Association for Behavior Analysis International

The impact of the pandemic caused by Coronavirus (COVID-19) cannot be overstated. One of the only reliable defenses against COVID-19 transmission is the use of facial coverings and masks (CDC, 2020). Unfortunately for many individuals with Autism Spectrum Disorder (ASD) or other intellectual disabilities (ID), donning a mask may be difficult or occasion refusal and other challenging behaviors. On an individual level, refusal to wear a mask can restrict an individual’s access to community supports, and more globally can contribute to an ever-worsening public health crisis. This symposium explores several different approaches to increase the appropriate donning of masks across a number of residential and community settings.

This symposium targets BCBA's and other professionals working with individuals with developmental disabilities across a wide-range of settings.

Concerns related to a dearth of opportunities for community access for adults diagnosed with developmental disabilities has increased exponentially amidst restrictions related to Coronavirus. This population is less likely to tolerate mask-wearing, and subsequently less likely to be able to access the community in the age of social distancing. It is important that these individuals are supported through increasing their tolerance to mask-wearing, such that they can engage in functional and enjoyable community activities. In addition, some basic services require mask-wearing without exception, such as some doctors’ offices, so increased mask tolerance is important to overall health and well-being. The present study utilized a non-concurrent multiple baseline across participants design to examine the effectiveness of the use of edible reinforcement to increase mask tolerance across participants. All participants resided in a campus-based residential center for adults, which primarily supports individuals diagnosed with Autism. Analyses of data indicated that participants were likely to tolerate increasing durations of mask-wearing when preferred edible items were delivered contingent upon meeting predetermined criteria. For all four participants, the treatment reliably increased tolerance over time.

It has been recommended that all adults and children over the age of two wear a mask that covers the nose and mouth mask to slow the spread of COVID-19 (CDC, 2020; WHO, 2020). One barrier to correct mask-wearing is a skill deficit in self-identification of when a mask needs to be adjusted. The verbal or physical prompting required for correct mask-wearing can lead to unwanted attention to the targeted behavior (Anson et al., 2008), distraction from other daily programming, and decreasing the proximity between the individual and the adult which is against the guideline of maintaining six feet of distance (CDC, 2020). One way to decrease verbal and physical prompting is to use a tactile prompt to signal mask checking. In a similar study, Anson et al. (2008) reduced verbal and gestural prompts to attend to the teacher through the use of a tactile prompt. Our study aimed to employ the strategies used in Anson et al. (2008) to decrease the number of verbal prompts required for correct mask-wearing in a community setting. The relation between reduction in verbal prompts and the percentage of correct mask-wearing will also be discussed.

The Covid-19 Pandemic has escalated the priority of children with autisms ability to tolerate various medical procedures. The Center for Disease Control and Prevention recommendations that any child over the age of 2 wear a mask to limit the spread of Covid-19. The inability to tolerate wearing a mask can limit the child’s ability to go into a public place and have a negative impact on family life. The present study evaluated the use of tolerating programming using shaping of the duration of mask exposure and pairing of preferred stimuli on two children diagnosed with autism. The use of systematic increases in the duration of time that the mask was in place paired with preferred activities resulted in the children wearing masks without the occurrence of challenging behavior for up to an 8-hour therapy day with built in breaks for one child and 15 minute time intervals for the second child. The tolerating behavior was shaped within a 30-day time frame and shown to generalize outside of the therapeutic setting.

The current COVID-19 pandemic has had a significant impact on the daily behavior of people across the globe. In an effort to limit the proliferation of this global pandemic, the World Health Organization and Centers for Disease Control and Prevention have recommended the use of masks or facial coverings when in public settings. Individuals with intellectual and developmental disabilities (IDD) may be less likely than others to tolerate personal protective equipment (PPE). Challenges with compliance with mask-wearing could limit individuals with ASD and/or ID’s access to education, medical and other community-based resources. This study investigates the effectiveness of treatment components including non-contingent reinforcement, response blocking and response cost to increase compliance with mask-wearing and decrease refusal behavior in 9 individuals with IDD living in a residential treatment facility. The results of this study indicate that NCR effectively increased mask wearing for 3 participants. Response cost was needed to increase mask wearing for 4 participants while the remaining 2 participants required the addition of response blocking. These findings extend the research reporting the effectiveness of these treatment components in increasing the wearing of medically-necessary prostheses (Deleon et al., 2008; Nipe et al., 2018; Richling et al., 2011) to medically-necessary PPE.