Influence of Adapted Environment on the Anxiety of Medically Treated Children with Developmental Disability

doi:10.1016/j.jpeds.2008.10.017

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 546-550

https://doi.org/10.1016/j.jpeds.2008.10.017 Get rights and content

Objectives

To examine the influence of a sensory adapted environment (SAE) on the behavior and arousal levels of children with developmental disability in comparison with typical children, during a stress-provoking medical situation.

Study design

Sixteen children (6-11 years old) with developmental disability and 19 age-matched typical children participated in a cross-over trial measuring behavioral and psychophysiological variables, performed during a dental intervention.

Results

Both groups performed better in the SAE compared with the regular environment (RE), by comparing: the mean duration of anxious behaviors in the SAE and RE (5.26 and 13.56 minutes; P ≤ .001); the mean electrodermal activity for arousal levels, before commencement of treatment in the SAE and RE (784 and 349 Kohms; P = .002); and the mean electrodermal activity during treatment in the SAE and RE (830 and 588 Kohms; P = .001). A significant group by environment interaction was revealed, indicating that the difference in the 2 environments was greater in children with developmental disability than typical children in all 3 measures.

Conclusions

These findings indicate the importance of environment in determining the comfort level of all children. The greater difference in the 2 environments observed in children with developmental disability suggests that this group benefits more from sensory adapted environments.

Section snippets

Patients

Estimation of sample size was based on published data that used a design similar to ours.18, 19, 20 Accordingly, a required sample size of 32 was calculated, including 16 children with developmental disability and 16 typical children. To ensure that this study was adequately powered and to reduce the risk of type II error, the number of children was increased beyond the suggested number to 40 (20 children for each group). However, only 19 children with developmental disability could be

Measures

The Negative Dental Behaviors Checklist (NDBC) was developed by the research team. Content inter-rater reliability was determined after training 2 independent coders (not researchers participating in this study) and yielded a standardized alpha value of 0.93. The NDBC contains 7 behavioral descriptors: movements of head, forehead, eyes, and mouth, coughing/gagging, crying/screaming, and other. All behaviors were recorded with videotape. Duration of negative behaviors in minutes was measured by

Results

In all analyses, the treatment sequence effect (time 1 versus time 2) was found not to be significant. Therfore we deduced that there was no cross-over effect and the independent treatment environment effect could be independently examined.

Discussion

This study confirms that the SAE creates a significant calming effect for both children with developmental disability and typical children undergoing a high anxiety procedure. In interviews with parents, it was clear that 63% of children with developmental disability exhibit more than average general anxiety, as compared with 38% of the typical children. Although both groups of children were significantly more relaxed during dental care in the SAE, the results of this research indicate that

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Cited by (41)

Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance
2021, Dental Clinics of North America
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It is important to ask about adolescents’ strengths, not just their disabilities.130 Further, it is important to inquire about sensory sensitivities at the initial interview, and interventions such as dimmed lighting, rhythmic music, and slow-moving visuals can provide a more pleasing environment.131 Every adolescent is a unique individual and communication should use person-first language.
Dental anxiety: An understudied problem in youth
2017, Clinical Psychology Review
Dental anxiety and dental phobia typically emerge during childhood; the associated avoidance of dental care can result in oral health problems and is associated with lower quality of life. In this review, we discuss the definition of dental phobia and dental anxiety and issues related to their differentiation. We then review the literature on dental anxiety and dental phobia, including its prevalence, assessment, and sequalae. Moreover, we provide a synthesis of findings on the etiology and maintenance of dental phobia and propose a comprehensive cognitive behavioral model to guide further study. We also present a systematic qualitative and a quantitative review of the treatment literature, concluding that although we have made strides in learning how to prevent dental anxiety in youth, the methods effective in preventing anxiety may not be equally effective in treating youth with dental phobia. We propose a multidisciplinary approach, including those with expertise in pediatric anxiety as well as pediatric dentistry, is likely required to move forward.
Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task
2016, Research in Developmental Disabilities
Citation Excerpt :
Environmental stimuli including emotionally loaded stimuli, also referred to as affective stimuli, may capture and divert attention regardless of their relevance to ongoing tasks (Dolcos & McCarthy, 2006), affecting children's cognitive control processes (Tottenham et al., 2011; Schell & Crone, 2013) and eliciting a range of subjective and autonomic responses (McManis et al., 2001; Shapiro, Sgan Cohen, Parush, & Melmed, 2009; Sharp et al., 2006). Shapiro et al. (2009), for example, demonstrated the significant value of a sensory adapted environment that included special lighting effects, relaxing music, vibrations, and aromas on the comfort level of children with and without developmental disabilities undergoing dental treatment as measured via electrodermal activity. They found that among the children with developmental delays the calming effect was more pronounced compared to typically developing children.
Efforts to improve the participation and performance of children with cerebral palsy (CP) are often related to the adaptation of environmental conditions to meet their cognitive and motor abilities. However, the influence of affective stimuli within the environment on emotion and performance, and their ability to improve or impede the children's participation has not been investigated in any systematic way although the emerging evidence suggests that it affects the individuals in many levels.
(1) To measure autonomic responses to affective stimuli during a simulated Meal-Maker task in children with CP in comparison to children who are typically developing, and (2) to examine the interactions between autonomic functions, subjective reports of stress, and task performance among children with and without CP.
Fifteen children with CP and 19 typically developing peers (6 to 12 years) participated. After completing behavioral questionnaires (e.g., State and Trait Anxiety Inventories), children prepared meals within a camera tracking virtual Meal-Maker environment. Either a negative, positive, or neutral visual stimulus was displayed, selected from the International Affective Picture System. Children also passively viewed the same pictures while rating their valence and arousal levels. Heart rate (HR) and skin conductance were recorded synchronously with stimulus onset.
Significant differences in autonomic functions were found between groups, i.e., a higher “low frequency” to “high frequency” (LF:HF) ratio in the children with CP during the meals associated with a negative stimulus (p = 0.011). Only children with CP had significant positive correlations between trait anxiety and LF:HF ratio during virtual meal-making associated with positive (p = 0.049) and negative stimuli (p = 0.003) but not during neutral stimuli. For children with CP the amplitude of skin conductance response during passive picture viewing was significantly higher for negative than for positive stimuli (p = 0.017) but there were no significant changes in autonomic responses during virtual Meal-Maker task.
Significant correlations between trait anxiety, autonomic activity during the calm state and Meal-Maker performance outcomes were found only for children with CP.
In general, the Meal-Maker virtual environment was shown to be a feasible platform for the investigation of the effect of emotionally loaded stimuli on the balance of autonomic functions in children with and without CP. Anxiety level appears to play a significant role in children with CP and should be considered as a potentially important factor during clinical evaluation and intervention. Further studies are needed to develop additional measurements of emotional responses and to refine the types of affective interference.
Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses
2023, BMC Oral Health
Evaluating a virtual reality sensory room for adults with disabilities
2023, Scientific Reports
Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits
2023, Journal of Clinical Pediatric Dentistry

View all citing articles on Scopus

: The authors declare no potential conflicts of interest.

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Original articleInfluence of Adapted Environment on the Anxiety of Medically Treated Children with Developmental Disability

Objectives

Study design

Results

Conclusions

Section snippets

Patients

Measures

Results

Discussion

Accid Emerg Nurs

Control Clin Trials

Control Clin Trials

Midazolam nasal spray reduces procedural anxiety in children

Pediatrics

Neurological examination of difficult and poorly cooperative children

J Child Neurol

Needle phobia and stress-reducing medical devices in pediatric and adult chemotherapy patients

J Pediatr Oncol Nurs

Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study

Pediatrics

Hypnosis reduces distress and duration of an invasive medical procedure for children

Pediatrics

International classification of functioning, disability and health (ICF)

Participation in the occupations of every day life

Am J Occup Ther

The ecology of human performance: a framework for considering the effect of context

Am J Occup Ther

The environment: a focus for occupational therapy

Can J Occup Ther

Application of the Person-Environment-Occupation Model: a practical tool

Can J Occup Ther

Behavioral and physiological effect of dental environment sensory adaptation on children's dental anxiety

Eur J Oral Sci

Evaluating Snoezelen for relaxation within chronic pain management

Br J Nurs

Original article
Influence of Adapted Environment on the Anxiety of Medically Treated Children with Developmental Disability