Functional analysis and generalized treatment of disruptive behavior during dental exams

Abstract

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.

Exposure‐based treatments for fear and reactivity to medical procedures: A systematic review of the literature with implications for research and practice

“…However, the procedures in many of the articles included in this review suggest some operant involvement. The blocking of safety behaviors in most Exposure Therapy (Abramowitz et al., 2019; Craske et al., 2022; Salkovskis, 1991) and the use of escape extinction combined with exposure components (Cuvo et al., 2010; McConnell et al., 2020; Slifer et al., 2008) point to the role of negative reinforcement in the maintenance of phobic behavior. That is, phobic people do what it takes to avoid or escape the feared stimuli, and therefore escaping or avoiding maintains these patterns.…”

On the longevity of behavioral interventions for challenging behavior

“…Typically, these studies are conducted to evaluate the internal validity of a specific therapeutic approach or set of treatment procedures. The few studies that have included post‐intervention data may better be classified as effectiveness studies: the extent to which interventions produce or maintain treatment effects under typical conditions (e.g., Dowdy & Tincani, 2020; Lichtblau et al., 2018; McConnell et al., 2020; Rose & Beaulieu, 2019). Typically, effectiveness studies are designed to evaluate the external validity of an intervention, given that the durability of an intervention is tested across time and settings.…”

Remote Training of Dental Students and Professionals to Promote Cooperative Behavior in Patients with Intellectual and Developmental Disabilities

“…Most interventions are based on a presumption that uncooperative behavior is maintained by escape or avoidance of aversive stimuli associated with dental procedures. These interventions, typically implemented in some combination, include tell-show-do (e.g., Luscre & Center, 1996 ; Mah & Tsang, 2016 ), escape extinction (McConnell et al, 2020 ; Szalwinski et al, 2019 ), graduated exposure (Altabet, 2002 ; Carter et al, 2019 ; Conyers et al, 2004 ; Cuvo et al, 2010 ), reinforcement for cooperation (e.g., Allen et al, 1992 ; Maguire et al, 1996 ), and noncontingent reinforcement in the form of frequent breaks or continuous access to preferred items (e.g., Isong et al, 2014 ; O'Callaghan et al, 2006 ). Thus, training curricula can draw on an extensive empirical base of efficacious interventions for individuals with IDD.…”