The Effect of ABA Therapy Based on Discrete Trial Training (DTT) on Knowledge, Attitudes, and Brushing Skills in Parents of Autistic Children

Abstract

Background: Children with autism spectrum disorder (ASD) frequently experience difficulties with self-care routines, including toothbrushing, because sensory sensitivities, communication differences, and behavioral challenges can interfere with effective oral hygiene. Parents therefore play a central role in establishing and maintaining daily oral-care behaviors.
Objective: This study evaluated the effect of an Applied Behavior Analysis (ABA) intervention based on Discrete Trial Training (DTT) on parents’ knowledge, attitudes, and skills related to toothbrushing for children with ASD.
Methods: A quasi-experimental one-group pretest-posttest design was conducted among 80 parents of elementary-school-aged children with ASD attending several special schools in Semarang City, Central Java, Indonesia. Participants received structured dental and oral-hygiene education and practical training using DTT principles, including stepwise instruction, repetition, and positive reinforcement. Knowledge, attitudes, and toothbrushing-guidance skills were assessed before and after the intervention using structured instruments. Because the outcome data were not normally distributed, pretest and posttest scores were compared using the Wilcoxon signed-rank test at a significance level of 0.05.
Results: Marked improvements were observed across all three outcomes. Good knowledge increased from 5.0% before the intervention to 56.2% after the intervention; good attitudes increased from 7.5% to 90.0%; and good skills increased from 10.0% to 73.8%. Wilcoxon signed-rank testing demonstrated statistically significant pretest-posttest differences for knowledge, attitudes, and skills (all p < 0.001).
Conclusions: DTT-based ABA education and training was associated with substantial short-term improvements in parents’ oral-health knowledge, attitudes, and practical toothbrushing-guidance skills. These findings support structured parent-focused behavioral training as a promising strategy for strengthening home-based oral hygiene support for children with ASD. However, the absence of a control group and long-term follow-up limits causal inference and assessment of sustained effects.