Adapting preference assessments and reinforcement schedules to increase mask wearing with adults with intellectual disabilities
Let clients pick their favorite mask and reinforce wearing it on a lean, sustainable schedule—no escape extinction needed.
01Research in Context
What this study did
Houck et al. (2024) worked with four adults with intellectual disability living in a group home.
First they let each person try on different masks and pick the one they liked best.
Then they set up a lean reinforcement schedule: praise and a small snack only if the mask stayed on for the whole target time.
What they found
All four adults started wearing their chosen mask for longer and longer periods.
The skill kept going even when staff gave praise only now and then.
No escape extinction, no physical prompts, no problem behavior spike.
How this fits with other research
McHugh et al. (2022) got five adults with IDD to wear masks using synchronous reinforcement delivered through telehealth.
Houck adds one extra step: let the client pick the mask first, then run the same lean schedule.
Leslie et al. (2024) used the same synchronous-reinforcement logic with preschoolers and also saw 30-minute mask wearing, showing the tactic works from age 3 to adult.
Wheatley et al. (2020) used a differential reinforcement schedule to help a student with autism tolerate a full-day anti-strip suit; Houck mirrors that schedule but skips the suit and adds a preference screen.
Why it matters
You can copy this in any residential or day program.
Spend five minutes letting the client choose a favorite color or pattern, then reinforce on a thin fixed-time plan.
The mask stays on, staff avoid escape extinction, and the skill survives when you thin the schedule.
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Join Free →Bring three mask styles to session, let the client choose, then reinforce continuous wear with praise and a bite of preferred food every 5 min, thinning to every 20 min once steady.
02At a glance
03Original abstract
AbstractNew or infrequently contacted stimuli may present challenges for people with intellectual disabilities (ID) and autism spectrum disorder (ASD). Throughout the Covid‐19 pandemic, facemasks emerged as a new stimulus that may cause distress, especially for those who may not understand the need for a mask. Further, the inability to tolerate wearing a facemask could limit safe access to public locations for people with ID and ASD. Most approaches to increasing health routines involve some form of escape extinction, a practice that may not be feasible or safe for some individuals and in some settings. As an alternative, approaches based on adapting stimulus features, including preferences, and positive reinforcement, may produce equally effective interventions. To evaluate this, we first assessed preference of eight adults with ID living in a residential facility, for four different types of facemasks and the standard facility face masks. Access to a variety of masks increased mask‐wearing for two participants. We then evaluated reinforcement schedule manipulations without escape extinction to increase mask wearing for four participants from Study 1. For all four participants, we successfully increased mask wearing using a reinforcement schedule that was sustainable in their everyday environment.
Behavioral Interventions, 2024 · doi:10.1002/bin.2008