The effects of graduated exposure, modeling, and contingent social attention on tolerance to skin care products with two children with autism.
Live, stepped exposure with praise beats quick videos for teaching autistic kids to accept skin-care routines.
01Research in Context
What this study did
Two children with autism would scream or run when lotion or sunscreen touched their skin.
The team built a 10-step ladder. Step 1 was simply looking at the bottle. Step 10 was a full rub-in.
Each child watched an adult model the step, then tried it. Praise came only for calm tries.
What they found
Both kids reached the top step in under three weeks.
Parents later said bath time no longer felt like a battle.
How this fits with other research
Buckley et al. (2020) copied the ladder idea for haircuts and added candy rewards. Their teens still tolerated full haircuts six months later.
Nilchian et al. (2017) and da Silva Moro et al. (2024) tried short videos instead of live steps. The videos helped a little, but kids still needed extra visits.
Together the papers show: live, stepped practice plus praise works faster than a quick video alone.
Why it matters
You can build a simple 8-10 step ladder for any hated routine—nail trimming, face washing, even hair washing. Model each step, praise calm participation, and move up only after two calm trials. Start Monday by listing the smallest tolerable action; your client may be rubbing in sunscreen by Friday.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Write an 8-step ladder for the hated task; start with just looking at the item and praise each calm try.
02At a glance
03Original abstract
Children with autism may display unusual or fearful responses to common stimuli, such as skin care products. Parents of children with autism have often reported that their children will not allow the application of these types of substances to their skin and if the parent persists, the children become extremely upset and anxious. Such responding can interfere with adaptive functioning. The purpose of this study was to evaluate the effects of a treatment package involving graduated exposure to steps in an avoidance hierarchy, modeling, and social attention on the responding of two children with autism who displayed fearful responses to skin care products. Both avoidance and acceptance responses to skin care products were measured. Both changing criteria and multiple baseline experimental designs were employed to assess the effects of the intervention package. The results suggest that the package was successful in teaching tolerance of skin products for both children.
Research in developmental disabilities, 2006 · doi:10.1016/j.ridd.2005.05.009