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.


48th Annual Convention; Boston, MA; 2022

Event Details

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Symposium #463
CE Offered: BACB
Using Individual Preferences, Reinforcement Systems, and Technology to Increase Engagement in Health and Hygiene Routines
Monday, May 30, 2022
10:00 AM–11:50 AM
Meeting Level 2; Room 205A
Area: EDC/CBM; Domain: Applied Research
Chair: Elizabeth Joy Houck (University of North Texas)
Discussant: Dorothea C. Lerman (University of Houston-Clear Lake)
CE Instructor: Elizabeth Joy Houck, M.Ed.
Abstract: The importance of interventions to teach and maintain hygiene routines has been especially important during the Covid-19 pandemic. Children and people with intellectual disabilities (ID) often demonstrate limited tolerance with, engagement with, and independence in hygiene routines, including toothbrushing, mask wearing and hand washing. Limited active participation in these routines places individuals at risk of adverse health outcomes. During the Covid-19 pandemic, limited participation in these routines could also place others at greater risk of adverse health outcomes. This symposium will present data on novel uses of preference assessments, reinforcement systems, and technology to improve engagement in hygiene routines with typically developing children and adults with intellectual disabilities. Outcomes from these studies demonstrate how adapting widely used procedures can be an effective method to improve many socially significant problems, including currently critical health and hygiene routines.
Instruction Level: Advanced
Keyword(s): Hand-washing, Hygiene, Mask Wearing, Toothbrushing
Target Audience: Audiences should have basic familiarity with common preference assessments, reinforcement schedules and standard measurement practices.
Learning Objectives: At the conclusion of this presentation participants will be able to: 1) Describe common strategies used to increase engagement in hygiene routines for typically developing children and adults with intellectual and developmental disabilities. 2) Describe the importance of increasing independence and engagement in hygiene tasks for typically developing children and adults with intellectual and developmental disabilities. 3) Describe the effects of noncontingent reinforcement without extinction on tooth brushing duration in one study with two participants. 4) Describe how preference assessments can be used to select the least aversive unfamiliar stimulus to improve compliance with hygiene interventions (specifically mask wearing). 5) Describe how preference assessment data can be used to select appropriate starting reinforcement schedules. 6) Describe how a person’s typical environment can be used to determine socially valid terminal reinforcement schedules. 7) Describe methods for thinning reinforcement schedules to align with terminal reinforcement schedule goals. 8) Describe the generalization effects of two different interventions to increase mask wearing. 9) Describe how image analysis software can be used to assess effectiveness of handwashing interventions. 10) Describe the benefits of utilizing technology to assess accuracy of skills in areas such as handwashing.

Effects of the Podcast Chompers® on Toothbrushing Duration by Children

CATHERINE LEWIS (Texana Center), Jennifer N. Fritz (University of Houston-Clear Lake), Samantha Jean Boyle (University of Houston-Clear Lake), Victoria Fletcher (University of Houston-Clear Lake)

It is important to establish proper dental hygiene routines in children to prevent cavities and other dental issues. The effects of noncontingent reinforcement (NCR) without extinction was used to increase compliance with tooth brushing for two elementary-aged siblings. Specifically, a podcast called Chompers® produced by Gimlet Media was played during treatment. The results showed that the podcast was ineffective in maintaining increased tooth brushing durations for both participants. The addition of a new instruction was also not effective for one of the participants, and the addition of sibling interaction did not lead to a consistent increase in the toothbrushing duration of both participants.


Adapting Preference Assessments and Reinforcement Schedules for Increasing Mask-Wearing With Adults With Intellectual Disabilities

ELIZABETH JOY HOUCK (University of North Texas), Joseph D. Dracobly (University of North Texas), Richard G. Smith (University of North Texas), Danielle Pelletier (University of North Texas), Melanie Bauer (University of North Texas), Aaron Joseph Sanchez (University of North Texas)

People with intellectual and developmental disabilities (IDD) and autism spectrum disorders (ASD) often have difficulty in tolerating new or infrequently contacted stimuli (e.g., Fisher et al., 2019; Woodcock & Humphreys, 2009). Limited tolerance for health-related behavior, such as nail cutting, haircuts, and dental cleanings can cause distress for these individuals and their families (e.g., Cavalri et al., 2013). During the Covid 19 pandemic, face masks are a new stimulus that may cause distress for many people, especially those who may not understand the need for a mask. The inability to tolerate face masks could limit safe access to public locations for people with IDD and ASD. Therefore, we evaluated preference for different types of face masks with five adults with IDD and limited verbal communication skills. Using a multielement design, we assessed the duration each participant wore five different face masks and subsequently used reinforcement schedule manipulations to increase mask wearing for all five participants. For all five individuals initial preference assessments proved helpful in determining appropriate, individualized treatment steps for increasing cooperation with wearing a face mask.


Using Synchronous Reinforcement to Increase Mask-Wearing in Young Children and Individuals With Developmental Disabilities

CATHERINE MCHUGH (University of Kansas), Claudia L. Dozier (The University of Kansas), Sara Camille Diaz de Villegas (University of Kansas), Nicole Kanaman (University of Kansas), Marissa E. Kamlowsky (The University of Kansas), Ky Clifton Kanaman (University of Kansas)

The Centers for Disease Control (CDC) provided the public with recommendations to slow the spread of Covid-19 in 2020, which including wearing a mask in the community. In Study 1, experimenters coached direct-care group home staff via telehealth to use synchronous schedules of reinforcement (SSR; Diaz de Villegas, 2020; Rovee-Collier & Gekoski, 1979) to increase mask wearing for 4 adults with intellectual and developmental disabilities. In Study 2, experimenters directly implemented SSR to increase mask wearing for four young children with and without disabilities. Results across both studies showed SSR effectively increased mask wearing (i.e., participants tolerated wearing their mask for increased durations up to 30 min). Additionally, some participants demonstrated generalization to the everyday environment (e.g., in the classroom with their teachers, in community locations). Furthermore, procedural integrity data in Study 1 suggested staff could be coached via telehealth to implement the intervention, and staff surveys suggested the procedures and coaching were socially valid.

Utility of an Image Analysis Method as a Handwashing Measurement Tool
RACHEL JESS (GoodLife Innovations), Claudia L. Dozier (The University of Kansas), Stacha Leslie (University of Kansas), Marissa E. Kamlowsky (The University of Kansas)
Abstract: Hands are the most common mode of transmission of infection from pathogens. Washing hands with soap and water is the most effective method for decreasing transmission of infection; however, research suggests children do not routinely wash their hands using best-practice methods. Researchers have evaluated various strategies to address appropriate handwashing in children. More research is needed, however, regarding the efficacy and efficiency of teaching and measuring handwashing accuracy and quality in children. One method for assessing handwashing quality is comparing pre- and post-handwashing levels of proxy contamination using image analysis software. Further evaluation of the correlation between handwashing accuracy and hand cleanliness using proxy contamination should be conducted to determine the validity of this analysis method. The purposes of this study were to (a) conduct a retrospective data analysis from a series of studies with children on handwashing errors and handwashing quality using an index of hand cleanliness and (b) examine the utility of an image analysis method as a measurement tool for hand cleanliness. Overall results suggest the most important components of handwashing for increasing hand cleanliness include use of soap, amount of vigor, scrubbing the tops and palms of hands, and duration of scrubbing.



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