Navigating toothbrushing challenges for caregivers of children with autism spectrum disorder: a qualitative study

This study aims to identify the challenges caregivers encounter in providing effective toothbrushing for children with autism spectrum disorder (ASD) and to propose caregiver-reported strategies for an optimal toothbrushing routine.

This qualitative study utilized focus group discussions (FGD) with primary caregivers of students from an early intervention program in Selangor, Malaysia. A semi-structured interview guide was designed to identify the challenges faced by caregivers in delivering toothbrushing for their children with ASD. Data were obtained from eight sessions of focus group discussions, and verbatim transcripts were analyzed thematically via an inductive and deductive approach.

A total of 26 caregivers attended the FGDs, the majority of whom were Malay mothers aged between 30 and 39 years and degree holders. The FGDs identified four themes. The themes are behavioral, physical, and functional-related challenges, which include insufficient manual dexterity and poor comprehension of toothbrushing techniques. The next themes were sensory challenges, characterized by oral hypersensitivity; routine-related challenges, which include inconsistent brushing routines and habit development; and caregiver-related factors, which include care burden and limited understanding of oral care challenges. To facilitate success, three core strategies were identified, which were modeling through siblings or videos, structured parental supervision, and the use of toothbrushing motivators such as music or specialized digital applications.

Formulating a home oral care routine for children with ASD is complex due to the variability between the child's unique behaviors, sensory and hygiene necessities, and caregiver-related burden. Success requires early and persistent planning, modeling, and motivators.