Predicting Child Cooperation Based on Child Anxiety and Maternal Stress in Children with Autism During Dental Interventions
Keywords:
Autism Spectrum Disorder, child cooperation, maternal stress, dental anxiety, pediatric dentistryAbstract
Objective: This study aimed to predict the level of cooperation in children with Autism Spectrum Disorder (ASD) during dental interventions based on their anxiety levels and maternal stress.
Methods and Materials: A cross-sectional, descriptive-analytical study was conducted on 32 children aged 3–6 years with a clinical diagnosis of ASD in Rasht, Iran. Participants were recruited through autism support organizations and underwent dental examinations at a private clinic. Data collection involved the Spence Children’s Anxiety Scale, the Frankl Behavioral Rating Scale, and the Parental Stress Scale. Children’s demographic and behavioral data were recorded, and statistical analyses including Spearman correlation and multiple regression were performed using SPSS version 26 at a significance level of 0.05.
Findings: Results showed that both child anxiety and maternal stress were significantly associated with the level of child cooperation during dental procedures. Spearman’s correlation revealed strong, positive relationships between child cooperation and specific anxiety subscales, while maternal stress was negatively correlated with cooperation. The multiple regression model demonstrated that these two predictors jointly explained 52.4% of the variance in cooperation levels (R² = 0.524, p < 0.001). Standardized beta coefficients indicated that child anxiety positively predicted cooperation (β = 0.244, p < 0.001), whereas maternal stress had a significant negative effect (β = –0.225, p < 0.001).
Conclusion: The findings suggest that both child-related emotional factors and maternal psychological states significantly influence cooperation during dental interventions in children with ASD. Screening for maternal stress and child anxiety before dental visits may enable more effective behavioral management strategies and reduce the need for invasive procedures.
Downloads
References
Albehbahani, m., Keykhosravani, M., amini, N., Narimani, M., & Jamei, B. a. (2021). A comparison of the effectiveness of interventions based on min dfulness for mothers and legotherapy training on the symptoms of autism disorder in children [Research]. Journal of Psychological Science, 20(97), 103-112. http://psychologicalscience.ir/article-1-997-en.html
Amrollahi, N., & Amouchi, R. (2021). Evaluation of Clinical Consequences of Dental Caries in Autistic Children in Isfahan Special Centers Based on pufa/PUFA index. Journal of Mashhad Dental School, 45(2), 113-122. https://doi.org/10.22038/jmds.2021.53559.1971
Bahrami, F., Movahedi, A., Marandi, S. M., Safavi, S., & Molakarimi, Z. (2013). The effect of training two selected karate-hand techniques on hand stereotypic movements in autistic boy (Case study). Journal of Research in Rehabilitation Sciences, 9(3), 387-398. https://doi.org/10.22122/jrrs.v9i3.814
Bahrololoomi, Z., Zarebidoki, F., Hosseini-Yekani, A., & Boostanifard, P. (2023). The Relationship between Temperament and Dental Anxiety in Children Aged 6 to 11 Referred to Yazd Dental School. Journal of Mashhad Dental School, 47(2), 124-134. https://doi.org/10.22038/jmds.2023.66163.2180
Bartolomé-Villar, B., Mourelle-Martinez, M. R., Diéguez-Pérez, M., & Nova-Garcia, M. J. (2016). Incidence of oral health in paediatric patients with disabilities: Sensory disorders and autism spectrum disorder. Systematic review II. Journal of Clinical and Experimental Dentistry, 8. https://doi.org/10.4317/jced.52923
Georgoula, E., Koustriava, E., & Papadopoulos, K. (2025). Technology‐enhanced Cognitive Training for Individuals With Autism Spectrum Disorder and Intellectual Disability. British Journal of Special Education. https://doi.org/10.1111/1467-8578.70026
Khusaifan, S. J., & El Keshky, M. E. S. (2022). Emotional divorce and behavioral problems in children with autism spectrum disorder and psychological distress in their parents in Saudi Arabia: The moderating effect of marital relationship satisfaction. Journal of Pediatric Nursing. https://doi.org/10.1016/j.pedn.2022.03.015
