Increasing passive compliance to wearing a facemask in children with autism spectrum disorder

MShawler et al. (2021) worked with six autistic children who would not keep a mask on.

The team used a resetting DRO. Kids got a small toy or snack every few minutes if the mask stayed on. No one blocked escape or held the mask on.

The goal rose in steps until each child wore the mask for 30 minutes straight. The team then checked if the skill carried over to new rooms and adults.

Every child hit the 30-minute mark. Four kids needed the DRO time slowly stretched. Two kids reached 30 minutes right away.

The mask wearing moved to new places without extra training.

Cowell et al. (2023) pooled seven mask studies and found the same pattern: graded exposure plus rewards works. MA et al. adds proof that you can skip escape extinction and still win.

Briere et al. (2025) used the same no-extinction DR plan for nasal swabs. All five kids learned to accept the swab. Together the papers show the tactic travels across medical tasks.

Aaronson et al. (2021) tried school-wide supports for masks but did not report clear gains. The tight DRO schedule in MA et al. gives a clearer road map when you need fast results.

You can run this protocol in one clinic room with a timer and tiny toys. No blocking, no hands over hands, no tears. Try a 30-second DRO at first, then add 30 seconds each day. Parents can keep the timer at home so the skill sticks.