Increase therapeutic adherence in an adolescent with intellectual disability through the use of behavioral strategies

Author/s Luca Vascelli, Vanessa Artoni
Publishing Year 2019 Issue 2019/3
Language Italian Pages 17 P. 137-153 File size 221 KB
DOI 10.3280/PDS2019-003008
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In the present intervention, the effects of a combined package of treatments consisting of in vivo de-sensitization (Conyers et al., 2004) and functional communication training (Durand and Carr, 1992) with reduction of the schedule of reinforcement (Hagopian et al., 2011), were evaluated in order to increase therapeutic adherence in an adolescent with moderate intellectual disability during a series of sessions in a dental practice. The intervention was designed by conducting measurement sessions before and after the training. The results seem to show that the in vivo de-sensitization procedure was mainly useful during the preliminary phases of the visits, while functional communication training allowed to teach an adequate communication behavior that would replace problematic and potentially dangerous behaviors of the participant. The related objective of reducing the schedule of reinforcement during functional communication training to levels reasonably managed by the caregivers was achieved by teaching the participant to wait for a previously agreed period of time before requesting a break from the ongoing therapy. The use of procedures derived from the principles of applied behavior analysis could therefore help dentists to manage problematic behaviors in an effective and systematic way, during routine dental treatment.

Keywords: Therapeutic adherence, dentistry, intellectual disability, de-sensitization, functional communication training, ABA.

