By Alison Betz, Ph.D., Associate Professor, School of Behavioral Analysis
Alison Betz, Ph.D., and her graduate students conduct research that targets improving the quality of life for individuals with autism and their families. Her research focuses on the evaluation of teaching procedures, assessment and treatment of problem behavior and food selectivity, and translational studies evaluating commonly implemented treatment procedures.
One exciting area of research Betz and her students are0 working on is the treatment of noncompliance with medical and dental procedures that is common in children with autism. Research suggests that children with co-morbidities and autism itself have more health care visits, more time during visits and more medications prescribed when compared to their neurotypical peers and that children with autism are more likely to be hospitalized with longer stays and higher associated costs.
Hospitalization, or even routine visits to a pediatrician’s office, may evoke various challenging behaviors, particularly in children with autism, which may result in more severe medical complications. Thus, it is not uncommon for medical professionals to use physical restraint or chemical sedation for extreme or emergency cases. Given the level of intrusiveness of restraint and sedation, as well as their potential side effects, it is critical to evaluate the effects of less intrusive options. Thus, Betz and her students are actively evaluating behavioral interventions targeting noncompliance with medical and dental procedures in children with autism.
In a recent study completed by Betz and colleagues, children who engaged in noncompliance during routine medical and dental procedures were recruited to participate in a study to evaluate stimulus fading and differential reinforcement, similar to traditional desensitization procedures used to treat phobias. During intervention, each medical procedure was broken down into multiple steps, which gradually exposed the participant to stimuli associated with procedures that evoked noncompliance (e.g., stethoscope, thermometer, toothbrush, etc.). If the participant complied with the required step, he/she earned a reinforcer (i.e., reward). If he/she engaged in noncompliance, the procedure was terminated. Overall, results suggested that the procedures were successful, with four participants showing improvements across both medical and dental procedures with stimulus fading alone, while the treatment package improved performance for the remaining three participants. In addition, compliance generalized to untrained procedures, and to novel therapists suggesting that it may not be necessary to train all medial personnel. Moreover, anecdotal parental reports suggest the treatment improved compliance during medical and dental exams; however, no formal procedures were conducted to assess generalization of compliance during regular checkups or exams.
To even further increase the social validity of behavioral intervention to treatment noncompliance with medical procedures, Betz and colleagues are currently working on two follow-up studies. In one study, more formal pre- and post-test measures in the doctor’s office will occur for each participant to determine whether compliance training occurring in a treatment center will improve performance during the exam. In another study, more traditional approaches such as parent coaching and handbooks will be evaluated and compared to the previously described procedures to determine the least intrusive training procedure necessary.