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| Methods for Teaching Children with Autism and Other Developmental Disorders to Cooperate with Health Care Procedures |
| Monday, May 26, 2008 |
| 10:30 AM–11:50 AM |
| Stevens 1 |
| Area: DDA/CBM; Domain: Service Delivery |
| Chair: Keith J. Slifer (The Kennedy Krieger Institute/Johns Hopkins University) |
| Discussant: Anthony J. Cuvo (Southern Illinois University) |
| Abstract: Behavior analysts may use their skills to address the many challenges that children with Autism, Pervasive Developmental or related disorders experience when undergoing various types of health care diagnostic procedures or treatments. Behavioral interventions have been shown effective for increasing child cooperation with medical procedures and regimens. They also have been used to teach specific child and parent skills needed for maintaining optimal health and quality of life. One of the most challenging problems encountered by health care professionals is the management of developmentally disabled children’s anxiety and related disruptive behavior during health care procedures. This symposium will focus on recent applications of behavioral interventions for managing acute distress and disruptive behavior in pediatric patients with developmental disorders during health care procedure. Three presentations will be made covering the following topics: (1) desensitization and shaping of compliance with routine vision screening (2) counter-conditioning to reduce distress and increase compliance during venipuncture and (3) behavioral intervention to increase compliance with electroencephalographic (EEG) procedures. The common characteristics of each of these applications will be discussed as well as their unique challenges and directions for future research. |
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| Desensitization and Shaping Compliance with Routine Vision Screening in Children with Developmental Disabilities. |
| NANCY M. SIMER (Southern Illinois University, Carbondale), Anthony J. Cuvo (Southern Illinois University) |
| Abstract: Vision screening is required when students enter an Illinois public school; however, children with developmental disabilities have demonstrated difficulties performing the skills required to complete the vision screening. The three participants in this study did not comply with three components of their visions screening and were scored “could not test” (CNT) by a licensed vision screener. The inability to be tested hinders early detection of a vision disorder (e.g., amblyopia). An intervention program was implemented that functioned both to shape new behavior and desensitize participants to aversive stimuli during a routine vision screening. Following training, two children who were previously classified as CNT completed and passed their individual vision screenings. In addition, compliance generalized to hearing screenings for both of these children who also scored CNT during the previous hearing screening. The third participant also demonstrated compliance when skills were trained. |
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| Counter-Conditioning to Reduce Behavioral Distress and Increase Compliance with Venipuncture for Children with Autism or Other Developmental Disabilities. |
| LANA L. HARDER (Texas Children's Hospital), Melissa H. Beck (Kennedy Krieger Institute), Melissa Ann DeMore (Kennedy Krieger Institute/Johns Hopkins University School of Medicine), Keith J. Slifer (Kennedy Krieger Institute/Johns Hopkins University) |
| Abstract: Children must sometimes tolerate aversive health care procedures to benefit from prescribed medical care. These procedures occur more frequently for children with disabilities because of associated medical conditions. Procedures requiring venipuncture typically produce acute pain. Undergoing such procedures often results in conditioned anxiety and avoidant behaviors (e.g., aggression, escape, verbal refusal), which interfere with the safe performance of medical care. Avoidant behaviors may develop by a process of aversive conditioning when children experience repeated exposure to painful stimulation. Data for children with autism or other disabilities will be presented. Prior to treatment, all children exhibited avoidant behaviors that prevented their participation in medical care. Outpatient treatment sessions were conducted to counter-condition the children's behavioral distress when encountering stimuli associated with venipuncture. Distraction and positive reinforcement were implemented to help these children relax during graduated mock venipunctures. The patients exhibited reduced behavioral distress during treatment sessions relative to baseline, and in most cases successfully completed actual venipunctures. Results will be discussed in relationship to conditioning and counter-conditioning processes. Factors that facilitate and prevent the generalization of treatment effects also will be discussed. |
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| Behavioral Intervention to Increase Compliance with Electroencephalographic (EEG) Procedures in Children with Autism and Related Disabilities. |
| ROBIN ANNE FRUTCHEY (Kennedy Krieger Institute), Kristin T. Avis (University of Alabama, Birmingham), Melissa A. Meyers (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute/Johns Hopkins University) |
| Abstract: The EEG, or electroencephalogram, is a neurophysiologic technique used to detect and record electrical activity in different areas of the brain. It is critical to diagnosis and management of seizure disorders, such as epilepsy, as well as other neurological conditions. The EEG procedure is often not well tolerated by children with developmental disabilities due to anxiety about unfamiliar equipment, difficulty inhibiting motion (particularly in children with hyperactivity), and tactile defensiveness. The inability of children with developmental disabilities to tolerate EEG procedure is especially problematic because the incidence of epilepsy is considerably higher for children with disabilities, particularly mental retardation, autism, brain injury, and cerebral palsy. This clinical outcomes study sought to determine the efficacy of using behavioral intervention to teach children with Autism or related developmental disorders to cooperate with an EEG procedure. The behavioral training employed modeling, counterconditioning, escape extinction, and differential reinforcement-based shaping procedures. Results indicated that behavioral training was successful in promoting EEG compliance without restraint, anesthesia, or sedation. This study therefore lends credence to the use of behavioral interventions with developmentally disabled children to increase their compliance with EEG and similar health care procedures. |
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