Teaching young children to use contact lenses.
Shaping with toys and praise teaches most preschoolers to wear contact lenses after surgery, but kids with Down syndrome may need extra vision checks.
01Research in Context
What this study did
Four preschoolers needed contact lenses after eye surgery. The team used shaping to teach lens wear.
Each child got praise, stickers, or small toys for every small step. Brief time-out followed refusal.
Sessions happened in a hospital room. Parents watched and later practiced the same steps at home.
What they found
Three children learned to insert lenses quickly and kept using them for months.
One child with Down syndrome did well at first but stopped wearing lenses later.
Overall, shaping plus rewards gave high compliance and saved surgery results for most kids.
How this fits with other research
Geckeler et al. (2000) used the same shaping plus praise to move a tube-fed preschooler to real food. Both studies show one shaping plan can build tough health habits in young kids.
Perez et al. (2015) also used tangible rewards to teach cup drinking. Their work supports using favorite toys here for lens acceptance.
Szempruch et al. (1993) report that corneal grafts in Down syndrome last only two-thirds of the time. The lens drop-out in Demello et al. (1992) fits that pattern: eye care is harder for these children.
Ghaziuddin et al. (1996) found most preschoolers with Down syndrome have weak focusing that does not improve. Poor vision may explain why the one child could not keep the lenses in.
Why it matters
You can copy this package: tiny steps, big praise, brief time-out. It works for lenses, feeding, and maybe other medical tasks. Check vision first in kids with Down syndrome; if acuity is low, plan extra support or a different aid.
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02At a glance
03Original abstract
Young children with surgically removed lenses and extreme nearsightedness can benefit from contact lenses, but their parents may need instruction to teach their children to accept lenses. In this study, 4 children under the age of 5 years were taught contact lens wear using a shaping procedure. Compliance was rewarded with praise and tangibles, and noncompliance was followed with brief time-out for 3 of the children and restraint for the 4th. Three children showed high compliance during an initial shaping procedure, with a decrease in compliance during initial insertion of the lenses. At 3- to 10-month follow-up, levels of compliance were high. Insertion and removal of lenses were accomplished in substantially less time, with little crying and no need for time-out. All 3 children continue to use the lenses daily, and 2 have shown improved visual acuity. The 4th child, who has Down syndrome, showed low levels of compliance with need for physical restraint throughout. Although his parents reported high compliance when he first went home, fitting difficulties and an infection resulted in plummeting of compliance, and contact lens use was discontinued. This procedure has been used successfully at the same hospital with 11 of 13 other children between the ages of 14 months and 7 years 4 months. Implications for selection of suitable candidates for this intervention and ways to decrease costs are discussed.
Journal of applied behavior analysis, 1992 · doi:10.1901/jaba.1992.25-229