Competing stimuli in the treatment of multiply controlled problem behavior during hygiene routines.

Three kids with developmental delay hated tooth-brushing and diaper changes. Each hit, screamed, or tried to run.

The team first ran a competing-stimulus assessment. They let each child play with ten sensory items. The top two items that kept hands and eyes busy became the treatment tools.

When the favorite items were available before and during the routine, problem behavior dropped 80-a large share. Gains stayed for weeks with no extra escape extinction.

One boy kept his vibrating snake toy. He rubbed it while staff brushed his teeth. Biting and kicking fell to zero.

Carr et al. (2002) showed the same trick cuts attention-maintained behavior during functional analyses. S et al. simply moved the idea into messy hygiene routines.

Podlesnik et al. (2017) warns that changing the alternative stimulus weakens the effect. S et al. kept the same toy every session, matching that advice.

Perry et al. (2024) later taught parents to give free access to competing items at home. Their parent-training model extends this clinic success into family homes.

You can drop multiply controlled problem behavior during baths, tooth-brushing, or diaper changes without blocking escape or adding restraint. Pick the child's top sensory item, hand it over before the routine starts, and keep it there until the task ends. No extra staff, no extinction bursts, just calm hygiene.