Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis.

A child with cystic fibrosis, autism, and intellectual disability fought every breathing treatment.

The team shaped cooperation step-by-step. If the child hit or pulled away, they paused and let him escape for a moment.

They praised and gave small toys for each little success. Sessions happened at home during real treatments.

Compliance rose from zero to full sessions. Problem behavior dropped to almost none.

Three months later the gains were still there. Treatments that once took an hour now finished in minutes.

Briere et al. (2025) got the same result without letting kids escape. They used differential reinforcement plus stimulus fading for nasal swabs.

MShawler et al. (2021) and Stuesser et al. (2020) also skipped escape and still reached full compliance with masks and exams. These newer studies show you can be kind without pausing for aggression.

Older work backs the core idea. Kirby et al. (1981) and Carr et al. (1985) already showed that boosting compliance cuts other problem behaviors. The 1999 paper moves that finding into tough medical routines.

You now have two clear paths. If safety allows, try Briere or MA’s no-escape packages first. If the child is strong or tubes are fragile, P et al.’s brief escape method still works and keeps staff safe. Pick the least intrusive option that protects the learner and the treatment.