Duration of whimpers, cries, or screams, as scored by video coding.

Frequency of whimpers, cries, or screams, as scored by video coding.

Frequency of mouth movement impeding treatment, as scored by video coding.

Frequency of head movement away from the dentist and/or equipment impeding treatment, as scored by video coding.

The Faces Pain Scale - Revised is single-item self-report measure used to assess the perception and intensity of pain in children. The scale is comprised of six faces depicting increasing levels of pain ranging from a neutral expression (no pain) to a face showing severe pain. Each face corresponds to a numerical value on a 0-10 scale (0, 2, 4, 6, 8, 10). Higher scores indicate greater perception and intensity of pain.

The Dental Sensory Sensitivity Scale is a child-report measure assessing the presence and magnitude of discomfort with different sensory stimuli in the dental environment (i.e., tactile, auditory, proprioceptive). The scale is comprised of 6 items rated on a 3-point Likert scale ranging from 0 (not at all) to 2 (a lot). Scores range from 0 - 12 with higher scores indicating greater sensory discomfort during routine dental treatment.

The Anxiety and Cooperation Scale (A & C Scale) has been shown to assess children's anxiety, fear, and cooperation as rated by dentists, and has good established reliability and validity. Following a routine dental cleaning, the dentist rated overall patient behavior during treatment using a one-item Likert scale ranging from 0 (relaxed, smiling, demonstrates desired behavior, complies with demands) to 5 (out of control, loud crying, reverts to primitive flight responses, physical restraint required).

The Frankl Scale is dentist-report measure of a child's overall behavior during a dental visit. It is an observational, single-item measure that includes four behavioral categories, each assigned a numerical value (1=definitely negative, 2=negative, 3=positive, 4=definitely positive). Higher scores indicate greater cooperation and less distress.

The length of time to complete the dental cleaning. Used for cost-analysis of the intervention.

The maximum number of hands (at any one time) required to restrain the child during the dental cleaning experience was utilized as a measure of cost and also a measure of uncooperative behavior. This variable was recorded on researcher notes during the dental cleaning and was verified using the videotape of the dental cleaning. Scoring included presence/absence as well as the number of hands used for restraint purposes during the cleaning.

Dental Visit #1 (Day 5-95) Participants received their first dental cleaning in the Sensory Adapted Dental Environment (SADE). In the SADE, the sensory characteristics of the dental environment are altered (visual, auditory, tactile adaptations) including dimming lighting, moving projections on the ceiling, exposure to soothing music, and application of a butterfly vest with wings that wrap around the child to provide a calming sensation.

Dental Visit #2 (Day 125-215) Participants received their second dental cleaning in the Regular Dental Environment (RDE) approximately 6 months after their first dental cleaning. In this condition, no sensory characteristics of the dental environment are altered and the cleaning is conducted in a standard manner (oral examination, prophylaxis, fluoride).

Total of all reporting groups

The ADOS-2 is a semi-structured, standardized performance-based observational assessment of social affect, communication, reciprocal social interaction, restricted and repetitive behaviors, imagination/creativity, stereotyped behaviors, and restricted interests. The severity (comparison) score is used as a standardized measure of autism symptom severity, independent of age and language level. The score ranges from 1 to 10, with higher scores indicating greater severity of autism-related symptoms (i.e., 3-4: low, 5-7: moderate, 8-10: high).

The WASI-II is a reliable and valid standardized measure of cognitive ability. The FSIQ-4 is derived from four subtests (Vocabulary, Similarities, Block Design, and Matrix Reasoning). The FSIQ-4 is calculated by summing the scaled scores from all four subtests and converting the total into a standard score using age-based normative data. The FSIQ-4 standard score ranges from 40 to 160. Higher scores represent better cognitive functioning and a score of <70 is used to determine intellectual disability.

The VABS-II is a reliable and valid parent-report assessment of receptive, expressive, and written communication skills in individuals aged 3 to 22. Each item is scored as 0 (never), 1 (sometimes/partially), or 2 (usually), and these item scores are summed to produce a raw score, ranging from 0 to 108, then converted to a scale score using age-specific data. The Expressive Communication subdomain yields a v-scale score ranging from 1 to 24. Higher scale scores indicate better expressive communication skills and a raw score of 83 is equivalent to the expressive language of a four-year-old.

The SensOR Inventory is a 76-item caregiver-report measure of sensory processing patterns and sensitivities in individuals ages 3 or older. Items are scored with dichotomous yes/no responses. The scale consists of six domains (i.e., tactile, auditory, visual, olfactory, food texture, and movement-proprioceptive) that are summed for a total score. Scores range from 0-76 with higher scores indicate greater sensory over-responsiveness.

The CASI-Anx is a 20-item parent-report measure of anxiety in children with autism. Items are scored on a four-point Likert scale (i.e., 0-never, 1-sometimes, 2-often, 3-very often). The total score is calculated by taking the sum of the responses to all items. Scores range from 0 - 60 with higher scores indicating greater anxiety symptom severity.

