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Health- and oral health-related quality of life among preschool children with autism spectrum disorders

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Abstract

Purpose

To assess the health-related quality of life (HrQoL) and oral health-related quality of life (OHrQoL) of preschool children with autism spectrum disorders (ASD) and to determine the associated factors.

Methods

A case–control study of preschool children with and without ASD was undertaken. H&OHrQoL were assessed employing Pediatric Quality-of-Life Inventory Version 4.0 (PedsQL™ 4.0) and Early Childhood Oral Health Impact Scale (ECOHIS). Differences in PedsQL and ECOHIS scores were determined between groups and correlation between PedsQL and ECOHIS was explored. Regression analyses were conducted to determine key factors associated with H&OHrQoL.

Results

Parents of 510 children (253 cases and 257 controls) completed the H&OHrQoL questionnaire assessments. Significant difference in PedsQL (p < 0.001) and ECOHIS (p < 0.001) scores was apparent between children with and without ASD. There was a positive and weak correlation between PedsQL and ECOHIS scores (r = − 0.45, p < 0.01). In regression analyses, the presence of ASD was associated with an increased likelihood of having lower PedsQL (OR 0.10, 95% CI 0.06–0.15, p < 0.001) and higher ECOHIS scores (OR 2.34, 95% CI 1.60–3.42, p < 0.001).

Conclusions

Differences in H&OHrQoL exist among preschool children with and without ASD. There was a significant but weak correlation between children’s H&OHrQoL. Both H&OHrQoL were associated with autism spectrum disorders.

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References

  • Adamec C. The use of Spearman's correlation order coefficient in validation. [Article in Czech]. Cesk Zdrav. 1966;14(2):100–2.

    PubMed  Google Scholar 

  • Allen PF. Assessment of oral health related quality of life. Health Qual Life Outcomes. 2003;1:40.

    Article  PubMed  PubMed Central  Google Scholar 

  • APA. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.

  • Barry S, O’Sullivan EA, Toumba KJ. Barriers to dental care for children with autism spectrum disorder. Eur Arch Paediatr Dent. 2014;15:127–34.

    Article  PubMed  Google Scholar 

  • Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45:601–13.

    Article  PubMed  Google Scholar 

  • Berman AH, Liu B, Ullman S, Jadbäck I, Engström K. Children’s quality of life based on the KIDSCREEN-27: child self-report, parent ratings and child–parent agreement in a Swedish random population sample. PLoS ONE. 2016;11(3):e0150545.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bhandary S, Hari N. Salivary biomarker levels and oral health status of children with autistic spectrum disorders: a comparative study. Eur Arch Paediatr Dent. 2017;18:91–6.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2016/p0331-children-autism.html. 2016. Accessed Apr 2016.

  • Chan LF, Chow SM, Lo SK. Preliminary validation of the Chinese version of the pediatric quality of life inventory. Int J Rehabil Res. 2005;28:219–27.

    Article  PubMed  Google Scholar 

  • Chang PC, Yeh CH. Agreement between child self-report and parent proxy-report to evaluate quality of life in children with cancer. Psychooncology. 2005;14:125–34.

    Article  PubMed  Google Scholar 

  • Cremeens J, Eiser C, Blades M. Factors influencing agreement between child self-report and parent proxy-reports on the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes. 2006;4:58.

    Article  PubMed  PubMed Central  Google Scholar 

  • Deth R, Muratore C, Benzecry J, Power-Charnitsky VA, Waly M. How environmental and genetic factors combine to cause autism: a redox/methylation hypothesis. Neurotoxicology. 2008;29(1):190–201.

    Article  PubMed  Google Scholar 

  • Du RY, McGrath C, Yiu CK, King NM. Health- and oral health-related quality of life among preschool children with cerebral palsy. Qual Life Res. 2010;19:1367–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Du RY, Yiu CC, Wong VC, McGrath CP. Autism developmental profiles and cooperation with oral health screening. J Autism Dev Disord. 2015a;45:2758–63.

    Article  PubMed  Google Scholar 

  • Du RY, Yiu CK, King NM, Wong VC, McGrath CP. Oral health among preschool children with autism spectrum disorders: a case–control study. Autism. 2015b;19:746–51.

    Article  PubMed  Google Scholar 

  • Du RY, Yiu CK, King NM. Oral health behaviours of preschool children with autism spectrum disorders and their barriers to dental care. J Autism Dev Disord. 2019;49:453–9.

    Article  PubMed  Google Scholar 

  • Eiser C, Morse RA. Review of measures of quality of life for children with chronic illness. Arch Dis Child. 2001;84:205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. Eur Arch Paediatr Dent. 2015;16:205–9.

