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Efficacy of Social Story Intervention in Training Toothbrushing Skills Among Special-Care Children With and Without Autism

A special-care child being guided by their mother in learning toothbrushing skills. The child holds a social story book about toothbrushing while practicing with a toothbrush. The setting is a brightly lit, child-friendly bathroom with colorful decorations. The mother offers gentle assistance and encouragement, creating a supportive and engaging environment, capturing the efficacy of social story intervention in training toothbrushing skills among special-care children.
Social Stories for Toothbrushing

Toothbrushing is a fundamental routine for maintaining oral hygiene, yet it presents significant challenges for young children with special care needs, particularly those with autism. A study published in "Autism Research" explored the effectiveness of using social stories to teach toothbrushing skills to preschool children with special needs. The study involved 181 children, comprising 87 with autism and 94 without, recruited from Special Child Care Centers. This blog delves into the findings and implications of this research.

Social stories are short, descriptive narratives that provide children with a clear understanding of specific social situations or skills. Developed by Carol Gray in the early 1990s, these stories aim to improve the social understanding and behavior of children with autism by illustrating appropriate responses and actions in various scenarios. In this study, a validated toothbrushing social story was employed to teach the toothbrushing procedure to the children involved.

Parents were encouraged to read the social story to their children before or during their daily toothbrushing routine. The intervention spanned six months, during which children's toothbrushing performance, oral hygiene status, and gingival health were assessed at the beginning and end of the period.

Significant Findings

The study found notable improvements in the toothbrushing performance, oral hygiene, and gingival health of the children after the six-month intervention. Specifically:

Overall Improvement: All children showed significant improvements in their toothbrushing skills and oral health. The social story intervention effectively enhanced their ability to perform this essential self-care task.

Children with Autism: Interestingly, children with autism exhibited better oral hygiene and gingival health than their peers without autism. The data showed a significant improvement (P = 0.01 for oral hygiene and P < 0.001 for gingival health), suggesting that the structured and predictable nature of social stories might resonate more effectively with children on the autism spectrum.

Parental Influence: The study also highlighted the role of parents in the success of the intervention. The improvement in children’s toothbrushing performance and oral health was associated with their intellectual functioning and the parents' attitudes towards the usefulness of social stories. This underscores the importance of parental involvement and positive reinforcement in health-promoting behaviors for children with special needs.

Practical Implications

The findings suggest that social story interventions can be a valuable tool in improving the oral hygiene practices of children with special needs, including those with autism. The structured format of social stories appears particularly beneficial for children with autism, possibly due to their preference for routine and predictability.

To maximize the benefits of social story interventions, parents and caregivers can adopt the following strategies:

Consistency: Regularly read the social story to the child before or during toothbrushing to reinforce the routine.

Engagement: Actively engage the child in the process, encouraging them to follow along with the steps outlined in the story.

Positive Reinforcement: Provide positive feedback and reinforcement to motivate the child and enhance their learning experience.

The research conducted by Ni Zhou, Hai Ming Wong, and Colman McGrath demonstrates the efficacy of social stories in training toothbrushing skills among special-care children. The study provides compelling evidence that social story-based interventions can significantly improve the oral hygiene and health of children, particularly those with autism. By incorporating these narratives into daily routines, parents and caregivers can foster better self-care practices and contribute to the overall well-being of their children.

Social stories, therefore, represent a practical and effective approach to addressing the unique challenges faced by children with special care needs in learning essential self-care skills. As this study highlights, with the right tools and support, these children can achieve significant improvements in their daily lives.

Zhou, N., Wong, H. M., & McGrath, C. (2020). Efficacy of Social Story Intervention in Training Toothbrushing Skills Among Special-Care Children With and Without Autism. Autism Research, 13(4), 666-674. doi:10.1002/aur.2256


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