Association for Behavior Analysis International

Children with developmental disabilities often emit avoidant behavior in the presence of stimuli associated with certain contexts and settings (Schumacher and Rapp, 2011). These conditioned aversive stimuli are often correlated with necessary medical procedures and personal hygiene routines, i.e., dental exams (Lee, Graham and Hughes, 2008); wearing of prescription prosthetics (Deleon et al., 2008; Richling, 2011); and haircuts (Schumaker and Rapp, 2011). Successful avoidance of these procedures can have deleterious effects on the health and well-being of the individuals emitting these avoidant behaviors. Missed or incomplete dental exams can lead to increased tooth decay and other related health concerns. Refusing to wear the prescribed prosthetics that would correct visual and hearing impairments for extended periods of time can delay development in various domains including motor and communication skills (Kiani & Miller, 2010). Refusing or receiving partial haircuts can lead to negative social stigmatization. This symposium summarizes the effects of treatment packages in increasing compliance with these necessary procedures.

Individuals diagnosed with intellectual disabilities often suffer from concomitant visual and hearing impairments (Nielsen, Skov, & Jensen, 2007; Kiani & Miller, 2010). This population often refuses to wear the prescribed prosthetics that would correct visual and hearing impairments for extended periods of time (Haugen, Aasved, & Bertelsen, 1995). These impairments can delay development in various domains including motor and communication skills (Rine et al., 2000, Kiani & Miller, 2010). This study investigates the effect of a treatment package on individuals compliance with the simultaneous wearing of eyeglasses and hearing aids. The treatment package consisted of noncontingent reinforcement, response cost and response blocking based upon the findings from the functional analysis. A component analysis was completed, which suggested that NCR was the necessary component to maintain wearing of both the hearing aid and eyeglasses for sufficient durations of time. The treatment package was then thinned from a continuous schedule to the terminal schedule which was based on an existing schedule within the participants 24 hr plan. These changes in behavior were generalized across environments and therapists.

Historically, children with autism spectrum disorder have difficulty with medical procedures including, but not limited to, routine dental exams. Lee, Graham, and Hughes (2008) found that more than half of the patients with autism exhibited uncooperative/negative behavior during dental exams. Research has shown that reinforcement schedules and shaping procedures can be effective in increasing positive behaviors and teaching skills. The current study examined the use of differential reinforcement during a dental desensitization program to increase compliance with dental cleanings across several students diagnosed with autism. Baseline was conducted for each individual to determine toleration of dental cleanings. Preference assessments were conducted to determine potential reinforcers. Differential reinforcement was implemented for completion of steps within a task analysis comprised of actions that are completed during a routine dental exam based on a set schedule of reinforcement. As progress was achieved, the schedule of reinforcement was thinned. Reinforcement has been thinned completely for one individual in the study. Differential reinforcement has proved to be effective within this desensitization program.

Minimal research has examined treatment effects for haircutting with individuals diagnosed with developmental disabilities. No research has examined treatment effects for individuals who engage in high intensity challenging behavior to escape the task of haircutting. This treatment package aimed to increase independence with the skill of haircutting while decreasing the overall duration of the haircut and rate of challenging behavior. Prior to assessment, the participant engaged in high rates of challenging behavior when haircuts were attempted and duration of haircuts could extend up to 8 hours before completion. Multiple interventions had been unsuccessful in increasing independence or decreasing challenging behavior prior to this presented treatment package. The treatment package consisted of avoidance from aversive stimuli, non-contingent reinforcement (NCR), and reinforcement for engaging in independent haircutting. Results showed that the treatment package reduced levels of challenging behavior during haircuts, decreased the overall duration of haircuts, and increased independence with haircutting behavior. The treatment was successfully generalized across environments and the primary caretakers were faded in as therapists. Follow-up probes showed that the participant had maintained low durations with haircutting and low levels of challenging behaviors associated with haircutting for over 2 months.