Evaluación de tres técnicas para el manejo de conducta odontológica en pacientes con trastorno del espectro autista / Evaluation of three techniques for the dental behavior management in autistic spectrum disorder patients

RESUMEN

Objetivo. Evaluar tres técnicas para el manejo de conducta Desensibilización Sistemática (DS), Método Treament and Education of Autistic and related Communication Handi-capped Children (TEACCH) y la técnica Decir, Mostrar, Hacer (DMH), durante la atención dental a personas con trastorno del espectro autista (TEA). Métodos. Participaron 18 personas del Noreste de México con diagnóstico de TEA, con un rango de 13 a 15 años divididos en tres grupos según la técnica TEACCH, DS y DMH con seis personas por grupo. A los participantes se les realizó una profilaxis dental empleando la técnica de manejo de conducta y comunicación según el grupo, la conducta se evaluó usando las escalas Frankl ́s Behavior Rating Scale (FBRS) y Comfort Behavior Scale (CBS). Se usaron las pruebas Chi cuadrado, ANOVA y t de Student para comparar los resultados. Resultados. La conducta evaluada con la escala de Frankl, fue definitivamente positiva en los grupos TEACCH (33,3%) y DS (16,7%). Conducta positiva semejante en los tres grupos (66,7%). Conducta negativa semejante en DS y DMH (16,7%). Conducta definitivamente negativa solo en el grupo DMH (16,7%). En la escala CBS, solo el grupo DMH presentó aumento del tono muscular (p= 0,013) y tensión facial no sostenida (p= 0,001), al compararlo con TEACCH y DS. Conclusiones. Las tres tecnicas utilizadas son efectivas para el manejo de conducta de las personas con TEA durante el tratamiento dental, sin embargo en la técnica DMH se observó conducta definitivamente negativa y respuesta corporal-conductual que refleja tensión emocional.

ABSTRACT

Objective. Evaluate three behavior management techniques Systematic Desensitization (SD), the Treament and Education of Autistic and related Communication Handicapped Children (TEACCH) and Tell, Show, Do (TSD) Method, during dental care for people with Autism Spectrum Disorder (ASD). Methods. Eighteen people from Northeast Mexico diagnosed with autism spectrum disorder participated, with a range of 13 to 15 years, divided in to three groups, according to the TEACCH, SD and TSD technique with six participants per group. A dental prophylaxis was performed on the participants, using the behavior management and communication technique according to the group, the behavior was evaluated using the Frankl's behavior rating scale (FBRS) and Comfort Behavior Scale (CBS). Chi square, ANOVA and Student's t tests were used to compare the results. Results. Behavior evaluated with Frankl scale was definitely positive in TE-ACCH (33.3%) and DS (16.7%) groups. Similar positive behavior in the three groups (66,7%). Similar negative behavior in DS and DMH (16.7%). Definitively negative behavior only in the DMH group (16.7%). With CBS scale, only the DMH group presented increased muscle tone (p= 0.013) and evident not sustained tension in some facial muscles (p= 0.001), when compared with TEACCH and DS by ANOVA analysis. Conclusions. The three techniques evaluated are effective for managing behavior of people with ASD during dental treatment, however, in DMH technique, definitely negative behavior and a corporal-behavioral response were observed, reflecting emotional stress.