Behavioral interventions addressing needle-based medical procedures in individuals diagnosed with intellectual and developmental disabilities: A scoping review.

Abstract

Current strategies to ensure compliance with needle-based medical procedures in populations with intellectual or developmental disabilities can have negative side effects, which include the use of restrictive practices, especially when patients exhibit challenging behavior. Using behavioral strategies may be a safer and effective alternative to traditional approaches. In the current study we sought to provide a scoping review of the research on the use of behavioral strategies to increase compliance with needle-based medical procedures. We analyzed research efficacy at both the study level and individual level to determine the impact of behavioral strategies on (a) compliance with needle-based medical procedures and (b) reduction of challenging behavior. Only one of nine studies met What Works Clearinghouse standards for single-case research design. Most studies were able to produce compliance with actual needle-based medical procedures either during the studies or during follow-up phases. Those studies that measured challenging behavior produced large reductions in challenging behavior throughout their interventions. Most studies used differential reinforcement techniques without extinction. Although study quality was generally limited, studies produced robust effects in all participants. Most studies involved multicomponent treatment packages that make it difficult to determine the effects of individual treatment components. Initial research in the application of behavioral strategies to needle-based medical procedures are compelling, but much more research is needed before recommending specific strategies for practitioners.

Behavior analysis in college classrooms: A scoping review

“…Consistent with the tenets of behavior analysis; e.g., conceptually systematic, effective; Baer et al, 1968). Our procedures were also commensurate with other recently published behavior-analytic scoping reviews (e.g., Walker et al, 2022). Including studies published in other journals (e.g., Teaching of Psychology) would require reviewing every intervention to determine if it was behavior-analytic.…”

Differential Reinforcement Without Extinction and Stimulus Fading to Teach Tolerance of a Sleep Study

“…The clinical team hypothesized that destructive behavior also produced escape from medical tasks. This is supported by research by Walker et al (2022) that suggests that escape is a common reinforcer for medical noncompliance when an individual is presented with an aversive medical procedure.…”

“…After their intervention concluded, the authors reported that stimulus distraction may not have been a necessary treatment component. Walker et al (2022) conducted a literature review on documented behavioral strategies with needle-based medical procedures to identify common strategies that promoted positive outcomes. Researchers identified Stuesser and Roscoe (2020) as the only article that met the What Works Clearinghouse (What Works Clearinghouse, 2020) standards for single-case research design.…”

“…These include reinforcement and systematic desensitization at the patient’s pace (Grider et al, 2012; Mednick & Claar, 2012; Reitman & Passeri, 2008). More current research has added the recommendation to avoid extinction if possible (Walker et al, 2022). For researchers and patients, these procedures are generalizable across several different medical procedures.…”

“…Given the research supporting the likelihood of an escape function for medical tasks (Walker et al, 2022) and other behaviors that occur immediately following aversive stimuli (e.g., inappropriate mealtime behavior; Piazza et al, 2003; Saini et al, 2022), practitioners may choose to allocate their precious appointment time to treatment, rather than additional assessment, unless they have reason to pursue assessment for hypothesized other functions. Walker et al, 2022 endorsed pretreatment assessments to identify potential reinforcers rather than taking time to conduct functional analyses, given that a functional analysis may not inform any additional treatment components. Regardless, this intervention still took a considerable amount of time which may not be feasible for families with time or insurance constraints.…”