Escape-motivated problem behavior in the medical and dental setting: A multicomponent intervention

Behavioral difficulties during medical/dental examinations are a significant barrier to the provision of adequate healthcare services to people with developmental disabilities. Two-process theory and the role of personal control in the development of fear offer logical theoretical bases for the development and maintenance of problem behavior in the medical/dental setting. The present study evaluated a multicomponent intervention for escape-motivated problem behavior during general medical and dental examinations. The first phase of the study involved the use of direct observation and interview with relevant staff to validate that escape was the motivating factor in the maintenance of problem behavior during medical/dental examinations. The second and third phases involved two multiple baseline studies, each across three participants. The second phase was conducted in a general medical setting and the third, in a dental setting. The purpose of these phases was to evaluate a multicomponent intervention protocol designed to ameliorate the conditioned negative responses (problem behavior) that participants displayed when presented with specific aversive stimuli in medical/dental settings. Results showed that the multicomponent intervention was effective in increasing both the latency to problem behavior and the number of examination steps completed without problem behavior during both medical and dental examinations. Issues pertaining to respondent processes, cost effectiveness, and medical risk reduction are discussed.