Graduated Exposure, Positive Reinforcement, and Stimulus Distraction in a Compliance-With-Blood-Draw Intervention for an Adult With Autism

Abstract

The authors report the case of a 21-year-old man who had autism and feared having his blood drawn as a required medical procedure. He was first exposed to simulated blood draws during a baseline phase and subsequently an intervention phase that (a) gradually exposed him to the procedures that constituted a blood draw, (b) reinforced his compliant behavior, and (c) provided stimulus distraction. He successfully completed intervention and tolerated actual blood draws 1 month and 4 months later. The authors discuss clinical and research issues when conducting intervention for medical fears among people who have intellectual and developmental disabilities.

A Review of Behavioral Interventions for Anxiety‐Related Behaviors in Lower‐Functioning Individuals with Autism

“…It is of interest to note that there were multiple studies that almost met full inclusion criteria for the review. For example, five studies in this process were identified as treating anxiety in individuals with LFA, but the within-subject design procedures did not meet full inclusion criteria because of a lack of experimental control (Chok, Demanche, Kennedy, & Studer, 2010;Ellis, Ala'i-Rosales, Glenn, Rosales-Ruiz, & Greenspoon, 2006;Grider, Luiselli, & Turcotte-Shamski, 2012;Ricciardi, Luiselli, & Camare, 2006;Slifer et al, 2011). Another within-subject study on increasing tolerance to injections omitted a baseline phase and did not attribute the symptoms to anxiety; otherwise, it would have met full inclusion criteria (Birkan, Krantz, & McClannahan, 2011).…”

“…Towards this end, future research should replicate the within‐subject trials reviewed herein, while taking care to meet the criteria of the Horner et al () quality indicators. Future trials should also ensure that all components of the within‐subject design are implemented, as seven studies were excluded in the present review for not utilizing an experimental design (Chok et al, ; Davis et al, ; Ellis et al, ; Grider et al, ; Ricciardi et al, ; Slifer et al, ) or including a baseline phase (Birkan et al, ). In addition, investigators should provide sufficient information on the participants' intellectual, verbal, adaptive, or developmental functioning, as two studies were excluded because we were unable to determine the functioning level of the participants based on the information provided therein (Davis et al, ; Isong et al, ).…”

Teaching students with autism spectrum disorder to tolerate haircutting

“…Many children and youth who have intellectual and developmental disabilities (IDD) do not comply with basic healthcare routines, necessitating intervention that teaches them to tolerate dental treatment (Conyers et al, 2004), physical examination (Cavalari et al, 2013;Cuvo et al, 2010), blood draws (Grider et al, 2012), and needle injections (Davit et al, 2011). Compliance problems are also frequently encountered in the area of personal hygiene, such as brushing teeth (Carter et al, 2019), washing hands (Walmsley et al, 2013), and applying lotion (Ellis et al, 2006).…”

Brief, Intensive, and Concentrated Treatment of Specific Phobia in a Child With Minimally Verbal Autism Spectrum Disorder

“…For example, Moree and Davis (2010) suggest several modifications including use of visual supports, greater parental involvement in treatment, symptom-based hierarchies, and use of reinforcement. Other studies have also demonstrated the use of some of these modifications; for example, one study notes the importance of frequent positive reinforcement in the treatment of a blood-draw phobia for an adult with ASD (Grider, Luiselli, & Turcotte-Shamski, 2012). There are also studies that emphasize the importance of parental involvement in the treatment of children with ASD (Agazzi, Tan, & Tan, 2013; Cambric & Agazzi, 2019).…”