Orthodontic Treatment in Pediatric Patients with Autism Spectrum Disorder: Compliance and Satisfaction: Pilot Study

Round 1

Reviewer 1 Report

Thank you for the manuscript, which is overall suitable for the applied sciences readership and very appropriate for the Special Issue "Vulnerability in Dentistry: Prevention and Treatment". In terms of content, the topic is appropriate and timely and of scientific interest. It emphasizes that the group of children and adolescents with ASD are considered a risk group in terms of dental and oral health or dental treatment. Therefore, these children and adolescents require individualized treatment and support services. The manuscript highlights - as a pilot study - in which form compliance and satisfaction exist in orthodontic treatment in pediatric patients with autism spectrum disorder. The manuscript needs to be slightly adjusted and improved in some places.

Basically, the authors are to be congratulated for this work, although I cannot judge in the sense of good scientific practice whether the present manuscript is already an adapted version - possibly even after 1st sighting. If this would be the case, as the indication v2 might suggest, then I cannot recognize any adaptations to the attached version 1 in the history. In the following some thoughts, in the hope to help you to improve the manuscript even a bit.

 

1.) Title: ok

 

2) Introduction: The introduction is comprehensible, just about appropriate in length and offers a concrete introduction and a well-founded international classification. The overview of international studies on orthodontics in ASD is somewhat lacking.

 

3) Materials:

Appropriate and would like to keep in the form.

 

4) Results: In my view, the presentation of the results lacks the qualitative data, which are named in the methodology. The results are too superficial and the weak point in the manuscript. Here in all tables the indication should be represented gladly also gender-referred. Also, the specification of the orthodontic treatment only according to fixed and removable or combination is too superficial. Please find enclosed a publication that retrospectively investigated orthodontic data in children with Down syndrome: doi: 10.1186/s13005-023-00362-5. Some comparable analysis and data evaluation could be suitable and helpful for your manuscript, if necessary. Since a truly quantitative analysis (duration of therapy, frequency of appointments, type of ASD) should be considered. There is a lack of reference of the data to the presented "sensory education" method. Where in the results do I see the success of the method? The results also do not offer a statement on the subtypes of ASD, however, in my view, this information is essential for classifying the challenges in treatment. Although girls are known to be much less likely to be included in ASD studies, were differences from boys qualitatively apparent? 

In addition, the layout of the tables needs to be adjusted.

 

 

 

5.) Discussion: The own results on orthodonitic results should be discussed much more intensively. Furthermore, there is a lack of a clear indication of why a pilot study was conducted and what findings are now being drawn for the main study.

 

Standardize the citation of the references.

Author Response

We thank the reviewer for these suggestions. The main text has been revised and proposed changes and implementations have been made with respect to the original submitted article.

Author Response File: Author Response.pdf

Reviewer 2 Report

The study uses too shallow methodology and analysis to be termed it as good scientific research. Besides it lacks focus and is quite confusing. 
English language expression used is incomprehensible at many occasions. Present, future and mixed tenses have been used erratically in many places. Sometimes it gives an impression of a research synopsis.

Major flaws:

Questionnaire development process is not explained anywhere on which this whole research is banking. Manuscript does not comment on validation of the tool and its reliability. 
Primary objective of the study is mentioned to be, "level of collaboration of children with ASD" (line 110) (this in itself is a confusing statement), however, there is no mention in the manuscript of when and how this was captured. Also, timing and methodology of recording of Frankl behavioral scale is not mentioned anywhere in the manuscript. 
For secondary objective questionnaire was disseminated using online method. Why was face to face interview not done when main objective had to be recorded during the treatment of ASD children. Email reminders were given which to me is not the best of the methods in this case. 

Other flaws:

Exclusion criteria cannot be mirror image of inclusion criteria, it has to be concrete which in this case doesn't reflect to be.
What is meant by Exploratory Qualitative Investigation (lines 128-9) ????
STROBE statement, which one? Needs to be specified.
..."Management of home hygiene resulting from the use of orthodontic devices" again a confusing statement
Analysis has been too simple to be termed as appropriate for such journal meeting international standards. Same is true for the presentation of the tables.

 

Not at all up to satisfactory level

Author Response

We thank the reviewer for these suggestions.

The study presented is a pilot study therefore it does not have the objective of validating but of proposing a method which certainly requires a greater number of subjects for validation.

The choice of online submission was determined by purely safety reasons for the caregivers due to the data collection times, which could not coincide with the scheduled visit on site.

The main text has been revised and proposed changes and implementations have been made with respect to the original submitted article.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Dear Author´s-Team!

Thank you very much for the implementation of the suggestions. From my point of view, it only remains for me to congratulate you on this valuable pilot study and publication.

Author Response

We thank you very much for your fundamental contribution

Reviewer 2 Report

The methodology adopted for data collection is seriously biased since orthodontic treatment is only achieved by regular visits of the patients and since the fact that ASD patients are bound to be accompanied by their caregivers, so questionnaire had to be get filled face to face to mitigate this bias.
Abstract mentions findings which are not quantified, please add accordingly.
In many places cohesion in writing expression is lacking
There are certain other issues which are as follows;
Lines 257-8, how was it concluded that treatment was a success or otherwise when the treatment is still underway (patients undergoing treatment for 12 months or more were recruited).
Table 3 bearing questionnaire has many questions needing to be rephrased or certain phrases needs to be replaced (e.g. clear and exhaustive???). Please carefully revise.
Lines 259-60, needs to be rephrased.
Line 240, replace evaluated to evaluate
Line 288, which table you are referring to mentioning p value=0.001when there is no such table.
Lines 370-3, what is this to do with findings of current study.

Generally fine but non-cohesive expression in many places

Author Response

We thank you very much for your contribution.

Author Response File: Author Response.pdf

Round 3

Reviewer 2 Report

The comments have been largely addressed. 

All the best

Language expression is fine