Association for Behavior Analysis International

Healthcare visits and routines often evoke anxiety or avoidance responses by children and adolescents with autism. These responses interfere with the provision of medical or hygiene care and might result in the use of restrictive procedures or medications. Research on treatments for problem behavior that occurs during healthcare visits and routines is limited. The current symposium includes four papers directed toward filling this gap in the literature. In the first paper, the authors developed and evaluated procedures for identifying and treating anxiety across a variety of health-related contexts. In the second paper, the authors treated phobia of physical examinations with a simulated physician and observed generalization to the childs pediatrician. In the third paper, the authors assessed the function of problem behavior and evaluated the effects of a dentist-implemented intervention on problem behavior during routine dental exams. In the fourth paper, the authors evaluated procedures to increase cooperation with routine fingernail grooming and observed generalization to the adolescents father.

Many individuals diagnosed with autism also are reported to have anxiety. From a behavior analytic perspective, anxiety is an emotion (part of which is a private event) consisting of a group of responses emitted and/or elicited in the presence of a specific stimulus that signals an upcoming aversive event. Treatment of anxiety often consists of procedures such as exposure, modeling, and differential reinforcement. The purpose of the current study was to develop a method for identifying and treating anxiety in children with autism. Three individuals with autism were asked to complete a behavioral chain which historically evoked anxious responding to identify whether or not it was likely that anxious responding reliably occurred. Subsequently, anxious responses were treated via prompting and reinforcing incompatible responding (i.e., relaxation) using shaping and gradually exposing the participant to anxiety-evoking stimuli while prompting the incompatible responding. A multiple baseline across contexts design was used. Results of the research showed that individuals tolerated anxiety evoking contexts with minimal to no problem behavior after intervention. Interobserver data were collected in a minimum of 33% of all conditions and mean total agreement was always above 85%.

Phobias involve both elements of respondent conditioning (elicitation of emotional behavior) and operant conditioning (avoidance behavior) and successful treatment should involve addressing both elements. In the current study we were referred a young child with autism who engaged in severe problem behavior associated with physician visits. We addressed both operant and respondent components of this behavior problem by (a) conducting a task analysis of a physician visit with physical, (b) differentially reinforcing compliance with each step of the task analysis, and (c) gradually increasing the task requirement to obtain reinforcement within a simulated physicians office environment. Following mastery level compliance with simulated physical examinations with multiple-exemplar physicians, we observed successful generalization to the childs pediatrician conducting a physical in their office.

Oral healthcare is essential for the maintenance of healthy teeth throughout an individual�s lifespan. For most individuals, complex dental procedures such as fillings and root canals can be challenging events. For children with autism, even a simple dental procedure, such as an exam, can be difficult and might result in problem behavior that interferes with the delivery of dental treatment. Although problem behavior exhibited during complex dental procedures may serve an escape function, assuming escape as the sole function for problem behavior during routine dental cleanings might result in less than adequate interventions. The purpose of this study was to (a) identify putative functions of problem behavior exhibited by three children with autism during a routine dental exam in a dental setting; (b) evaluate the efficacy of having a pediatric dentist and trained dental office staff conduct a trial-based functional analysis; and (c) evaluate the effects of an intervention package on problem behavior and successful completion of a routine dental exam. Results of the study indicated that problem behavior was maintained by social negative reinforcement (escape) for all participants and that problem behavior for two participants might have been maintained by escape to attention. Compliance for all participants increased and dental exams were successfully completed with the introduction of an intervention package that addressed putative functions.

Many children with disabilities engage in uncooperative behavior (e.g., noncompliance, problem behavior) during routine hygiene and healthcare procedures (Collado, Faulks, & Hennequin, 2008; Ellis, Alai-Rosales, Glenn, Rosales-Ruiz, J., & Greenspoon, 2006; Schumacher & Rapp, 2011). Uncooperative behavior and avoidance responses during these procedures might have detrimental implications for the childs health (Collado et al., 2008) and might result in the use of restrictive procedures or medication (Shabani & Fisher, 2006). Caregivers of children with disabilities frequently report difficulty grooming their childrens fingernails. The purpose of the current study was to replicate and extend the procedures of Shabani and Fisher (2006) to routine fingernail grooming with an adolescent diagnosed with autism. Our results indicated that differential reinforcement alone was insufficient to reduce avoidance behavior during fingernail grooming. Differential reinforcement plus stimulus fading produced low to zero levels of avoidance responses, problem behavior, and negative vocalizations during fingernail grooming. These findings are consistent with those reported by Shabani and Fisher (2006). Additionally, behavioral skills training (based on Marcus, Swanson, & Vollmer, 2001) was used to teach the participants father to implement the treatment procedures. Implications for clinical practice will be discussed.