Association for Behavior Analysis International

Participation in health, hygiene, and self-care routines is important for individuals with intellectual and developmental disabilities (IDD) to promote wellness and safety. Challenges to participate in health or wellness routines are associated with negative outcomes such as lack of independence, poor hygiene, stigmatization, and other health issues. The present symposium comprises four presentations that evaluate various aspects of health and wellness care for learners with IDD. We begin by presenting an evaluation of the use of synchronous schedules of reinforcement when increasing tolerance during eight types of health routines for adults with disabilities. The next presentation evaluates the impact of conducting terminal probes after mastery of steps in health and self-care routines for young children with autism. The third presentation consists of an intervention package including noncontingent reinforcement, differential reinforcement, and graduated exposure on disruptive behavior and cooperation during mock medical examinations for individuals with disabilities. Our final presentation entails a multidisciplinary approach, involving both medical and behavioral methods, to treat encopresis in children with autism. Together, the symposium provides recommendations for practitioners and caregivers regarding the implementation of wellness practices and implications are highlighted.

Audience will benefit from an understanding of evidence-based, behavior analytic practices for instruction when attending this CE event.

Toleration of health routines (i.e., the absence of interfering behavior during medical and health-related procedures) is important for individuals with intellectual and developmental disabilities (IDD) to promote health and safety (Centers for Disease Control & Prevention, 2018). In the current study, we evaluated the use of synchronous schedules of reinforcement (SSR; Diaz de Villegas, 2020) for increasing tolerance during eight types of health routines with five adults with IDD. Results showed SSR alone was effective for increasing tolerance during five of eight health routines. Additionally, procedural modifications of SSR were necessary to increase tolerance during two routines, and SSR with modifications was ineffective for one participant. Finally, we extended treatment effects by training participants’ direct-care staff to implement procedures using behavioral skills training (BST; Parsons et al., 2013). Results showed staff implemented procedures with high fidelity, and treatment effects maintained. Measures of social validity (e.g., participant affect and staff acceptance), limitations, and areas for future research are discussed.

Individuals with autism often exhibit fears and challenging behaviors during health- and self-care routines. Caregivers may also avoid or delay completing vital self-care routines (e.g., toothbrushing) due to the fear their child experiences. Negative consequences are associated with poor compliance with health and self-care routines, such as poor hygiene, stigmatization, illness, and potential health issues that remain untreated due to missed appointments. Although graduated exposure has been shown to increase tolerance, this procedure can be time and resource intensive. It is possible that many intermediate steps that were trained as part of previous research may not be necessary and could be skipped throughout treatment, which would increase efficiency. The present investigation addressed this by conducting terminal probes after mastery of every three training steps across a variety of health or self-care skills for young children with Autism. Results suggested that all current participants skipped multiple steps (e.g., range 2 to 18 steps), resulting in mastery across tolerance skills (e.g., dental routines, haircutting, taking medications). Future research and clinical implications will be discussed.

Toilet training is a common challenge for caregivers, particularly for caregivers of children with Autism Spectrum Disorder (ASD). Incontinence can negatively impact the hygiene, physical comfort, independence, and quality of life for children with ASD. Encopresis, or incontinent bowel movements, is typically caused by constipation for most children. Children with ASD are 3.8 times more likely to have constipation than their typically developing peers. Thus, the purpose of the present study was to address limitations in previous research treating encopresis by evaluating a brief multidisciplinary intervention, involving both medical and behavioral approaches, to treat encopresis in children with ASD without the use of laxatives, enemas, and punishment procedures. We conducted a randomized clinical trial with a treatment as usual group and one intervention group, receiving the Multidisciplinary Intervention for Encopresis (MIE). Results indicate that the MIE resulted in statistically significant changes in independent continence with a for participants completing the MIE. Additionally, participants in the MIE group continued to improve post-treatment in follow up. The presentation discusses practical significance and impact for children, caregivers, and practitioners in the treatment of encopresis.

Individuals with neurodevelopmental disabilities often sustain several comorbid medical diagnoses, resulting in the need for increased usage of health care services. They also experience greater health disparities than their neurotypical peers, at least partially as a result of challenging behaviors exhibited during healthcare visits (Ervin et al., 2014). Behavioral interventions that would be feasible for health care providers to implement during routine medical procedures may help increase access to care. Following an assessment to determine if disruptive behavior was maintained by escape from medical demands, the present study evaluated the effects of an intervention package consisting of noncontingent reinforcement, differential reinforcement, and brief graduated exposure on disruptive behavior and cooperation during mock medical examinations. Both generalization to a novel implementer and maintenance across 2 weeks were evaluated for each participant. Preliminary results suggest that the standard intervention package may be effective for reducing challenging behavior and increasing cooperation during routine medical examinations for a noteworthy portion of patients.