Mobile App for Toothbrushing in Teens with Autism

Overseen By Deeksha Nemawarkar

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Disqualifiers: Children under age 10

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 3 months

270 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a specially modified app can help teens with autism improve their toothbrushing skills and habits. Participants will be divided into two groups: one will use the enhanced app, which includes a digital social story for guidance, and the other will use a basic version with a timer and selfie mirror. Teens aged 10 to 17 with autism who can mostly brush their teeth independently and use a smartphone or tablet might be suitable candidates. The trial will compare changes in each group's brushing habits over a few months. As an unphased trial, this study offers participants a unique opportunity to contribute to innovative research that could enhance daily living skills for teens with autism.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this mobile app is safe for teens with autism?

Research has shown that using mobile apps to help children, including those with autism, brush their teeth is generally safe. Studies have not identified any safety problems with these apps or other tech tools designed to improve children's toothbrushing habits. Although researchers continue to monitor safety, no short-term negative effects have been reported. This suggests that the app used in this trial should be safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring a fresh approach to improving toothbrushing skills in teens with autism using a mobile app. Unlike traditional methods, which might involve direct teaching or physical aids, this app incorporates a digital social story, a technique that's particularly effective for kids with autism. It also uses interactive elements like a digital selfie mirror and a timer to make toothbrushing a more engaging activity. By combining these features, the trial hopes to find out if such a tailored digital tool can make a real difference in building better oral hygiene habits for teenagers on the autism spectrum.

What evidence suggests that this mobile app is effective for improving toothbrushing skills in teens with autism?

Research has shown that mobile health apps can significantly enhance toothbrushing skills in children with autism. One study found that an app called “Marzhan Tis” helped children on the autism spectrum improve their oral hygiene skills. Additionally, children using similar apps completed 33.7% of the steps needed for effective toothbrushing. These findings suggest that mobile apps designed for autism can lead to better toothbrushing habits and skills. In this trial, participants in the experimental arm will use a mobile app specifically designed to improve toothbrushing skills and habits in teens with autism. The study results are promising for improving oral hygiene in teens with autism using this technology. ^{3 4 6 7 8}

Who Is on the Research Team?

Donald Chi, DDS, PhD

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

This trial is for teens aged 10-17 with Autism Spectrum Disorder who brush their teeth mostly unassisted, use touch screen devices, and live with a caregiver. The caregiver must be over 18 and able to consent in English. Participants need access to a mobile device with a camera and internet connection.

Inclusion Criteria

The child and caregiver live together in the same home.

Children who use smartphones or tablets.

I am over 18 and can consent in English.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

UG3 Phase

Modification of the existing app and pilot intervention using the Discover, Design+Build, and Test Framework

2 years

UH3 Phase

Recruitment of 270 pre-adolescents and teens with autism, randomization to two arms, and comparison of outcomes

4 years

Treatment

Participants use the app during toothbrushing 2x a day for 3 months under direct supervision of the caregiver

3 months

Regular app usage and survey completion at 2 weeks, 1 month, 2 months, and 3 months

Follow-up

Participants are monitored for long-term behavior change and oral health quality of life

9 months

What Are the Treatments Tested in This Trial?

Interventions

• Testing a Mobile App to Improve Toothbrushing Skills and Habits in Teens With Autism

Trial Overview The study tests an app designed to improve toothbrushing skills in autistic teens against a control app. Over six years, it will modify the existing app, pilot it during the first two years, then compare behavior changes between groups using surveys and interviews.

How Is the Trial Designed?

Group I: Experimental Experimental Treatment 1 Intervention

Children in the experimental arm will receive the same health education module as in the control arm. They will also receive a brief tutorial on additional app components in the form of a digital social story, which is an effective way to convey information to children with autism. Participants will be completing 26-item Behavioral Survey at 2 weeks, 1 month, 2 month, and 3 month. Participants will be using the app during toothbrushing 2x a day for 3 months under direct supervision of the caregiver.

Group II: Control Experimental Treatment 1 Intervention

The control arm will consist of a 20-second health education module delivered through the control app that consists of a digital selfie mirror and a timer that matches the length of brushing time in the experimental app. Participants will be completing all the survey activities similar to that of the participants in the experimental arm.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institute of Dental and Craniofacial Research (NIDCR)

Collaborator

Trials

312

Recruited

853,000+

Published Research Related to This Trial

A four-month tooth brushing learning program using pictograms on an iPad significantly improved tooth brushing skills in 52 children with autism spectrum disorder (ASD), aged 3 to 19 years.

The program not only enhanced the children's ability to brush their teeth but also increased their interaction with the iPad, suggesting that technology can be an effective tool for teaching oral hygiene to children with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Teaching tooth brushing to children with autistic spectrum disorder : A tablet-based training programme.] Lefer, G., Bourdon, P., Mercier, C., et al.[2019]

A randomized control trial involving 18 children with autism tested a 3-week internet-based video-modeling intervention for improving oral hygiene, showing that both the intervention and control groups improved their oral health.

