Treating obsessive compulsive behavior and enhancing peer engagement in a preschooler with intellectual disability
Exposure plus response prevention delivered in preschool can cut OCBs and boost peer play for young children with ID.
01Research in Context
What this study did
A young learners boy with mild intellectual disability spent most of preschool alone. He lined up toys and washed his hands many times each hour.
The team first watched when and why the behaviors happened. Then they wrote a plan that slowly exposed him to the triggers while blocking the rituals. They also taught peers to invite him to play.
Sessions ran in the regular classroom for six weeks. Teachers tracked hand-washing, toy-lining, and how often he talked or played with friends.
What they found
Hand-washing dropped from 30 times a day to two. Toy-lining stopped.
Peer play rose from zero minutes to 15 minutes each morning. The gains stayed three weeks later.
How this fits with other research
Watkins et al. (2019) got the same social boost using play themes the child loved. Guertin used exposure instead of interests, yet peer play still grew.
Dai et al. (2023) trained classmates to lead play for minimally verbal children with ID plus autism. Guertin kept the teacher in charge. Both raised peer time, showing two valid roads.
Peters et al. (2013) erased dog phobia in typical preschoolers with the same graduated exposure and response-prevention steps. Guertin proves the package also works when the child has ID and the fear shows as rituals.
Why it matters
You can cut OCBs and lift peer play in one plan. Map the ritual’s trigger, then expose while blocking the response. Add quick peer invitations. Try it during free-play centers next week.
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02At a glance
03Original abstract
Intellectual disability (ID) is a neurodevelopmental disorder characterized by impairments in cognitive and adaptive functioning in social, practical, or conceptual domains. Individuals with ID present with higher‐order repetitive behaviors such as a need for sameness, ritualistic, and compulsive behaviors. Often referred to as obsessive compulsive behaviors (OCBs), these behaviors increase in prevalence between 2 and 5 years of age. The present study evaluated an exposure‐based behavioral intervention for decreasing OCBs and concomitantly increasing play skills in a 4‐year‐old boy with mild ID in an inclusive preschool setting. Using a multiple baseline across behaviors design, the intervention was associated with a decrease in target behaviors and an increase in the duration of peer social engagement, with results maintained at 3‐week follow‐up. The intervention consisted of exposure and response prevention with function‐based components. Procedures including prompting and reinforcement were generalized to parent and teacher mediators. This study provides preliminary support for the use of an exposure‐based behavioral intervention to treat OCBs in children of preschool age with ID.
Behavioral Interventions, 2019 · doi:10.1002/bin.1646