Physical guidance is a common treatment component to treat destructive behavior reinforced by escape from demands. Despite its demonstrated effectiveness in behavior reduction and skill acquisition programming, physical guidance may be contraindicated in some situations (e.g., touch aversion, large stature, history of physical abuse). The present study systematically evaluated the efficacy of alternative instructional strategies to teach chained tasks to four participants. A multiple opportunity probe (MOP), a single opportunity probe (SOP), and physical guidance were used to teach three equally matched arbitrary chained tasks in a multiple baseline design. Although both physical guidance and the MOP resulted in mastery, all participants mastered tasks more efficiently using the MOP and participants preferred the instructional methods without physical guidance (i.e., SOP, MOP). The MOP was then used to efficiently teach each participant three generalization tasks. Results suggest the utility of the MOP as a socially valid alternative to physical guidance.
There are a growing number of publications supporting behavior-analytic strategies to increase compliance with medical procedures. However, little research has been conducted on the application of applied behavior analysis to teach compliance with and completion of the setup required for an overnight sleep study (polysomnography). The client in this report presented with autism, cerebral palsy, epilepsy, strokes, and severe destructive behavior (i.e., aggression, property destruction, self-injury). These conditions combined with a poor sleep/wake schedule and gasping during the night necessitated a sleep study. The caregiver referred their child to behavioral outpatient services due to medical noncompliance and severe destructive interfering behaviors with similar procedures (e.g., failed electroencephalogram [EEG]). We evaluated the effects of differential reinforcement without extinction and stimulus fading on compliance and reduction of destructive behavior with a 25-step sleep study procedure. Our approach successfully taught tolerance of the procedure and reduced destructive behavior. The client completed the scheduled sleep study and received a diagnosis of mild obstructive sleep apnea.
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