Association for Behavior Analysis International

Individuals with autism spectrum disorder (ASD) and their caregivers face a multitude of barriers when attempting to access healthcare including sensory sensitivities and the limited knowledge and training in autism of treating clinicians (Walsh et al., 2020). This present symposium details four papers addressing improving access to healthcare for autistic individuals. The first paper presents a review of behavioral interventions used during routine dental checkups for children with intellectual and developmental disabilities. Practical implications and suggestions for future research will be discussed. The second paper presents a literature review and process for developing a menstrual hygiene management (MHM) program for individuals with ASD that exhibit challenging behavior. The third paper explores the utility of video training, practice, and feedback to teach healthcare professionals to implement various behavior analytic procedures such as non-contingent reinforcement, frequent breaks and within-session graduated exposure, in the context of physical examinations. Results demonstrate the efficacy and efficiency of this training method to train healthcare providers. Finally, the fourth paper used systematic desensitization to reduce fear responses during phlebotomy appointments in two adults with autism and a history of severe challenging behavior. The results of the study suggest an effective model of desensitization to reduce fear responses and aid adults with ASD in successfully completing blood draws. All together these papers display a variety of behavior analytic methods and procedures that can be used to increase access to healthcare for people with ASD.

general understanding of graduated exposure, staff training, complexities of medical treatment of individuals with autism

Access to education and resources for safe menstruation is a human right. Researchers estimate globally over 700 million women and girls with disabilities experience monthly menstruation (UN Secretary General, 2017). Menstrual hygiene management (MHM) is a critical issue connected to gender equality, gender equity, education, empowerment, and human dignity (UNICEF, 2019). The lack of knowledge and awareness about menstruation contributes to harmful practices and health-related outcomes, including cervical cancer, pelvic infections, school drop-out, low academic performance, increased abuse risk, sterilization or long-term dependence on medication for menstrual suppression, and poor quality of life. This talk will address a critical gap in applied behavior analysis (ABA) services that negatively impacts individuals with ASD and ID/DD during menstruation. We present: a concise literature review of caregiver perspectives and trends in issues related to menstruation; the process for development of a pilot MHM program for individuals who many engage in challenging behavior as informed by multidisciplinary collaboration; and assessment and intervention results from pilot participants. The primary aim of this talk is to address how practitioners of behavior analysis can address menstrual hygiene management and menstrua-behavioral issues using person-centered, evidence-based methods grounded in autonomy and independence-affirming care.

People with intellectual and developmental disabilities (IDD) sometimes emit challenging behaviors during physical examinations that interfere with their health care. To help, we created a 24-min video training to teach healthcare providers to use or offer (a) non-contingent reinforcement, (b) tell-show-do, (c) frequent breaks, (d) within-session graduated exposure, and (e) tangible reinforcers to patients with IDD during physical examinations. Afterward, participants practiced implementing the behavioral interventions using a novel method in which they rotated through the roles of physical examiner, patient, and evaluator. The physical examiner practiced the behavioral interventions with a patient who followed a randomized script to emit challenging behaviors. Simultaneously, up to two evaluators scored the physical examiner’s intervention use and gave performance feedback. In a pre-test, post-test design, before viewing the video, 22 participants produced a mean score of 47% during practice. After the video, their mean score increased to 93%, and 65 additional participants produced a mean score of 92% in a post-test-only design. The results also indicate that the participant-led practice method can be completed more quickly and with fewer resources than a facilitator-led practice method, which makes the novel method more suitable for medical educators to use with their students and residents.

Trypanophobia, a fear of medical procedures involving needles, can co-occur in individuals diagnosed with autism spectrum disorder (ASD). Complications with medical procedures involving needles, such as blood draws, are further exasperated for individuals with severe problem behavior such as self-injury and aggression. Systematic desensitization is a behavioral technique that gradually exposes an individual to anxiety provoking stimuli while learning relaxation techniques and shows promise as an effective tool to treat needle phobia in adults diagnosed with ASD (Wolff & Symons 2012). The purpose of the current study was to expand on this literature by evaluating the effectiveness of medical desensitization to phlebotomy procedures with two adults with ASD and history of severe aggression and self-injury. Results of the present evaluation demonstrate the effectiveness of medical desensitization in the reduction of fear responses. Low levels of fear responses generalized with a phlebotomist in an in-vivo blood draw for one participant, and both participants successfully completed the in-vivo blood draw without engaging in problem behavior.