Brief report: Avoidance extinction as treatment for compulsive and ritual behavior in autism.

The team worked with three adults who had autism and intellectual disability.

Each adult had a private ritual they tried to protect. One man tapped a cup three times before every drink.

The researchers guessed the rituals were avoidance behaviors. They stopped letting the adults escape from not doing the ritual. This is called avoidance extinction.

They watched to see if the rituals would shrink or stop.

Two of the three adults lost almost all ritual behavior. The cup tapper quit after a few sessions.

The third adult kept a milder version, but it no longer ruled his day.

No new problem behavior popped up while the rituals dropped.

Dawson et al. (2000) saw the same escape story first. They showed that aggression can be a way to keep people from stopping a ritual. Tassé et al. (2013) took the next step and removed the escape hatch itself.

Sullivan et al. (2020) warn that when you use extinction, old behaviors can pop back later. Their kids with autism showed resurgence. J et al. did not track this, so you should watch for it.

Lin et al. (2018) tried a softer route. They taught preschoolers to manage their own higher-order rituals with points and praise. J et al. show that for adults with ID, simply blocking the escape can also work.

If your client fights to finish a ritual, test if the fight is really about avoiding the stop cue.

When the data say yes, run brief extinction trials. Block the escape and stay calm.

Track resurgence for at least a month. Pair the procedure with reinforcement for flexible play when you can.