Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


47th Annual Convention; Online; 2021

All times listed are Eastern time (GMT-4 at the time of the convention in May).

Event Details

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Symposium #363
CE Offered: BACB
Tolerating Tough Stuff: How to Teach Getting Through Important but Aversive Situations
Monday, May 31, 2021
9:00 AM–9:50 AM
Area: AUT/DDA; Domain: Translational
Chair: Jennifer L. Cook (University of South Florida)
CE Instructor: Jennifer L. Cook, M.S.
Abstract: Individuals with ASD and other neurodevelopmental disorders often have difficulty tolerating stimulus events that are important to their medical well-being (e.g., dental exams, blood draws), general health (e.g., wearing eye glasses, hearing aids, and winter mittens), safety (e.g., wearing seatbelts, bike helmets), and daily social routines (e.g., getting a haircut, managing a fear of escalators). These issues have been addressed across various research studies, but the aggregate results of these studies are not well known. The first presentation of this symposium will review the literature in this area, followed by two presentations discussing recent research on teaching children with ASD to tolerate wearing aversive apparatus. One study will describe a DRO procedure to teach two children to tolerate wearing their heart rate monitors, and the other study will demonstrate the use of a DRO plus DNRO procedure to teach four children to tolerate wearing face masks for sustained durations throughout the COVID-19 pandemic. Taken together, these three presentations will highlight an area of research that is commonly overlooked as an evidenced-base compilation of studies for teaching toleration.
Instruction Level: Intermediate
Keyword(s): exposure, face masks, medical devices, tolerating
Target Audience: Behavior analysts who directly work with or supervise others who work with children with ASD or related disorders, or behavior analysts who support their clients in the school, home, or community setting(s).
Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Define passive cooperation (2) Describe some stimulus situations to which passive cooperation procedures have been applied in the literature (3) Describe intervention options that may be used to teach toleration of aversive situations (4) Describe how fading procedures have be used to teach children with ASD to wear a heart rate monitor or a face mask.
Passive Cooperation: A Review of the Literature on Tolerating Aversive Events
Jennifer L. Cook (University of South Florida), Raymond G. Miltenberger (University of South Florida), RASHA BARUNI (University of South Florida ), Anna Kate Edgemon (Auburn University), Anthony Concepcion (University of South Florida)
Abstract: Active and passive cooperation are concepts delineated by the form of behavior, which is conditional on an aversive stimulus change. Active cooperation describes dynamic behavior in response to an instruction. Passive cooperation involves the omission of problem behavior in response to specific stimulus conditions. The antecedent stimulus conditions for either active or passive cooperation are considered aversive because they have a history of evoking uncooperative escape behaviors (Rapp, 2012, 2013; Cook et al., 2015). Despite the importance of passive cooperation interventions for teaching individuals to tolerate stimuli required for medical, health, safety, or daily activities, there are no existing literature reviews on this topic. The purpose of this review is to (a) systematically review the behavior analytic literature on passive cooperation for individuals with Autism Spectrum Disorder (ASD) and related disabilities, and (b) categorize these studies to guide researchers and practitioners to identify efficacious assessments and interventions. We found that passive cooperation research has been applied to four broad categories of stimulus situations involving (a) medical and dental procedures, (b) hygiene routines, (c) prolonged tactile contact (e.g., clothing, devices), and (d) feared stimuli.

Increasing Compliance With Wearing a Medical Device in Children With Autism

(Applied Research)
MARIE-MICHÈLE DUFOUR (Université de Montréal), Marc J. Lanovaz (Université de Montréal)

Health professionals often recommend the use of medical devices to assess the health, monitor the well-being, or improve the quality of life of their patients. Children with autism spectrum disorder (ASD) may present challenges in these situations as their sensory peculiarities may increase refusals to wear such devices. To address this issue, the current study systematically replicated prior research that implemented interventions to increase compliance with wearing different medical devices (Cook et al., 2015; Richling et al., 2011). More specifically, we examined the effects of differential reinforcement of other behavior (DRO) to increase compliance with wearing a heart rate monitor in 2 children with autism. The intervention increased compliance to 100% for both participants when an edible reinforcer was delivered every 90 s. The results indicate that DRO does not require the implementation of extinction to increase compliance with wearing a medical device. More research is needed to examine whether the reinforcement schedule can be further thinned.


Wearing Face Masks: Removing Barriers to Accessing School and the Community for Children With Autism Spectrum Disorder

(Applied Research)
Jennifer L. Cook (University of South Florida), VANESSA MARIE LARSON (Positive Behavior Supports Corporation), Raymond G. Miltenberger (University of South Florida)

With the onset of the COVID-19 pandemic, parents and teachers have faced the unique challenge of quickly teaching children with ASD to tolerate face masks, so they may continue therapy, attend school, or otherwise participate in community spaces, such as retail stores. We used a DRO procedure within a changing criterion design consisting of no-mask breaks and tangible reinforcers to teach four children with ASD of varying abilities to cooperate with wearing face masks for up to one hour. Additionally, one participant was taught over telehealth, with the aid of a Spanish-language interpreter. We included video models that were also narrated in Spanish within a behavior skills training procedure for the parent. During baseline, none of the children were able to meet the one-hour criterion. Results demonstrate that systematic fading of latency criteria across trials was successful in teaching all children to cooperate with keeping their masks on for at least one hour. Further, all participants were able to wear masks across consecutive one-hour periods (with brief no-mask breaks), and two participants that attended an inclusive classroom were able to keep their masks on for the full duration of the school day without any programmed no-mask breaks.




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