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.


49th Annual Convention; Denver, CO; 2023

Event Details

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Symposium #372
CE Offered: BACB
Considerations for Addressing Dental Concerns for Children With Autism
Monday, May 29, 2023
3:00 PM–3:50 PM
Convention Center Mile High Ballroom 4A/B
Area: AUT; Domain: Applied Research
Chair: Savannah Tate (University of Florida)
CE Instructor: Savannah Tate, M.Ed.

Children with autism sometimes have difficulty tolerating oral health and hygiene procedures. This may result in oral pain or abnormalities, longer wait time for services due to the need for sedation, and problem behavior related to these medical variables. The purpose of this symposium is to propose considerations for addressing oral health and hygiene issues as it relates to multidisciplinary care and identifying behavioral indicators of oral pain, diurnal bruxism, which is an oral form of self-injury, and increasing engagement in oral hygiene skills without escape extinction. First, we will present data on a developmental history survey of children with autism who have dental issues, including a case example of indicators of oral pain. Next, we will present a larger scale study of assessment and treatment of diurnal bruxism. Finally, we will discuss results of a study on teaching oral hygiene without escape extinction. Implications and future directions for research will also be discussed.

Instruction Level: Intermediate
Keyword(s): Autism, Hygiene skills, Oral health, Stimulus fading
Target Audience:

This is an appropriate topic for behavior analysts that understand the basics of assessment and treatment of problem behavior.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify the extent to which children with autism may experience resistance to dental procedures and self-injury that may be exacerbated by oral health problems; (2) describe how treatments typically prescribed for self-injury maintained by automatic reinforcement may affect diurnal bruxism; (3) identify methods for increasing engagement in oral hygiene skills without the use of extinction.

Incorporating Dental Considerations Into Multidisciplinary Behavioral Treatments

JANAE' PENDERGRASS (University of Florida), Lindsay Lloveras (University of Florida ), Kerri P. Peters (University of Florida), Nicole Perrino (Florida Autism Center, University of Florida), Vivian F Ibanez (University of Florida), Sean Smith (SUNY Upstate Medical University), Timothy R. Vollmer (University of Florida)

Individuals with autism are more likely to be diagnosed with additional chronic medical conditions than their neurotypical peers (Copeland and Buch, 2019). However, they are less likely to have the communication skills to express feelings of pain or discomfort that may surface from these conditions (McKeown et al., 2022). One common issue that arises for most children are problems with dental health. This occult medical condition could potentially produce pain and has implications for health outcomes. Failing to address concerns associated with oral health and hygiene could result in false positives during behavior assessments and could lead clinicians to implement behavioral treatments that disregard relevant variables. Collaborating with other healthcare professionals to address these medical issues may assist practitioners in providing holistic, high-quality care to clients. Children with autism are more susceptible to dental issues due to a number of variables (Krahn et al., 2016). In this presentation, we will discuss the results of a developmental history survey of children with dental issues, a case example of the effects of dental issues on elevated rates of self-injurious behavior before and after collaborating with a dentist, and the assessment of toothbrushing in children in collaboration with a pediatric feeding professional. We will also discuss future areas for research.

Assessment and Treatment of Diurnal Bruxism
SAVANNAH TATE (University of Florida), Catherine Kishel (The University of Florida), Rachel LeeAnn Schmidli (BlueSprig Pedatrics), Timothy R. Vollmer (University of Florida)
Abstract: Children with autism are more likely to experience difficulty tolerating dental procedures. This poses challenges for individuals who engage in diurnal bruxism (i.e., teeth grinding while awake), a form of self-injurious behavior. There are few studies with sufficient experimental design in the literature that evaluate treatment for bruxism. Most of these studies evaluate a combined cue procedure, which includes a gentle touch on the chin and a vocal prompt contingent on bruxism. Only three of these studies include a functional analysis of bruxism. We applied assessment and treatment procedures typical for self-injury maintained by automatic reinforcement to bruxism. We started with a functional analysis to confirm that the bruxism was maintained by automatic reinforcement. Next, we conducted a competing stimulus assessment. Depending on results of the initial competing stimulus assessment, we modified the augmented competing stimulus assessment to include a combined cue procedure. We used the results of the competing stimulus assessments to inform treatment. Treatment analyses included evaluations of noncontingent reinforcement, combined cue procedures, and combined cue procedures with the addition of a chewy. Results indicate that noncontingent reinforcement and the combined cue procedure may not be effective enough to reduce diurnal bruxism in some children with autism.

Teaching Oral Hygiene Skills Without Escape Extinction

JEANNE STEPHANIE GONZALEZ (University of Florida), Lindsay Lloveras (University of Florida ), Ciobha A. McKeown (University of Florida), Timothy R. Vollmer (University of Florida)

Many children do not tolerate oral hygiene activities such toothbrushing or dental visits despite the fact these are essential for medical care. This study sought to replicate and extend the literature on teaching oral hygiene skills to children with autism. Participants were taught to tolerate toothbrushing using stimulus fading and no escape extinction. Removal of assent was defined for each participant and included any behavior that suggested the participant wanted to terminate the session. We also conducted generalization probes with caregivers and dental visits. All participants made progress with toothbrushing across multiple stimuli. Limitations including long durations to terminal goals will be addressed.




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