Functional analysis and generalized treatment of disruptive behavior during dental exams.

Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.

[1]  Derek D. Reed,et al.  The Fuzzy Concept of Applied Behavior Analysis Research , 2017, The Behavior Analyst.

[2]  K. D. Allen,et al.  Compliance with Medical Routines , 2016 .

[3]  A. Cuvo,et al.  Training children with autism spectrum disorders to be compliant with an oral assessment , 2010 .

[4]  A. Cuvo,et al.  Training children with autism spectrum disorders to be compliant with a physical exam , 2010 .

[5]  J. E. Carr,et al.  Function-Based Treatments for Escape-Maintained Problem Behavior: A Treatment-Selection Model for Practicing Behavior Analysts , 2010, Behavior analysis in practice.

[6]  C. Loo,et al.  The caries experience and behavior of dental patients with autism spectrum disorder. , 2008, Journal of the American Dental Association.

[7]  L. Hagopian,et al.  Behavioral Assessment and Treatment of Anxiety in Individuals with Intellectual Disabilities and Autism , 2008 .

[8]  J. Luiselli,et al.  Escape-Maintained Problem Behavior in a Child With Autism , 2007 .

[9]  Hubert Korzilius,et al.  Behavioral treatment of challenging behaviors in individuals with mild mental retardation: meta-analysis of single-subject research. , 2006, American journal of mental retardation : AJMR.

[10]  J. Waller,et al.  A survey of members of the American Academy of Pediatric Dentistry on their use of behavior management techniques. , 2004, Pediatric dentistry.

[11]  C. Piazza,et al.  On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal. , 2003, Journal of applied behavior analysis.

[12]  Nathan A. Call,et al.  Differential reinforcement with and without instructional fading. , 2002, Journal of applied behavior analysis.

[13]  P. Herrström,et al.  Dental care of autistic children within the non-specialized Public Dental Service. , 2001, Swedish dental journal.

[14]  A. Nowak,et al.  Characteristics of patients with autistic disorder (AD) presenting for dental treatment: a survey and chart review. , 1999, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[15]  W. Fisher,et al.  The evaluation and treatment of aggression maintained by attention and automatic reinforcement. , 1998, Journal of applied behavior analysis.

[16]  B. Iwata,et al.  Developing a technology for the use of operant extinction in clinical settings: an examination of basic and applied research. , 1996, Journal of applied behavior analysis.

[17]  B. Iwata,et al.  TOWARD A FUNCTIONAL ANALYSIS OF SELF‐INJURY , 1994 .

[18]  R. G. Smith,et al.  Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading. , 1994, Journal of applied behavior analysis.

[19]  B. Iwata,et al.  Stimulus (instructional) fading during extinction of self-injurious escape behavior. , 1993, Journal of applied behavior analysis.

[20]  R. G. Smith,et al.  Reduction of multiple aberrant behaviors and concurrent development of self-care skills with differential reinforcement. , 1992, Research in developmental disabilities.

[21]  K. McPherson,et al.  Evaluation of behavior management technology dissemination in pediatric dentistry. , 1990, Pediatric dentistry.

[22]  B. Iwata,et al.  Experimental analysis and extinction of self-injurious escape behavior. , 1990, Journal of applied behavior analysis.

[23]  W. Fisher,et al.  Enhancing Child Compliance with Nebulized Respiratory Treatment , 1988, Clinical pediatrics.

[24]  F C Mace,et al.  Functional analysis and treatment of severe pica. , 1986, Journal of applied behavior analysis.