    Article  PubMed  Google Scholar 

  • Feinberg E, Augustyn M, Fitzgerald E, Sandler J, Suarez ZF, Chen N, Cabral H, Beardslee W, Silverstein M. Improving maternal mental health after a child’s diagnosis of autism spectrum disorder: results from a randomized clinical trial. JAMA Pediatr. 2014;168:40–6.

    Article  PubMed  Google Scholar 

  • Hernandez P, Ikkanda Z. Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments. J Am Dent Assoc. 2011;142:281–7.

    Article  PubMed  Google Scholar 

  • Ikeda E, Hinckson E, Krageloh C. Assessment of quality of life in children and youth with autism spectrum disorder: a critical review. Qual Life Res. 2014;23:1069–85.

    Article  PubMed  Google Scholar 

  • Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci. 2011;19:212–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kamp-Becker I, Schröder J, Muehlan H, Remschmidt H, Becker K, Bachmann CJ. Health-related quality of life in children and adolescents with autism spectrum disorder. Z Kinder Jugendpsychiatr Psychother. 2011;39:123–31.

    Article  PubMed  Google Scholar 

  • Kandel ER. A new intellectual framework for psychiatry. Am J Psychiatry. 1998;155:457–69.

    Article  PubMed  Google Scholar 

  • Khanna R, Madhavan SS, Smith MJ, Patrick JH, Tworek C, Becker-Cottrill B. Assessment of health-related quality of life among primary caregivers of children with autism spectrum disorders. J Autism Dev Disord. 2011;41:1214–27.

    Article  PubMed  Google Scholar 

  • Kuhlthau K, Orlich F, Hall TA, Sikora D, Kovacs EA, Delahaye J, et al. Health-related quality of life in children with autism spectrum disorders: results from the autism treatment network. J Autism Dev Disord. 2010;40:721–9.

    Article  PubMed  Google Scholar 

  • Lai B, Milano M, Roberts MW, Hooper SR. Unmet dental needs and barriers to dental care among children with autism spectrum disorders. J Autism Dev Disord. 2012;42:1294–303.

    Article  PubMed  Google Scholar 

  • Lam PPY, Du RY, Peng S, McGrath CPJ, Yiu CKY. Oral health status of children and adolescents with autism spectrum disorder: a systematic review of case–control studies and meta-analysis. Autism; 2019. (In press).

  • Lee GH, McGrath C, Yiu CK, King NM. Translation and validation of a Chinese language version of the Early Childhood Oral Health Impact Scale (ECOHIS). Int J Pediatr Dent. 2009;6:399–405.

    Article  Google Scholar 

  • Lee YC, Yang HJ, Chen VC, Lee WT, Teng MJ, Lin CH, Gossop M. Meta-analysis of quality of life in children and adolescents with ADHD: by both parent proxy-report and child self-report using PedsQL™. Res Dev Disabil. 2016;51:160–72.

    Article  PubMed  Google Scholar 

  • Levy SE, Mandell DS, Schultz RT. Autism. Lancet. 2009;374:1627–38.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lewis C, Vigo L, Novak L, Klein EJ. Listening to parents: a qualitative look at the dental and oral care experiences of children with autism spectrum disorder. Pediatr Dent. 2015;37:E98–104.

    PubMed  Google Scholar 

  • Locker D. Issues in measuring change in self-perceived oral health status. Community Dent Oral Epidemiol. 1998;26:41–7.

    Article  PubMed  Google Scholar 

  • London EA. The environment as an etiologic factor in autism: a new direction for research. Environ Health Perspect. 2000;108(Suppl 3):401–4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loo CY, Graham RM, Hughes CV. Behaviour guidance in dental treatment of patients with autism spectrum disorder. Int J Paediatr Dent. 2009;19:390–8.

    Article  PubMed  Google Scholar 

  • Lowe O, Lindemann R. Assessment of the autistic patient’s dental needs and ability to undergo dental examination. ASDC J Dent Child. 1985;52:29–35.

    PubMed  Google Scholar 

  • Luppanapornlarp S, Leelataweewud P, Putongkam P, Ketanont S. Periodontal status and orthodontic treatment need of autistic children. World J Ortho. 2010;11:256–61.

    Google Scholar 

  • Marion IW, Nelson TM, Sheller B, McKinney CM, Scott JM. Dental stories for children with autism. Spec Care Dentist. 2016;36:181–6.

    Article  PubMed  Google Scholar 

  • McGrath C, Bedi R. Measuring the impact of oral health on quality of life in britain using OHQoL-UK(W). J Public Health Dent. 2003;63:73–7.

