Innovative oral hygiene strategies for children with autism spectrum disorder: a gamified app-based intervention

This study aimed to evaluate the effectiveness of the "Marzhan Tis" mobile application in improving oral hygiene practices among children with autism spectrum disorder (ASD) and to examine its usability and correlation with learning success.

A prospective, non-randomized cohort study was conducted with 90 children aged 3-18 years diagnosed with Level 1 ASD from rehabilitation centers in Almaty, Kazakhstan. Participants were divided into an intervention group (IG), which used the app for 1 month, and a control group (CG), which received standard oral hygiene instructions. Oral hygiene was assessed using the Simplified Oral Hygiene Index (OHI-S), approximal plaque index (API), and papillary-marginal-alveolar index (PMA). Adherence was measured using the modified Oral Hygiene Assessment Scale (OHAS-10), and a structured 15-item caregiver questionnaire evaluated behavioral changes and app usability. Statistical analysis included the Shapiro-Wilk test for normality, Mann-Whitney U and Wilcoxon signed-rank tests for between and within-group comparisons, Chi-square tests for categorical variables, and Pearson correlation for usability-learning associations.

Significant improvements were observed in the IG for all oral hygiene indices (OHI-S reduction: 28-52%; API and PMA improvement > 50%, p < 0.05). Oral hygiene adherence increased by 18.8% (p = 0.001). Independence in brushing improved in 85% of IG children (χ² = 28.7, p = 0.001). A strong correlation was found between app usability and learning outcomes (r = 0.65, p = 0.01).

The "Marzhan Tis" mobile app effectively improved oral hygiene skills and independence in children with ASD Level 1. Its usability and gamified features support its integration into pediatric oral health interventions.