Functional analysis and generalized treatment of disruptive behavior during dental exams
Pair graduated dental steps with immediate escape extinction—breaks for cooperation, never for screams—and autistic adults can finish full exams in weeks.
01Research in Context
What this study did
Four autistic young men, screamed, hit, or ran from the dental chair.
The team first ran a 5-minute functional analysis in a dental operatory. They tested if the men acted out to escape the light, suction, or drill.
Next they added graduated exposure plus extinction. The men got praise and small toys for staying seated. Disruption no longer bought a break; only cooperation did. Sessions moved from a brief mirror exam to a full cleaning with the dentist.
What they found
All four men cut disruptive behavior by at least 90 %. Full exams rose from zero to 100 %.
The gains held when they later visited a new dental clinic with a different dentist.
How this fits with other research
Sullivan et al. (2020) warned that when you stop one problem behavior, other topographies can pop up. McConnell’s team watched for this and saw almost none, likely because breaks were still available for calm cooperation.
Fontes et al. (2018) showed that punishing an alternative response can bring the old target back. McConnell avoided this trap by reinforcing, not punishing, the replacement.
Weyman et al. (2022) also started with a brief functional analysis, but then used functional communication training. McConnell shows that when the function is clearly escape, you can skip teaching a new request and simply withhold escape for problem behavior while granting it for compliance.
Why it matters
You can copy this package tomorrow. Run a 5-minute FA in the clinic hallway. Then schedule short, sweet exposures where the client earns a 10-second break only for calm sitting. Track disruption and exam length; you should see both improve within three visits. Bring different staff or a new dental office early to lock in generalization.
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02At a glance
03Original abstract
Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.
Journal of Applied Behavior Analysis, 2020 · doi:10.1002/jaba.747