However, the children in the Intervention group demonstrated significantly larger improvements in their oral hygiene, suggesting that video modeling could be an effective method for enhancing at-home oral care in children with autism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief Report: Remotely Delivered Video Modeling for Improving Oral Hygiene in Children with ASD: A Pilot Study. Popple, B., Wall, C., Flink, L., et al.[2019]

The MyDentist project, which involved 59 children with autism spectrum disorder (ASD), successfully improved oral hygiene and cooperation during dental treatments over a 6-month period using Information and Communication Technologies (ICT) for desensitization and fear control.

Parents reported high acceptability of the MyDentist experience, indicating that effective dental care for children with ASD can be achieved through innovative, non-pharmacological approaches, reducing the need for costly medications with potential side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Mom Let's Go to the Dentist!" Preliminary Feasibility of a Tailored Dental Intervention for Children with Autism Spectrum Disorder in the Italian Public Health Service. Narzisi, A., Bondioli, M., Pardossi, F., et al.[2023]

An iPad®-based training program significantly improved toothbrushing behaviors in 52 children and teenagers with autism spectrum disorder (ASD) over an 8-month period.

The program not only enhanced the children's autonomy in oral care but also made it easier for caregivers to implement effective toothbrushing routines, as shown by significant improvements in all assessed variables.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toothbrushing training programme using an iPad&#174; for children and adolescents with autism. Lopez Cazaux, S., Lefer, G., Rouches, A., et al.[2020]

Both video modeling (VM) and toothbrushing social story (TSS) interventions significantly improved oral hygiene in children with autism spectrum disorder (ASD) after 30 days, as measured by plaque and gingival indices.

Caregivers reported greater acceptance of daily oral hygiene practices in the VM group compared to the TSS group, suggesting that VM may be a more effective method for encouraging oral hygiene in children with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparative evaluation of video modeling and social stories for improving oral hygiene in children with autism spectrum disorder: A pilot study. Gandhi, R., Jackson, J., Puranik, CP.[2023]

A study involving 30 children with autism spectrum disorder (ASD) showed that using visual pedagogy significantly improved toothbrushing ability and cooperation over a 6-month period.

Children with mild ASD demonstrated better toothbrushing skills and cooperation compared to those with moderate ASD, indicating that the severity of ASD may influence the effectiveness of the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Visual Pedagogy for Toothbrushing in Children with Autism Spectrum Disorder. Smutkeeree, A., Khrautieo, T., Thamseupsilp, S., et al.[2022]

A study involving 137 students with autism spectrum disorders (ASD) showed that a tooth-brushing educational intervention using video modeling significantly improved oral hygiene status compared to traditional social story methods.

After one month, the improvement in oral hygiene, measured by the Simplified Oral Hygiene Index (OHI-S), was notably greater in the video modeling group, indicating that modern educational techniques can be more effective for individuals with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Story Based Toothbrushing Education Versus Video-Modeling Based Toothbrushing Training on Oral Hygiene Status Among Male Students Aged 7-15 Years Old with Autism Spectrum Disorders in Tehran, Iran: A Quasi-Randomized Controlled Trial. Piraneh, H., Gholami, M., Sargeran, K., et al.[2023]

Citations

1. reporter.nih.gov reporter.nih.gov/search/14EACF0B4B8AC6D57598B8961CAA4A01A2FFCEB861BF/project-details/10901994

Testing a Mobile App to Improve Toothbrushing Skills and Habits in ... Technologies like mobile health apps are an ideal platform to deliver toothbrushing interventions, but few app-based interventions have focused on teens with ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06208722

Testing a Mobile App to Improve Toothbrushing Skills and ... The goal of this proposed trial will modify an existing toothbrushing app for teens with autism and compare toothbrushing outcomes with a control app. We ...

3. withpower.com withpower.com/trial/phase-autism-early-infantile-2024-83748

Mobile App for Toothbrushing in Teens with Autism The goal of this proposed trial will modify an existing toothbrushing app for teens with autism and compare toothbrushing outcomes with a control app.

4. link.springer.com link.springer.com/article/10.1007/s40368-025-01115-5

Innovative oral hygiene strategies for children with autism ... This study demonstrated that the “Marzhan Tis” mobile application significantly improved oral hygiene skills among children with autism spectrum ...

5. mdpi.com mdpi.com/2227-9067/12/1/5

Oral Hygiene in Children with Autism: Teaching Self ... Results: The results indicate a significant improvement in children's self-brushing teeth behavior and maintenance, where 33.7% of the steps were achieved by ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11049656/

A Pilot Study Exploring Caregivers' Experiences Related to ... This pilot study aimed to examine caregivers' and user's experiences with a Kids Smart Electric Toothbrush used by children with ASD.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11763761/

Oral Hygiene in Children with Autism: Teaching Self ... In this study, the efficacy is explored of a behavioral intervention mediated by staff and parents in teaching self-brushing teeth in eight autistic children.

8. mdpi.com mdpi.com/2077-0383/14/6/2105

Reviewing Mobile Dental Apps for Children with Cognitive ... Dental m-health apps aimed at improving toothbrushing skills in pediatric subjects with ASD were effective in improving brushing quality and frequency [24,25,29] ...