Increasing compliance with wearing a medical device in children with autism
A 90-second edible DRO can give you 100% compliance with medical wearables in kids with autism—no extinction needed.
01Research in Context
What this study did
Two children with autism refused to wear a heart-rate monitor. The team set a timer for 90 seconds. Every time the buzzer rang while the monitor stayed on, the child got a bite of candy.
No one blocked escape or said "you must." They simply rewarded the absence of removal.
What they found
Both kids soon kept the monitor on all session. Compliance hit 100% and stayed there. Problem behavior stayed low without any extinction procedure.
How this fits with other research
Sutton et al. (2022) got the same 100% result with masks, but they used tiny, slow steps instead of timed candy. The two studies show you can go gradual or go straight to DRO—both work.
Fisher et al. (2019) added escape extinction to DRA for kids who hate change. Dufour skipped extinction and still won. The difference: Fisher treated wide refusal to any shift; Dufour targeted one clear wearable. When the goal is narrow, sweet DRO alone can do the job.
McClannahan et al. (1990) and Kahng et al. (1999) already showed edible DRO beats problem behavior without extinction. Dufour extends that old rule to medical-device compliance.
Why it matters
If a client pulls off a monitor, gait belt, or pulse-ox, try a 90-second edible DRO first. Set a timer, deliver candy, and skip the battle. You may hit full compliance in one session without blocking or escape extinction.
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02At a glance
03Original abstract
Health professionals often recommend the use of medical devices to assess the health, monitor the well-being, or improve the quality of life of their patients. Children with autism may present challenges in these situations as their sensory peculiarities may increase refusals to wear such devices. To address this issue, we systematically replicated prior research by examining the effects of differential reinforcement of other behavior (DRO) to increase compliance with wearing a heart rate monitor in 2 children with autism. The intervention increased compliance to 100% for both participants when an edible reinforcer was delivered every 90 s. The results indicate that DRO does not require the implementation of extinction to increase compliance with wearing a medical device. More research is needed to examine whether the reinforcement schedule can be further thinned.
Journal of Applied Behavior Analysis, 2020 · doi:10.1002/jaba.628