Lack of parental time as a mediator between child challenging behavior and dentist refusal to treat children with ASD
DOI:
https://doi.org/10.35699/2178-1990.2025.62326Keywords:
autism spectrum disorde, social determinants of health, dental care for persons with disabilities, health inequities, integrality in healthAbstract
Introduction: children with Autism Spectrum Disorder (ASD) face individual and family barriers to accessing dental care due to behavioral and sensory characteristics inherent to the condition.
Aim: to evaluate whether caregivers perceived lack of time mediates the relationship between children’s behavioral challenges during dental visits and dental care refusal.
Materials and Methods: observational, cross-sectional, descriptive, and analytical study with a census sample of parents and caregivers of children aged 4–12 years with ASD attended at a reference center in Paraíba, Brazil. Sociodemographic data and dental care-related variables were collected through a structured questionnaire applied by two trained examiners. Statistical analysis included a simple mediation model with 5,000 bootstrap resamples (95% CI) using Jamovi 2.7.6.
Results: the sample included 104 participants, mostly male (82.7%) with a mean age of 6.7 years. Among caregivers, 20.2% reported lack of time to take the child to the dentist, 42.3% reported children’s cooperation difficulties, and 7.7% reported dental care refusal. Children’s cooperation difficulties were not directly associated with care refusal (β = 0.129; p = 0.185), but a significant indirect effect mediated by caregivers’ lack of time was observed (β = 0.135; p < 0.01). Cooperation difficulties were also associated with higher perceived lack of time (β = 0.393; p < 0.01) which, in turn, was associated with professional refusal (β = 0.343; p < 0.01).
Conclusion: caregivers’ lack of time mediated the relationship between children’s cooperation difficulties and dental care refusal, suggesting that family barriers significantly influence access to dental services for children with ASD.
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