Stimulus Fading and Differential Reinforcement for the Treatment of Needle Phobia in a Youth With Autism

Abstract

Stimulus fading in the form of gradually increased exposure to a fear-evoking stimulus, often combined with differential reinforcement, has been used to treat phobias in children who are otherwise normal and in children with autism. In this investigation, we applied stimulus fading plus differential reinforcement with an adolescent with autism and diabetes whose needle phobia had prevented medical monitoring of his blood glucose levels for over 2 years. Results showed that the treatment was successful in obtaining daily blood samples for measuring glucose levels.

Chronic Disease Risks in Young Adults With Autism Spectrum Disorder: Forewarned Is Forearmed

“…Screening for chronic diseases requires measurement of weight, height, blood pressure, and venipunctures for blood glucose, kidney function, and lipid testing; these seemingly trivial actions may trigger panic, aggression, fear, or other catastrophic reactions in persons with autism spectrum disorders. Some individuals require extensive desensitization techniques to allow these requisite screenings to be conducted (Shabani & Fisher, 2006). Similarly, management of chronic disease requires creative, thoughtful, tailored care.…”

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

“…We suggest further that task analysis steps in a graduated hierarchy be arranged conservatively in small increments and paced slowly to maximize early compliance. Finally, it is critical to identify reinforcers that will sufficiently motivate a person to participate in intervention, usually praise (Conyers et al, 2004), social interaction (McComas et al, 1998, and sometimes tangible items such as food (Shabani & Fisher, 2006). From a research perspective, it is desirable to further evaluate ABA intervention procedures with other medical fears in people with IDD.…”

Blending Stimulus Fading Procedures with Forward Chaining to Address Treatment Resistance in an Adult with an Autism Spectrum Disorder

“…Avoidance responses have been treated using various behavioral procedures (Jones and Friman 1999;Shabani and Fisher 2006). These approaches have employed graduated exposure protocols or hierarchies in order to expose the subject to the avoided stimulus.…”

“…The intent is to induce extinction of the avoidance response through the systematic presentation of the feared stimulus. Shabani and Fisher (2006) demonstrated this intervention when applied to the needle phobia of an 18 year old with an autism spectrum disorder. The results showed that he was able to tolerate the use of the lancet and to follow the steps that were required to draw his blood at the completion of the hierarchy.…”

“…An obstacle to completing the chain can be escapemaintained disruptive behavior. The use of effective chaining procedures can be combined with other behavioral techniques to facilitate learning despite significant aggression.Avoidance responses have been treated using various behavioral procedures (Jones and Friman 1999;Shabani and Fisher 2006). These approaches have employed graduated exposure protocols or hierarchies in order to expose the subject to the avoided stimulus.…”