310 - A Retrospective Analysis of Behavior Shaping Techniques and Treatment Outcomes in Pediatric Patients at the NYUCD Oral Health Center for Individuals with Autism Spectrum Disorder

Abstract:

Purpose: This retrospective chart review evaluated the association between Applied Behavior Analysis (ABA)–grounded behavior shaping techniques and clinical outcomes in autistic pediatric dental patients treated in a university-based special care dentistry setting.

Methods: Records of patients diagnosed with Autism Spectrum Disorder (ASD) aged 5–18 years treated at the NYU College of Dentistry Oral Health Center for People with Disabilities between January 2023 and January 2025 were reviewed. A total of 100 patient charts were analyzed, including 78 patients who received behavior shaping techniques and 22 control patients without documented behavior shaping. Documented behavior shaping techniques included positive and negative reinforcement, contingent and non-contingent escape, modeling, and temporal framing, as well as the number of techniques used per patient. The primary outcome was overall procedural success at the patient level, defined as successful completion of planned routine dental care without referral to general anesthesia or oral conscious sedation. Secondary outcomes included sedation use, protective stabilization, number of completed dental visits, and return visits following sedation.

Results: Patient charts were analyzed to evaluate associations between behavior shaping techniques, sedation use, stabilization, and number of visits required. Patients who received sedation (general anesthesia or oral conscious sedation) required significantly more visits (mean = 4.14, SD = 1.62) compared to those who did not (mean = 3.13, SD = 1.19; p = 0.002). Use of behavior shaping techniques overall was also associated with a higher number of visits (mean = 3.63 vs. 2.84; p = 0.004). Among individual techniques, contingent escape was associated with increased number of visits (p = 0.008), suggesting greater treatment complexity. No significant associations were found between behavior shaping techniques and sedation use (p = 0.695) or protective stabilization use (p = 0.359). Procedural success was achieved in 100% of cases, limiting the ability to assess predictors of treatment success.. Behavior shaping techniques were documented, with variability in both type and number of techniques used. Analyses examined associations between specific behavior shaping strategies and procedural success, sedation utilization, protective stabilization, visit completion, and post-sedation return visits.

Conclusion: Behavior shaping techniques grounded in ABA principles may be associated with improved treatment completion and reduced reliance on pharmacologic management in autistic pediatric dental patients. These findings may inform targeted behavior management strategies and training for dental practitioners and residents, ultimately improving care for this underserved population, while supporting structured, non-pharmacologic behavior guidance consistent with American Academy of Pediatric Dentistry recommendations in clinical settings serving autistic individuals.