Kosić, R., Petrić, D., Vlašić-Cicvarić, I., & Kosec, T. (2025). Associations Between Parental Alexithymia and Family Dynamics in Autism Spectrum Disorder. Healthcare, 13(4), 373. https://doi.org/10.3390/healthcare13040373
Maserat, E., Mohammadzadeh, Z., & Monaghesh, E. (2021). Elaboration of a Framework for Assessment of IT-based Interventions in the Field of Autism Disorder. Depiction of Health, 12(3), 224-239. https://scholar.archive.org/work/y7po6sm6pjfjdbdbx6whdiwoca/access/wayback/https://doh.tbzmed.ac.ir/PDF/doh-12-224.pdf
Masoudi, M., Maasoumi, R., Effatpanah, M., Bragazzi, N. L., & Montazeri, A. (2022). Exploring Experiences of Psychological Distress Among Iranian Parents in Dealing With the Sexual Behaviors of Their Children With Autism Spectrum Disorder: A Qualitative Study. Journal of Medicine and Life, 15(1), 26-33. https://doi.org/10.25122/jml-2021-0290
Mello, C., Rivard, M., Morin, D., Patel, S., & Morin, M. (2022). Symptom severity, internalized and externalized behavioral and emotional problems: Links with parenting stress in mothers of children recently diagnosed with autism. Journal of Autism and Developmental Disorders, 52(6), 2400-2413. https://doi.org/10.1007/s10803-021-05131-4
Neijs, L. D., Boeke, D. B., Berckelaer‐Onnes, I. A. v., Swaab, H., & Ester, W. A. (2024). Parental Stress and Quality of Life in Parents of Young Children With Autism. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-024-01693-3
Nematollahi, H., & Nasehi, A. (2019). Evaluation of the Correlation between Sensory Processing Abilities and Anxiety with Cooperation of Preschool Children Referred To Mashhad Dental School. Journal of Mashhad Dental School, 43(2), 179-196. https://doi.org/10.22038/jmds.2019.13218
Okkenhaug, I. (2025). Movement Behaviors in Youth on the Autism Spectrum: The HUNT Study, Norway. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-025-06835-7
Rojas-Torres, L. P., Alonso-Esteban, Y., & Alcantud-Marín, F. (2023). Parents of children with autism spectrum disorders: interventions with and for them. In A. S. El-Baz & J. S. Suri (Eds.), Neural Engineering Techniques for Autism Spectrum Disorder (pp. 81-98). Academic Press. https://doi.org/10.1016/B978-0-12-824421-0.00012-6
Sartor, T., Lange, S., Kuhn, J. T., & Tröster, H. (2023). Stress and Perceived Partnership Quality of Parents to Children With Autism Spectrum Disorder: A Random Intercept Cross-Lagged Panel Approach. The Family Journal, 32(1), 139-148. https://doi.org/10.1177/10664807231198093
Selles, R. R., & Storch, E. A. (2013). Translation of Anxiety Treatment to Youth with Autism Spectrum Disorders. Journal of Child and Family Studies, 22(3), 405-413. https://doi.org/10.1007/s10826-012-9593-1
Wahdan, M. M., Malak, M. Z., Al-Amer, R., Ayed, A., Russo, S., & Berte, D. Z. (2023). Effect of Incredible Years Autism Spectrum and Language Delays (IY-ASD) Program on Stress and Behavioral Management Skills Among Parents of Children with Autism Spectrum Disorder in Palestine. Journal of Pediatric Nursing, 72, 45-52. https://doi.org/10.1016/j.pedn.2023.03.018
Widyagarini, A., & Suharsini, M. (2017). Dental care for children with autism spectrum disorder. Dental Journal, 50(3), 160-165. https://doi.org/10.20473/j.djmkg.v50.i3.p160-165
Xing, Y., & Wu, X. (2025). Effects of Motor Skills and Physical Activity Interventions on Motor Development in Children with Autism Spectrum Disorder: A Systematic Review. Healthcare, 13(5), 489. https://pubmed.ncbi.nlm.nih.gov/40077051/
Zarebidoki, F., Bahrololoomi, z., & Vafaee Shahi, M. (2022). Investigation of the Relationship of Media Habits with Anxiety and Fear in Dentistry among People Aged 6 to 15 Years. Journal of Mashhad Dental School, 46(4), 372-383. https://doi.org/10.22038/jmds.2022.60861.2101
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2024 Arash Ebrahimi (Author); Seyedeh Maryam Mousavi (Corresponding Author); Shadi Dehghanzadeh , Samereh Asadi Majareh , Zeynab Sirousjahed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
