Research Article Physiological and Behavioral Stress and Anxiety in Children with Autism Spectrum Disorders during Routine Oral Care Leah I. Stein, 1 Christianne J. Lane, 2 Marian E. Williams, 3 Michael E. Dawson, 4 José C. Polido, 5 and Sharon A. Cermak 1 1 Division of Occupational Science and Occupational herapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089, USA 2 Division of Biostatistics, Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, SSB 220X, Los Angeles, CA 90089, USA 3 Keck School of Medicine of USC, he USC University Center for Excellence in Developmental Disabilities (USC UCEDD), Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS No. 53, Los Angeles, CA 90027, USA 4 Department of Psychology, of the Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, SGM 3620 McClintock Avenue, SGM 501, Los Angeles, CA 90089-1061, USA 5 Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS No. 116, Los Angeles, CA 90027, USA Correspondence should be addressed to Leah I. Stein; lstein@usc.edu Received 28 February 2014; Accepted 3 June 2014; Published 10 July 2014 Academic Editor: Jose G. D´ orea Copyright © 2014 Leah I. Stein et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children’s behavior or a physiological measure of distress. his study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress. Methods. Participants were 44 children ( = 22 typical,  = 22 ASD) aged 6–12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleanings. Results. Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing diiculties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing diiculties in the ASD group. Conclusions. Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic. 1. Introduction Children with autism spectrum disorders (ASD) exhibit more dental behavior management problems (uncooperative behaviors) compared to typically developing children, with research indicating that approximately 50–72% of children with ASD exhibit uncooperative behavior during dental treat- ment [1–3]. hese uncooperative and problematic behaviors may include hyperactivity, quick frustration, short atten- tion span, impulsivity, agitation, anger, self-stimulatory, self- injurious, repetitive, aggressive, and disruptive behaviors as well as temper tantrums [4, 5]. Repetitive behaviors and unpredictable, uncontrolled, and impulsive body movements may also complicate dental care by endangering patient safety and posing risk of injury to the dental staf[5]. Autism spectrum disorder is diagnosed based on the presence of speciic behavioral criteria including impaired social interaction, social communication, and restricted and repetitive patterns of behavior, interests, or activities [6]. Children with ASD are a heterogeneous group; some are verbally luent and have average cognitive functioning, while others may have no spoken language and engage in frequent Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 694876, 10 pages http://dx.doi.org/10.1155/2014/694876