Association for Behavior Analysis International

The symposium includes three studies that targeted healthcare and hygiene routines for individuals with developmental disabilities. The first presentation evaluated the utility of a total-task chaining procedure to teach female adolescents with autism spectrum disorder to care for menses followed by assessing responding in a non-training setting and in the absence of an instructor. The second presentation examined a forward chaining procedure combined with positive and negative reinforcement for task tolerance to establish compliance with hygiene routines and extinguish problem behavior for an individual diagnosed with autism spectrum disorder and down syndrome. The third presentation conducted a treatment procedure that consisted of demand fading and differential reinforcement both with and without extinction, and evaluated the negative side effects associated with the use of extinction to assess the extent to which extinction can be safely included when teaching compliance with healthcare procedures. Collectively these studies provide support for the value of teaching the healthcare needs for individuals with developmental disabilities.

Target audience are practitioners and researchers who serve the needs of individuals with autism spectrum disorder and other developmental disabilities.

Feminine hygiene skills, including steps required for care of menses, is a skill that nearly all young females with autism spectrum disorder need to be taught. Little applied research has focused on procedures to teach these skills. Two studies have demonstrated chaining to be a successful procedure in teaching related skills. This study extends methods used by Veazey et al. (2016) on using total-task chaining to teach females with autism to care for menses by programming for and assessing generalization in novel settings and in the absence of an instructor. Results demonstrate increases in correct responding across conditions for two participants, and generalization was demonstrated for one participant.

Hygiene related tasks are commonly non-preferred tasks for individuals with intellectual and developmental disabilities, but individuals who engage in problem behavior to escape and avoid these tasks are at particular risk for infection, dental decay, and potential social ostracization. This presentation describes a case study in which we established compliance with hygiene routines including tooth brushing, shaving, hair combing, and the application of chap stick with a 21-year old male diagnosed with autism spectrum disorder and down syndrome who displayed escape-maintained aggression and property destruction. The model for each of these tasks was to (a) conduct a task analysis of each task, (b) gradually introduce each step of the task analysis using forward chaining, (c) provide positive and negative reinforcement for task tolerance, and (d) extinguish problem behavior. Following acquisition of these tasks, we completed parent training and observed successful generalization of tolerance to applying deodorant and lotion, changing clothing, and spraying cologne.

The presence of certain stimuli during healthcare procedures (e.g., haircuts, dental) may evoke noncompliance in children with intellectual and developmental disabilities (Shumacher & Rapp, 2011). Noncompliance with such procedures can be a serious problem, especially when sharp objects are involved. Numerous interventions have been described, several of which included the use of extinction (e.g., Allen & Stokes, 1987; Cuvo, et al., 2010). However, the use of extinction treatment procedures may be associated with increased problem behavior. We evaluated a treatment procedure that included demand fading and differential reinforcement both with and without extinction. Additionally, negative side effects associated with the use of extinction were evaluated. A multiple-baseline-across-subjects design was combined with a multiple-probe design to evaluate acquisition, maintenance, and generalization. Ten young children with IDD participated. Results showed successful increases in compliance both in the presence and absence of extinction. However, acquisition was much slower without extinction. Further, the use of extinction was associated with moderate increases in problem behavior and negative vocalizations. This study extends behavior-analytic literature by assessing the extent to which extinction can be safely included as a treatment component when teaching compliance with healthcare procedures.