Futuro alcance del proyecto

1- Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS):

This measure was developed by Cuthbert and Melamed (1982) and is a standardised questionnaire that has been used widely and internationally (Kroniņa, Stradins & Care, 2014). The CFSS-DS has undergone various reliability and validity testing (Al-Namankany, De Souza, & Ashley, 2012) and has demonstrated high internal consistency, as well as good test-retest reliability, satisfactory criterion and construct validity in English, as well as numerous other languages (El-Housseiny et al., 2016). The research by Stein et al. (2014), mentioned above, is

the only recent study to have used the CFSS-DS with children with ASD, and those specifically within the age range of this present study.

The CFSS-DS contains 15 items with agreement with each statement rated on a 5 point Likert scale; items in this scale are related to dental situations and treatments. To ensure the items were understood and rated properly by the children (both ASD and TD), pictures of faces that represent each rating were added (Appendix 20, p. 263). Although the CFSS-DS shows good validity and reliability, it was found that parents tend to estimate the dental fear of their children slightly higher than their children’s own scores show. Such findings have been confirmed by other research that has found mixed results in terms of parental assessments of anxiety (with some studies classifying this as ‘good’, while others as ‘weak’, or ‘poor’) (El- Housseiny, Merdad, Alamoudi & Farsi, 2015; Gustafsson, Arnrup, Broberg, Bodin & Berggren, 2010).

2- The Spence’s Children’s Anxiety Scale (SCAS: Spence, 1997)

This scale was developed to measure anxiety symptoms according to the DSM-IV anxiety disorders dimensions. The SCAS evaluates six aspects of anxiety: social phobia, separation anxiety, physical injury fears, generalised anxiety, panic/agoraphobia, and obsessive-compulsive disorder. Children were required to rate each experience on a 4-point frequency scale.

The scale involves 44 items in total; 38 of them are specific to anxiety symptoms and 6 are positive filler items to decrease negative response bias. The SCAS shows good psychometric properties, which makes it an acceptable measure for anxiety. Wigham and McConachie (2014) conducted a thorough assessment of psychometric measures, which were employed in intervention research for youngsters with ASD and anxiety. It was reported that the SCAS is a strong measure regarding its properties, and it showed high internal consistency (Wigham & McConachie, 2014; Zainal, Magiati, Tan, Sung, Fung, & Howlin, 2014). This scale has also been examined by other studies of tools used with children with ASD, including by Grondhuis and Aman (2012), who found the SCAS to be a measure commonly applied where

anxiety is comorbid with ASD. Those authors stated that the psychometric properties of the SCAS were ‘fair-to-good’, although commented that the scale lacks characteristics for children with ASD (Grondhuis & Aman, 2012).

The SCAS’s broad applicability has led to it being relied upon extensively in studies for children, a recent example being May, Cornish, and Rinehart (2015). The SCAS’s validity has led to it being used frequently as an outcome measure in studies of ASD and anxiety, as has been recognised in a meta-analysis undertaken by Sukhodolsky, Bloch, Panza, and Reichow (2013), as well as Kreslin, Robertson, and Melville’s (2015) systematic review. Both drew on a number of studies that had used the SCAS. In addition, SCAS provides a version for the parent/caregiver to complete.

The SCAS’s effectiveness has recently been examined by Zainal et al. (2014) in their paper, ‘A Preliminary Investigation of the Spence Children’s Anxiety Parent Scale as a Screening Tool for Anxiety in Young People with Autism Spectrum Disorders’, which considered the utility of the SCAS-P (parental version) as an assessment measure for anxiety disorders. They found the SCAS-P apparently strikes an acceptable stability between level of sensitivity and specificity, apart from its positive predictive value, which the authors explained may be due to a lack of precision in appropriate screening for young people with clinically elevated levels of anxiety (Zainal et al., 2014).

