The effects of differential reinforcement without extinction and stimulus fading on tolerating routine medical check-up

Abstract

Adherence to medical routines, including standard medical check-up, is a crucial aspect of primary healthcare for all individuals. Children diagnosed with autism spectrum disorder or intellectual and developmental disabilities tend to have more health related issues than typically developing children. In addition, they experience increased intensity of fear and anxiety in relation to medical routines which can lead to higher frequency of disruptive behavior and non-adherence to medical routines. Therefore, it is critical to develop evidence-based interventions for tolerating medical routines without disruptive behavior. The purpose of the current study was to expand previous research on differential reinforcement without extinction and stimulus fading. The study aimed to evaluate the effects of these components on disruptive behavior that indicates discomfort and tolerance of medical check-ups for two individuals diagnosed with autism spectrum disorder and/or intellectual and developmental disabilities. The intervention phase consisted of two conditions, differential reinforcement without extinction and stimulus fading. If differential reinforcement without extinction was not sufficient in increasing medical adherence for a certain task, then stimulus fading was implemented and the task was divided further into smaller sub-steps. Differential reinforcement without extinction was effective in increasing medical adherence for both participants and stimulus fading had to be implemented for one task for both participants. Limitations and strengths of the current study will be discussed as well as future research.