Stein Duker, Katharine E Zuckerman, Larry Yin and Olga Solomon in Autism</p