Analysis of behavior and communication during dental appointments in children with attention and learning problems

Attention and learning problems in children are common and have a substantial impact on many situations in the child s daily life. The present thesis investigates the prevalence of behavior management problems (BMP) and the characteristics of communication during dental appointments in a group of children with attention and learning problems compared to a control group. The thesis comprises a retrospective dental record study of BMP and a prospective, detailed video analysis of the behavior of a group of children during a dental recall visit. The first aim was to investigate whether children with attention and learning problems had more dental behavior management problems (BMP), more cancelled and missed appointments, and more traumatic dental injuries compared with a control group. The second aim was to make a detailed analysis of behavioral interactions between the dentist and the child patient with attention and learning problems. All children born in 1991 (n=555) in one Swedish municipality were screened for attention and learning problems with Conner s 10-item questionnaire and a questionnaire focused on executive and learning problems. The dental records of 128 screen-positive index cases and 131 screen-negative control cases were studied from 1 year of age until the child turned 10. BMP on at least one occasion were more common in the index group than in the control group (54% vs. 37%). The percentage of appointments at which the children exhibited BMP was also higher in the index group (13% vs. 7%). No differences were found concerning cancelled or missed appointments or dental traumatic injuries between the two groups. The dental recall visit at 11 years of age for 65 index cases and 60 control cases was recorded on video and analyzed. The interaction between the dentist and the child was scored as verbal and nonverbal initiatives and responses. Total examination time was significantly longer in the index group. The children in the index group took significantly more initiatives, had significantly fewer verbal responses, were less coordinated between verbal and nonverbal responses, and had more missing responses than the children in the control group. In conclusion, the results of this thesis show that children with attention and learning problems had significantly more behavior management problems compared to a control group. The problems in communication observed in the children with attention and learning problems resulted in less two-way communication between the dentist and the child and poorer timing compared to the interaction between the dentist and the children in the control group