Teaching the Skills Required to Undergo a Dental Exam to Adults With Profound Autism Using a Communication and Reinforcement Package

Abstract

Individuals diagnosed with intellectual and developmental disabilities, including those meeting criteria for profound autism, often experience significant difficulty tolerating dental procedures. This often leads to the use of restraint, sedation, or results in incomplete exams due to severe challenging behavior. The current study evaluated a functional communication and reinforcement package designed to teach skills required to undergo a dental exam to three adults with profound autism living in a congregate care setting. The intervention utilized a changing criterion design for reinforcing completion of successive steps in the dental exam related skills task analysis. A functional communication response (FCR) to request a break was also taught to participants. At the conclusion of the study, all three participants acquired a FCR and all of the targeted dental exam-related skills without relying on escape extinction procedures. In addition, challenging behavior was observed to occur infrequently. For one participant, skills generalized to an actual dental office, where a cleaning and exam provided by a dental hygienist were successfully completed without challenging behavior. Social validity ratings from implementers, staff, and a community-based dental hygienist indicated that both the procedures and outcomes were acceptable and clinically meaningful. These findings suggest that a functional communication and reinforcement package may be an efficacious and compassionate approach for teaching the skills required to participate in a dental exam to adults with profound autism and severe challenging behavior.