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As children with autism spectrum disorder (ASD) face significant disparities in oral health compared to their neurotypical peers, it's essential to develop innovative strategies to improve their oral hygiene practices. This study aimed to evaluate the effectiveness of a gamified mobile application, "Marzhan Tis," in enhancing oral hygiene skills and independence among children with ASD.
Methodology
A prospective 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) that used the app for one month and a control group (CG) that 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.
Results
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).
Conclusion
The "Marzhan Tis" mobile app effectively improved oral hygiene skills and independence in children with ASD Level 1. Its gamified features and usability support its integration into pediatric oral health interventions.
Introduction
Children with autism spectrum disorder (ASD) face significant disparities in oral health compared to their neurotypical peers. Studies consistently report higher rates of dental caries and poorer oral hygiene indices in this population, attributed to a range of behavioral, sensory, and systemic challenges. Globally, the prevalence of ASD is estimated to be approximately 1 in 100 children, with some regions reporting rates as high as 1 in 54.
Barriers to oral care in children with ASD are multifactorial. Sensory sensitivities, communication difficulties, and behavioral rigidity further complicate home care routines like tooth brushing. To address these challenges, researchers and clinicians have developed various adaptive strategies, including behavioral interventions, visual supports, environmental modifications, and structured learning strategies.
Evidence shows that these tools can significantly reduce plaque accumulation and improve behavioral compliance in children with ASD. Mobile health applications represent a promising avenue for supporting and reinforcing oral hygiene routines at home. Gamified digital tools, which use game design elements to motivate behavior change, have gained popularity in pediatric health promotion.
In countries like the USA, Sweden, and Japan, greater access to specialized dental services and caregiver training has been associated with better oral health outcomes in children with ASD. In regions like Pakistan, Egypt, and the UAE, higher caries rates persist due to limited services and socioeconomic constraints.