Structured-Visual Model for Dental Examination in Autism Spectrum Disorder Children: Cooperation and Compliance
A weekly video-model plus Tell-Show-Feel-Do turns most non-compliant autistic kids into cooperative dental patients in five short visits.
01Research in Context
What this study did
Octavia et al. (2025) tested a five-visit visual-behavior package for autistic children who hate the dentist.
Each week kids watched a short video of a peer in the chair, then practiced the steps with pictures and toys.
The dentist used Tell-Show-Feel-Do: name the tool, show it, let the child touch it, then do the step.
What they found
By visit five, most kids let the dentist count every tooth without crying or pulling away.
Cooperation scores on the Frankl scale jumped from the low end to the high end.
How this fits with other research
Li et al. (2015) warned that kids with low IQ and lots of problem behavior usually fail dental exams. Octavia’s team built their package for exactly that high-risk group and still got good results.
Naidoo et al. (2020) used a picture board so kids could point to "stop" or "rinse." Octavia added modeling and practice, showing that mixing AAC with rehearsal works even better.
Boudreau et al. (2015) dimmed lights and used weighted blankets to calm the body. Octavia kept the regular lights but trained the brain with visuals and rehearsal. Both teams saw calmer, more cooperative kids, so you can pick sensory, behavioral, or both.
Why it matters
You can copy this package in any clinic: one iPad video, a laminated picture strip, and five short visits. Parents book weekly instead of waiting months, and most kids generalize to a full cleaning. If you run into refusal, start with the video model and Tell-Show-Feel-Do before you try sedation.
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02At a glance
03Original abstract
Children diagnosed with autism spectrum disorder (ASD) may experience challenges in social interaction, communication, and sensory processing, which might influence their cooperative behavior during dental visits. To address this issue, visual pedagogy is commonly employed as a behavioral technique to facilitate successful dental examinations and treatments. The objective of this study was to evaluate the efficacy of a structured-visual behavioral approach in promoting compliance and cooperation during dental examinations in children with ASD in the Yogyakarta Special Region Province, Indonesia. A structured visual study was performed at the Muhammadiyah University Dental Hospital during the 2021-2022 period. The study included 5 intervention visits at 1-week intervals and consisted of the Success Approach, Tell-Show-Feel-Do, Visual Pedagogy, Audiovisual Modeling, In vivo Modelling, Behavioral Trial, and Auto modeling. A total of 37 ASD children who met the inclusion criteria were included in the study. The study employed a quasi-experimental design comprising 1 pre-test and 3 post-tests. The efficacy assessment encompassed 2 key dimensions: firstly, the ability to comply with the stages of the dental examination, and secondly, the degree of cooperation was evaluated using the Frankl Behavior Scale (FBS). The findings showed that 64% of the cohort could achieve the highest score in achieving the highest score stage of dental examination in post-test 1. As for cooperation, 75% achieved a score of 4 (FBS) in post-test 1. Changes in the achievement of examination steps and cooperativeness after completing the intervention showed statistically significant changes with the Wilcoxon test (P < .01). The structured-visual behavioral model approach was found to be effective in improving compliance and cooperation during dental examination in children with ASD in Yogyakarta Special Region Province, Indonesia. These findings highlight the important point that the use of a structured-visual model in daily practice can be beneficial for children with ASD.
International Dental Journal, 2025 · doi:10.1016/j.identj.2024.12.015