Increasing Child Compliance with Essential Healthcare Routines: Acquisition, Maintenance, and Generalization

Abstract

Child noncompliance with essential healthcare routines is a widely reported problem, especially for children with intellectual and developmental disabilities (IDD) (Allen, Stanley, & McPherson, 1990). Noncompliance with essential healthcare routines has the potential to be a serious problem particularly with a given routine that involves the use of sharp objects (e.g., scissors, dental scrapper) that may cause harm to a child who refuses to comply with, or exhibits avoidant behaviors during, the procedure. Study 1 assessed the number of children who exhibit noncompliance with essential healthcare routines in a local early education program serving children, both of typical development and those with (or at risk for) intellectual and developmental disabilities, ranging in age from one to seven years. Study 2 evaluated the effects of a reinforcement-based treatment procedure, without extinction, on the acquisition, maintenance, and generalization of compliance with two essential healthcare routines identified as problematic by Study 1. To date, seven young children diagnosed with autism have participated in Study 2. Each child received compliance training within a simulated context of either a haircut appointment or a dental examination, or both. Probes in the simulated setting were conducted periodically to evaluate potential maintenance of compliance in the absence of treatment, as well as generalization of performance to novel therapists. Child compliance was also assessed during haircuts and dental examinations conducted by healthcare professionals in the actual relevant environments to determine the extent to which trained performance generalized. Results showed that mere exposure to the simulated environment increased compliance for two children. Treatment was necessary to increase compliance for five children. Successful generalization of compliance in the actual healthcare environments was observed for only two children. However, dramatic decreases in the occurrence of negative vocalizations and the use of physical restraint in the actual setting were observed across all subjects. The results extend the literature by assessing the extent to which treatment for compliance with healthcare routines that does not involve escape extinction can be effective and by assessing whether the effects of compliance training in an analogue setting will generalize to the actual healthcare setting. Keywords: demand fading, differential reinforcement, essential healthcare routines, compliance, problem behavior, negative vocalizations, generalization, maintenance