    Article  PubMed  Google Scholar 

  • Moyal WN, Lord C, Walkup JT. Quality of life in children and adolescents with autism spectrum disorders: what is known about the effects of pharmacotherapy? Paediatr Drugs. 2014;16:123–8.

    Article  PubMed  Google Scholar 

  • Murshid EZ. Characteristics and dental experiences of autistic children in Saudi Arabia: cross-sectional study. J Autism Dev Disord. 2011;41:1629–34.

    Article  PubMed  Google Scholar 

  • Namal N, Vehit HE, Koksal S. Do autistic children have higher levels of caries? A cross-sectional study in Turkish children. J Indian Soc Pedod Prev Dent. 2007;25:97–102.

    Article  PubMed  Google Scholar 

  • Nelson LP, Getzin A, Graham D, Zhou J, Wagle EM, McQuiston J, McLaughlin S, Govind A, Sadof M, Huntington NL. Unmet dental needs and barriers to care for children with significant special health care needs. Pediatr Dent. 2011;33:29–36.

    PubMed  Google Scholar 

  • Pahel BT, Rozier RG, Slade GD. Parental perceptions of children’s oral health: the early childhood oral health impact scale (ECOHIS). Health Qual Life Outcomes. 2007;5:6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pani SC, Mubaraki SA, Ahmed YT, Alturki RY, Almahfouz SF. Parental perceptions of the oral health-related quality of life of autistic children in Saudi Arabia. Spec Care Dentist. 2013;33:8–12.

    Article  PubMed  Google Scholar 

  • Richa, Yashoda R, Puranik MP. Oral health status and parental perception of child oral health related quality-of-life of children with autism in Bangalore, India. J Indian Soc Pedod Prev Dent. 2014;32:135–9.

    Article  Google Scholar 

  • Sheldrick RC, Neger EN, Shipman D, Perrin EC. Quality of life of adolescents with autism spectrum disorders: concordance among adolescents’ self-reports, parents’ reports, and parents’ proxy reports. Qual Life Res. 2012;21:53–7.

    Article  PubMed  Google Scholar 

  • Shipman DL, Sheldrick RC, Perrin EC. Quality of life in adolescents with autism spectrum disorders: reliability and validity of self-reports. J Dev Behav Pediatr. 2011;32:85–9.

    Article  PubMed  Google Scholar 

  • Spieth LE, Harris CV. Assessment of health-related quality of life in children and adolescents: an integrative review. J Pediatr Psychol. 1996;21:175–93.

    Article  PubMed  Google Scholar 

  • Stein LI, Polido JC, Najera SO, Cermak SA. Oral care experiences and challenges in children with autism spectrum disorders. Pediatr Dent. 2012;34:387–91.

    PubMed  Google Scholar 

  • Tonge B, Brereton A, Kiomall M, Mackinnon A, King N, Rinehart N. Effects on parental mental health of an education and skills training program for parents of young children with autism: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2006;45:561–9.

    Article  PubMed  Google Scholar 

  • Uneri OS, Agaoglu B, Coskun A, Memik NC. Validity and reliability of pediatric quality of life inventory for 2- to 4-year-old and 5- to 7-year-old Turkish children. Qual Life Res. 2008;17:307–15.

    Article  PubMed  Google Scholar 

  • Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12.

    Article  PubMed  Google Scholar 

  • Veenstra-Vanderweele J, Christian SL, Cook EH Jr. Autism as a paradigmatic complex genetic disorder. Annu Rev Genomics Hum Genet. 2004;5:379–405.

    Article  PubMed  Google Scholar 

  • Williams JG, Higgins JP, Brayne CE. Systematic review of prevalence studies of autism spectrum disorders. Arch Dis Child. 2006;91:8–15.

    Article  PubMed  Google Scholar 

  • Yuen K. The two-sample trimmed t for unequal population variances. Biometrika. 1974;61:165–70.

    Article  Google Scholar 

Download references

Acknowledgements

I would like to express my gratitude to all the parents, children and teachers who participated in this study, as well the assistants and technicians who contributed to the whole project.

Funding

This is a Ph.D. study, and no funding was received.

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Correspondence to R. Y. Du.

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All the authors declare that there was no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) [IRB Reference Number: UW 11-184].

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Informed consent was obtained from all the individual participants (parents of children with and without ASD) included in the study.

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Du, R.Y., Yiu, C.K.Y. & King, N.M. Health- and oral health-related quality of life among preschool children with autism spectrum disorders. Eur Arch Paediatr Dent 21, 363–371 (2020). https://doi.org/10.1007/s40368-019-00500-1

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