The CFSS-DS is a reliable and valid measure of dental fear in children. It is a 15-item, parent-report measure scored on a 5-point Likert scale (i.e., 1-not afraid at all to 5-very afraid). The total score is calculated by taking the sum of the responses to all items. Scores range from 15 -75 with higher scores indicating greater dental fear. Scores of 32-38 indicate borderline fear and those >38 suggest high dental fear.

Parent report of child diagnoses.

Parent report of mother's education.

Parent report of father's education.

In the Sensory Adapted Dental Environment the sensory characteristics of the dental environment are altered (visual, auditory, tactile adaptations).

Sensory Adapted Dental Environment: The SADE intervention includes adaptations such as dimmed lighting, moving projections on the ceiling (fish, bubbles), exposure to soothing music, and application of a butterfly vest with wings that wrap around the child to provide calming sensations.

Electrodermal activity (EDA) is a non-invasive measure of the ability of the skin to conduct an electrical current, which increases when the sympathetic "fight or flight" nervous system is activated during times of stress. Each unique increase >0.05uS in the EDA waveform is counted as an NS-SCR, indicating a increase in sympathetic nervous system activation; NS-SCRs are measured as a frequency per minute (calculated as the number of NS-SCRs/time).

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 245 analyzable observations for EDA NS-SCRs.

The CDBRS is a video-coded measure of overt distress behaviors exhibited by children during a routine dental visit. A research team member marks the presence or absence of three distress behaviors (mouth movement, head movement, forehead movement) and the presence or absence and the severity of two distress behaviors (whimper/cry/scream, verbal stall or delay) during each one-minute interval of a five-minute recording of a child receiving prophylaxis during their dental cleaning. Coding is conducted by a trained research team member who achieves strong inter-rater reliability with a second trained rater on a representative sample of children with and without ASD. Raw scores (range=0-45) are converted to a scale score ranging from 1 to 100, with higher scores indicating greater distress.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 analyzable observations for CDBRS.

Duration of whimpers, cries, or screams, as scored by video coding.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 analyzable observations for whimper, cry, scream duration.

Frequency of whimpers, cries, or screams, as scored by video coding.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 analyzable observations for whimper, cry, scream frequency.

Frequency of mouth movement impeding treatment, as scored by video coding.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 analyzable observations for mouth movement frequency.

Frequency of head movement away from the dentist and/or equipment impeding treatment, as scored by video coding.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 analyzable observations for head movement frequency.

The Faces Pain Scale - Revised is single-item self-report measure used to assess the perception and intensity of pain in children. The scale is comprised of six faces depicting increasing levels of pain ranging from a neutral expression (no pain) to a face showing severe pain. Each face corresponds to a numerical value on a 0-10 scale (0, 2, 4, 6, 8, 10). Higher scores indicate greater perception and intensity of pain.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 114 usable scores for the Faces Pain Scale-Revised.

The Dental Sensory Sensitivity Scale is a child-report measure assessing the presence and magnitude of discomfort with different sensory stimuli in the dental environment (i.e., tactile, auditory, proprioceptive). The scale is comprised of 6 items rated on a 3-point Likert scale ranging from 0 (not at all) to 2 (a lot). Scores range from 0 - 12 with higher scores indicating greater sensory discomfort during routine dental treatment.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 106 usable scores for the Dental Sensory Sensitivity Scale.

The Anxiety and Cooperation Scale (A & C Scale) has been shown to assess children's anxiety, fear, and cooperation as rated by dentists, and has good established reliability and validity. Following a routine dental cleaning, the dentist rated overall patient behavior during treatment using a one-item Likert scale ranging from 0 (relaxed, smiling, demonstrates desired behavior, complies with demands) to 5 (out of control, loud crying, reverts to primitive flight responses, physical restraint required).

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 usable scores for the Anxiety and Cooperation Scale.

The Frankl Scale is dentist-report measure of a child's overall behavior during a dental visit. It is an observational, single-item measure that includes four behavioral categories, each assigned a numerical value (1=definitely negative, 2=negative, 3=positive, 4=definitely positive). Higher scores indicate greater cooperation and less distress.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 276 usable scores for Frankl Scale.

The length of time to complete the dental cleaning. Used for cost-analysis of the intervention.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 252 analyzable durations.

The maximum number of hands (at any one time) required to restrain the child during the dental cleaning experience was utilized as a measure of cost and also a measure of uncooperative behavior. This variable was recorded on researcher notes during the dental cleaning and was verified using the videotape of the dental cleaning. Scoring included presence/absence as well as the number of hands used for restraint purposes during the cleaning.

As this was a crossover study, all participants received cleanings in both the RDE and SADE conditions. Of the 162 participants, there were 302 analyzable data points.

In the Sensory Adapted Dental Environment the sensory characteristics of the dental environment are altered (visual, auditory, tactile adaptations).

Sensory Adapted Dental Environment: The SADE intervention includes adaptations such as dimmed lighting, moving projections on the ceiling (fish, bubbles), exposure to soothing music, and application of a butterfly vest with wings that wrap around the child to provide calming sensations.