3- Adolescent/Adult Sensory Profile (Brown & Dunn, 2002)

This self-questionnaire is intended to measure sensory processing and reflects neurological thresholds and self-regulation patterns (Blanche, Parham, Chang & Mallinson, 2014; Engel-Yeger, 2012). A person will respond to questions concerning how he /she reacts to sensations, in comparison to the way he/she he reacts at different time. The Adolescent/Adult Sensory Profile is divided into four quadrants based on an intersection between a neurological threshold continuum and a behavioural response continuum, namely, 1) low registration, 2) sensation seeking, 3) sensory sensitivity and 4) sensation avoiding (Brown & Stoffel, 2010).

the psychometric characteristics of this measure are good (Engel-Yeger, 2012). The Adolescent/Adult Sensory Profile has been considered the most widely used measure for adults with ASD (Tavassoli, Hoekstra & Baron-Cohen, 2014) and has been advised to be employed with children with ASD by professionals because of its accurate assessment of an individual’s sensory processing threshold (Kern et al., 2007). The Adolescent/Adult Sensory Profile has been applied in several studies examining children with ASD (Hilton et al., 2010; Schoen, Miller, Brett-Green & Nielsen, 2009; Tomchek & Dunn, 2007), which makes it appropriate and useful for the current study.

4- The Dental Cognitions Questionnaire (DCQ) (De Jongh, Muris, Schoenmakers & Horst, 1995)

The DCQ has been found to demonstrate satisfactory psychometric characteristics, good internal consistency, high test-retest reliability, as well as satisfactory concurrent validity (Hood & Anthony, 2012). The DCQ uses a yes/no dichotomous scale consisting of 38 items that measure the individual’s present beliefs about the dental care treatment. This scale is divided into two parts, of which the initial 14 questions examine beliefs about oneself and dentistry in general, and the subsequent 24 assess self-statements during treatment. This measure was modified after being piloted, with some of the items deleted and the language simplified, as required for the target sample, which resulted in a scale that is divided into three parts, of which the first seven questions examine worries about the dentist; the next three assess worries about the self and the last 19 examine worries about treatment.

Table 5.2: Changes in the Dental Cognitive Questionnaire

Original Rephrased / Deleted Items Beliefs about Oneself and

Dentistry in General

Worries about the Dentists When knowing that I have

to undergo dental treatment very soon. I think:

This was removed and instead ‘I think’ was put before each statement.

Dentists do as they please. I think dentists do as they please Yes No Dentists are often impatient. I think dentists are often

impatient.

Yes No

The dentist does not care if it hurts.

I think dentists do not care if it hurts.

Yes No

Dentists do not understand you.

I think dentists do not understand you.

Yes No

Dentists are often incapable. I think dentists are often not good at their job.

Yes No

Dentists think you act childish.

I think dentists think I am acting childish.

Yes No

Treatment often fail. I think treatment won’t work. Yes No

My teeth can’t be saved. Deleted Yes No

Worries about self I should be ashamed about

my teeth.

I think I am ashamed of my teeth.

Yes No

My teeth might break. Deleted

I did not find in the literature nor in my first study anything that mentioned fear about broken teeth.

Yes No

I can’t stand pain. I think I can’t stand pain. Yes No I am a tense person. I think I am a nervous person. Yes No I am a difficult person. Deleted

They won’t call themselves difficult, especially at this age.

Yes No

I am someone with very long roots.

Deleted

Very difficult questions for the age range.

Yes No

Worries about Treatment While being treated, I think:

Everything goes wrong. I think everything will go wrong.

Yes No

This treatment will hurt. I think the treatment will hurt. Yes No My teeth will break. Deleted

I did not find in the literature nor in my first study anything that mentioned fear about broken teeth.

Yes No

Something surely will go wrong.

Deleted . Yes No

It never runs smoothly. Deleted

Similar to the 1st _{item in} “worries about treatment”.

Yes No

I am helpless. I think I can’t tell the dentist when to stop.

Yes No

5.4.2 Measures Completed by the Parents Regarding the Child