Improving wellness-exam and vaccination attendance in children with developmental disabilities using reinforcement and fading techniques

Abstract

Individuals with neurodevelopmental disorders have numerous medical comorbidities, worse health outcomes and higher all-cause mortality, which underlines the importance of a well-built medical care system tailored to support their specific needs. In addition, anxiety and fear of those procedures are common and can sometimes lead to the medical professionals using physical or chemical restraints, or in many cases ceasing necessary medical procedures. This current study’s purpose was to evaluate the effectiveness of stimulus fading and differential reinforcement without extinction as strategies to help two children, diagnosed with autism spectrum disorder and developmental delays, to overcome their fear of medical procedures, or more specifically, vaccination. A changing criterion design was used to evaluate the effects of differential reinforcement and fading on the participants behavior during medical examination and vaccination. Participants were always allowed to leave the medical setting and if they chose not to participate the researcher stopped the session. The intervention led to both participants receiving the vaccination successfully. The current status of the literature and limitations of the study are discussedKeywords: autism spectrum disorder, intellectual disorder, differential reinforcement, stimulus fading, graduated exposure, medical adherence, fear, avoidance, vaccination, needle phobia.