Preliminary Results of an Interdisciplinary Behavioral Program to Improve Access to Preventative Dental Care for Adults With Intellectual and Developmental Disabilities.

Adults with intellectual and developmental disabilities (AIDD) experience significant oral health disparities, partially due to perceived behavioral issues. This article describes the preliminary outcomes of a developing interdisciplinary (dental, medical, behavioral) program involving a behavioral intervention for AIDD previously receiving preventative dental care with sedation, general anesthesia, or protective stabilization (SAS). After a baseline assessment, a board-certified behavior analyst implemented increasingly complex behavioral interventions during simulated dental visits. Prior to COVID-19 pandemic-related restrictions, there were 32 active participants; 15 (46.9%) successfully completed a focused, real dental exam with simple behavioral interventions and 17 (53.1%) remain in treatment. These preliminary results suggest that many AIDD previously receiving SAS may participate in a preventative dental exam with minimal behavioral supports, if given the opportunity.

Evaluation of a Graduated Exposure Procedure to Teach Extended Mask Wearing in Various Settings to Children With Autism.

During the COVID-19 outbreak, the Center for Disease Control (CDC) recommended that everyone 2 years and older wear a face mask while in a community setting. However, children with autism may be reluctant to wear a mask, particularly for extended durations. In the current study, we implemented a graduated exposure procedure to teach mask wearing for a minimum of 1 hour in an early intensive behavioral (EIBI) intervention clinic to three children diagnosed with autism. We subsequently probed mask wearing, and if necessary implemented the graduated exposure procedure, in each participant's home and in a mock physician's office. Finally, we collected probe data on mask wearing in another community setting and 1 month post-treatment maintenance data in the EIBI clinic. During baseline, participants wore masks for 0 second to 5 minutes. After treatment, all participants wore the mask for at least 1 hour in each setting, with maintenance probes indicating 4 to 5 hour mask tolerance.

Tolerance of face coverings for children with autism spectrum disorder.

Healthcare professionals and government officials have advised the use of personal protective equipment, such as face masks and face shields, to assist with limiting the spread of the SARS-CoV-2 (COVID-19). Due to the prevalence of challenging behavior associated with other medical routines, the present study evaluated a treatment package composed of graduated exposure, prompts, reinforcement, and escape extinction on tolerance of wearing a face covering for up to 5 min for 12 children with ASD in a systematic replication of Cox et al. (2017) and Sivaraman et al. (2020). We also extended previous research by measuring generalization of face covering type (i.e., face shield) and the efficacy of a treatment extension for tolerating a face covering for up to 15 min during the participants' trial-based instruction and play periods.

Tolerance Training with Adolescents in a Residential Juvenile Facility.

For individuals receiving treatment in residential juvenile facilities, the inability to tolerate typical but unpleasant stimulus events may manifest in aggressive behavior toward staff or other residents. Such behaviors can lead to loss of privileges, interfere with other treatments, and contribute to negative staff-student relationships. As a procedure, tolerance training (TT) involves systematically increasing the duration of exposure to an undesired stimulus event or situation. The current study evaluated the effects of a procedure to increase tolerance of aversive situations for four adolescents who were receiving treatment for sexual offenses in a residential detention facility. Results from single-subject experimental designs indicate that TT increased all four adolescents' ability to tolerate a non-preferred stimulus event. We briefly discuss the clinical implications of the use of behavior-analytic procedures to improve skill sets for adolescents in residential treatment facilities.

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.

Teaching students with autism spectrum disorder to tolerate haircutting.

We describe intervention with 2 adolescent male students who had autism spectrum disorder (ASD) and resisted haircutting performed by care providers at a residential school. The students were exposed to a graduated hierarchy of steps including the presence of hair clippers, and increased duration of hair clippers against their scalp and hair. Edible reinforcement was presented contingent on completion of a step without interfering behavior. Both students learned to tolerate all of the steps in the graduated hierarchy and a full haircut with maintenance at 2-, 4-, and 6-month follow-up. The study supports previous tolerance-training research with children and youth who have intellectual and developmental disabilities and resist personal care and hygiene routines.

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care.

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3-5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.

Water-balance response of Rhinella arenarum (Hensel, 1867) tadpoles to graduated increase in environmental osmolarity / Resposta de Rhinella arenarum larvae a meio electrolítico e não electrolítico com aumento escalonado da osmolaridade

The water balance and the upper limit of osmotic tolerance of premetamorphic Rhinella arenarum larvae (Gosner's stage 26) was evaluated after semistatic incubation in electrolyte (NaCl) and non-electrolyte (mannitol) media following a protocol of progressively increased osmotic pressure. Wet and dry weights were measured to calculate the water content as a derived variable indicative of the hydric balance. Statistical analysis was performed using univariate and integrated multivariate analysis. Tadpoles survived in electrolyte and non-electrolyte solutions up to 200 mOsm. The discriminant function was the best tool to describe the responses of the animals to external environmental stress under experimental conditions. The results were compared with those obtained in previous studies using a protocol of acute exposure to the same media used in this study. It was concluded that a) multivariate analysis is an appropriate approach to describe the responses of tadpoles to changes in the environmental physicochemical parameters, and b) progressive and acute acclimation to the experimental solutions induced similar responses.

Avaliou-se o balanço hídrico e o limite superior de tolerância osmótica em larvas pré-metamórficas do Rhinella arenarum (etapa 26 de Gosner) sob condições de incubação semiestáticas, num meio eletrolítico (NaCl) e não eletrolítico (manitol), seguindo um protocolo de aumento progressivo da pressão osmótica do meio. A quantificação das respostas se efetuou por meio da medição dos valores de peso úmido e seco e do cálculo, a partir destes, do conteúdo de água, como variável derivada indicativa do equilíbrio hídrico. A análise estatística foi realizada usando análise univariada e multivariada. As larvas conseguiram sobreviver em soluções eletrolíticas e não eletrolíticas até 200 mOsm. A função discriminante foi a melhor ferramenta para descrever as respostas dos animais ao estresse osmótico ambiental. Os resultados foram comparados com os obtidos em estudos anteriores, usando um protocolo de exposição aguda aos mesmos meios de incubação usados neste estudo. Concluiu-se: a) a análise multivariada é a aproximação adequada para descrever as respostas das larvas às mudanças nos parâmetros físico-químicos do seu meio; e b) tanto a aclimatação progressiva, como as exposições agudas às soluções experimentais induziram as respostas semelhantes.