Child Dental Control Assessment (CDCA)

Abstract

The Child Dental Control Assessment (CDCA) is a specialized Psychological scale designed to measure the specific coping and control strategies children employ or desire to employ during dental treatment. Originally developed by Weinstein et al. (1996) and later refined and validated by Coolidge et al. (2005), the CDCA assesses the child’s perception of control in a stressful clinical environment, specifically focusing on the dentist-patient interaction.

The instrument consists of 20 items distributed across five primary subscales: Dentist-Mediated Control, Active Coping, Cognitive Withdrawal, Reassurance, and Physical Escape. The scale helps clinicians and researchers understand how children attempt to manage dental anxiety and behavioral distress, providing insight into preferred coping mechanism styles.

Keywords

Child Dental Control Assessment, CDCA, Pediatric Dentistry, Coping mechanism, Perceived Control, Dental anxiety, Behavioral Assessment, Psychological scale

Authors

P. Weinstein, P. Milgrom, O. Hoskuldsson, D. Golletz, E. Jeffcott, M. Koday, T. Coolidge, M. Heima, L.J. Heaton, S.E. Coldwell, H.L. Logan

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Purpose

The primary purpose of the CDCA is to quantify and categorize the specific behavioral and cognitive control strategies utilized or desired by children during dental visits. This assessment is vital for identifying children who may benefit from interventions aimed at increasing their sense of control, thereby reducing treatment-related distress and dental anxiety.

The instrument allows dental practitioners to tailor their communication and procedural approach based on the child’s preferred style of control (e.g., whether they prefer information, distraction, or the ability to signal a stop). By understanding these strategies, dental teams can improve patient cooperation and promote positive long-term dental health behaviors.

Construct

The CDCA is designed to measure Situation-Specific Control, which refers to the perceived ability of the child to influence or manage the events and environment within the dental setting. The scale conceptualizes control as a multi-dimensional construct encompassing both active, behavioral attempts to influence the environment and passive, cognitive strategies used to manage internal distress. The five factors measured are:

• Dentist-Mediated Control: Items reflecting the child’s desire for the dentist to provide procedural information, answer questions, or allow breaks.
• Active Coping: Items reflecting the child’s internal efforts to manage fear or pain (e.g., trying to stay calm).
• Cognitive Withdrawal: Items reflecting the child’s use of distraction or mental avoidance (e.g., trying not to think about the procedure).
• Reassurance: Items reflecting the child’s desire for verbal comfort and positive feedback from the dental team.
• Physical Escape: Items reflecting the child’s desire for physical means of control, such as having a family member present or requesting sedation/general anesthesia.

Validity

The validity of the CDCA has been investigated through studies confirming its relationship with measures of dental anxiety and behavioral outcomes. Coolidge et al. (2005) conducted studies examining the scale’s validity and cross-cultural differences, supporting its application across diverse youth populations. The scale demonstrates construct validity by differentiating between distinct coping mechanism styles relevant to the dental environment.

Reliability

The Reliability of the CDCA subscales, measured using Cronbach’s Alpha (internal consistency), indicates acceptable to good reliability, particularly in the revised 20-item version (Coolidge et al., 2005). The reported internal consistency coefficients for the primary factors are:

• Dentist-Mediated Control: 0.68
• Active Coping: 0.70
• Cognitive Withdrawal: 0.60
• Reassurance: 0.55
• Physical Escape: 0.52

While some subscale alphas (Reassurance and Physical Escape) are modest, they are considered acceptable for exploratory research scales, especially those measuring situation-specific coping in pediatric populations.

Factor Analysis

The structure of the CDCA was empirically derived through Factor analysis, resulting in five distinct factors or subscales. This analysis helps confirm that the items cluster into meaningful constructs related to different modalities of perceived control during a dental visit. The five resulting factors and the items loading onto them (based on the Coolidge et al., 2005, revision) are:

• Dentist-Mediated Control: Items 3, 4, 5, 6.
• Active Coping: Items 16, 17, 18.
• Cognitive Withdrawal: Items 8, 13, 15.
• Reassurance: Items 1, 14. (Note: Item 13, Story, also loads on Reassurance in some analyses).
• Physical Escape: Items 7, 9, 10. (Note: Item 20, Leave if sick, is also often associated with Physical Escape).

This structure underscores the multidimensional nature of control assessment, distinguishing between requests for external help (Dentist-Mediated) and internal self-management efforts (Active Coping).

Instrument

Test Type: Psychological scale / Self-report or Interview-based assessment.

Format: 20 items (Revised Version). Responses are scored on a 3-point Likert scale.

Language Available: English (Original development and primary validation).

Population Group: Pediatric patients receiving dental care.

Age Group: Children and youth (typically school-age children capable of self-reporting).

Population Details: Used primarily in clinical and non-clinical pediatric dental settings to assess coping preferences and potential for distress.

Test Methodology: Children respond to statements regarding their desires and expectations for the next dental visit (the prospective version). The response options are typically False, Sometimes, or True.

Keywords

Pediatric psychology, Dental treatment, Reliability, Factor analysis, Control assessment, Child behavior, Coping strategies, Psychological scale

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Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The original version of the CDCA was developed in 1996 by Weinstein et al., with the revised 20-item version being validated and published by Coolidge et al. in 2005. The scale is frequently reproduced in academic texts and journals for non-commercial research and clinical use. The instrument can be found in sourcebooks such as Fischer & Corcoran’s Measures for Clinical Practice and Research (2007).

The original PDF of the 2005 validation study, which includes the instrument, can be downloaded here: http://admin.ejpd.eu/download/2005-01-05.pdf

Reference’s

• Coolidge, T., Heima, M., Heaton, L.J., et al. (2005). The Child Dental Control Assessment (CDCA) in youth: reliability, validity and cross-cultural differences. Eur J Paediatr Dent, 6(1), 35-43.
• Coolidge, T., Heima, M., Coldwell, S.E., Weinstein, P., Logan, H.L., Milgrom, P. (2005). Reliability and validity of the Revised Iowa Dental Control Index in a non-clinical sample. Pers Individ Dif, 38, 773-83.
• Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page(s): 443-446.
• Weinstein, P., Milgrom, P., Hoskuldsson, O., Golletz, D., Jeffcott, E., Koday, M. (1996). Situation-specific child control: a visit to the dentist. Behaviour Research and Therapy, 34(1), 11-21.

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Items of the Child Dental Control Assessment (CDCA)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. These items represent the prospective, 20-item version published by Coolidge et al. (2005).

1. I want the dentist to tell me everything will be okay.
2. I want the dentist to ask me how I feel.
3. I want the dentist to answer my questions.
4. I want to have a rest.
5. I want the dentist to stop when I ask.
6. I want someone in my family in the room with me.
7. I want them to ask me to breathe the special stuff.
8. I want to be sleepy again.
9. I want them to let me watch what is going on.
10. I want them to tell me how long things will last.
11. I want the dentist to tell me what will happen.
12. I do not want to think about what the dentist is doing.
13. I want someone to tell me a story.
14. I want the dentist to tell me I am doing a good job.
15. I want to think about something else while the dentist works.
16. I want to hold the suction.
17. I will try to keep myself from getting scared.
18. I will try hard to keep myself calm.
19. I want to listen to music.
20. I’ll want to leave if I feel sick.