  1. AlHumaid J., Tesini D., Finkelman M. and Loo C.Y. (2016). Effectiveness of the D-TERMINED program of repetitive tasking for children with autism spectrum disorder. Journal of Dentistry for Children, 83 (1): 16-21.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). Washington, DC: American Psychiatric Association.
  3. Anders P.L. and Davis E.L. (2010). Oral health of patients with intellectual disabilities: A systematic review. Special Care Dentist, 30 (3): 110-117.
  4. Beavers G.A., Iwata B.A. and Lerman D.C. (2013). Thirty years of research on the functional analysis of problem behavior: thirty years of functional analysis. Journal of Applied Behavior Analysis, 46 (1): 1-21.
  5. Beck M.H., Cataldo M., Slifer K.J., Pulbrook V. and Guhman J.K. (2005). Teaching children with attention deficit hyperactivity disorder (ADHD) and autistic disorder (AD) how to swallow pills. Clinical Pediatrics, 44 (6): 515-526. DOI: 10.1177/00099228050440060
  6. Center D. (1989). Curriculum and Teaching Strategies for Students with Behavioral Disorders. Englewood Cliffs, NJ: Prentice Hall.
  7. Connick C., Pugliese S., Willette J. and Palat M. (2000). Desensitization: strengths and limitations of its use in dentistry for the patient with severe and profound mental retardation. ASDC journal of dentistry for children, 67 (4): 250-255.
  8. Conyers C., Miltenberger R.G., Peterson B., Gubin A., Jurgens M., Selders A., Dickinson J. and Barenz R. (2004). An evaluation of in vivo desensitization and video modeling to increase compliance with dental procedures in persons with mental retardation. Journal of Applied Behavior Analysis, 37 (2): 233-238.
  9. Cooper J.O., Heron T.E. and Heward W.L. (2014). Applied behavior analysis. London, UK: Pearson.
  10. Cuvo A.J., Godard A., Huckfeldt R. and DeMattei R. (2010). Training children with autism spectrum disorders to be compliant with an oral assessment. Research in Autism Spectrum Disorders, 4 (4): 681-696.
  11. Dunlap G. and Fox L. (2011). Function-Based Interventions for Children With Challenging Behavior. Journal of Early Intervention, 33 (4): 333-343. DOI: 10.1177/105381511142997
  12. Durand V.M. and Carr E.G. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25 (4): 777-794.
  13. Fox C. and Newton J.T. (2006). A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dentistry and Oral Epidemiology, 34 (6): 455-459.
  14. Geiger K.B., Carr J.E. and LeBlanc L.A. (2010). Function-Based Treatments for Escape-Maintained Problem Behavior: A Treatment-Selection Model for Practicing Behavior Analysts. Behavior Analysis in Practice, 3 (1): 22-32. DOI: 10.1007/BF0339175
  15. Greer B.D., Fisher W.W., Saini V., Owen T.M. and Jones J.K. (2016). Functional communication training during reinforcement schedule thinning: An analysis of 25 applications: FCT SCHEDULE THINNING. Journal of Applied Behavior Analysis, 49 (1): 105-121.
  16. Hagopian L.P., Boelter E.W. and Jarmolowicz D.P. (2011). Reinforcement Schedule Thinning Following Functional Communication Training: Review and Recommendations. Behavior Analysis in Practice, 4 (1): 4-16. DOI: 10.1007/BF0339177
  17. Hällström T. and Hailing A. (1984). Prevalence of dentistry phobia and its relation to missing teeth, alveolar bone loss and dental care habits in an urban community sample. Acta Psychiatrica Scandinavica, 70 (5): 438-446.
  18. Hanley G.P., Iwata B.A. and Thompson R.H. (2001). Reinforcement schedule thinning following treatment with functional communication training. Journal of Applied Behavior Analysis, 34 (1): 17-38.
  19. Hernandez P. and Ikkanda Z. (2011). Applied behavior analysis. The Journal of the American Dental Association, 142 (3): 281-287.
  20. Horwitz S.M., Kerker B.D., Owens P.L., Zigler E. (2000). Dental health among individuals with mental retardation. The health status and needs of individuals with mental retardation. Department of Epidemiology and Public Health, Yale University School of Medicine. Washington: Special Olympics, Inc.
  21. Kroeger R.F. (1986). The dental fear control program: a behavioral model to treat dental phobia. Journal of the Massachusetts Dental Society, 35 (4): 175.
  22. Kuhaneck H.M. and Chisholm E.C. (2012). Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Special Care in Dentistry, 32 (6): 229-233.
  23. Loo C.Y., Graham R.M. and Hughes C.V. (2009). Behaviour guidance in dental treatment of patients with autism spectrum disorder. International Journal of Paediatric Dentistry, 19 (6): 390-398.
  24. Luscre D.M. and Center D.B. (1996). Procedures for reducing dental fear in children with autism. Journal of Autism and Developmental Disorders, 26 (5): 547-556. DOI: 10.1007/BF0217227
  25. Maguire K.B., Lange B., Scherling M. and Grow R. (1996). The use of rehearsal and positive reinforcement in the dental treatment of uncooperative patients with mental retardation. Journal of Developmental and Physical Disabilities, 8 (2): 167-177. DOI: 10.1007/BF0257844
  26. Nelson T., Chim A., Sheller B.L., McKinney C.M. and Scott J.M. (2017). Predicting successful dental examinations for children with autism spectrum disorder in the context of a dental desensitization program. The Journal of the American Dental Association, 148 (7): 485-492.
  27. Nelson T.M., Sheller B., Friedman C.S., and Bernier R. (2015). Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder. Special Care in Dentistry, 35 (3): 105-113.
  28. Obler M. and Terwilliger R.F. (1970). Pilot study on the effectiveness of systematic desensitization with neurologically impaired children with phobic disorders. Journal of Consulting and Clinical Psychology, 34 (3): 314-318.
  29. O’Callaghan P.M., Allen K.D., Powell S. and Salama F. (2006). The Efficacy of Noncontingent Escape for Decreasing Children’s Disruptive Behavior During Restorative Dental Treatment. Journal of Applied Behavior Analysis, 39 (2): 161-171.
  30. Orellana, L. M., Martínez-Sanchis, S., and Silvestre, F. J. (2014). Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach. Journal of Autism and Developmental Disorders, 44 (4): 776-785.
  31. Shapiro M., Melmed R.N., Sgan-Cohen H.D., and Parush S. (2009). Effect of sensory adaptation on anxiety of children with developmental disabilities: a new approach. Pediatric Dentistry, 31 (3): 222-228.
  32. Traci M.A., Seekins T., Szalda-Petree A. and Ravesloot C. (2002). Assessing secondary conditions among adults with developmental disabilities: a preliminary study. Mental Retardation, 40 (2): 119-131.
  33. U.S. Department of Health and Human Services (2000). Oral health in America: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.
  34. Wang Y.-C., Lin I.-H., Huang C.-H. and Fan S.-Z. (2012). Dental anesthesia for patients with special needs. Acta Anaesthesiologica Taiwanica, 50(3): 122-125.
  35. Wolpe J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press.
  36. Wyne A.H. (2002). Dental management of mentally retarded patients. Pakistan Oral & Dent Jr, 22: 3-8.

Luca Vascelli, Vanessa Artoni, Aumentare l’aderenza terapeutica in un paziente adolescente con disabilità intellettiva attraverso l’utilizzo di strategie comportamentali in "PSICOLOGIA DELLA SALUTE" 3/2019, pp 137-153, DOI: 10.3280/PDS2019-003008