Adapting preference assessments and reinforcement schedules to increase mask wearing with adults with intellectual disabilities

New or infrequently contacted stimuli may present challenges for people with intellectual disabilities (ID) and autism spectrum disorder (ASD). Throughout the Covid-19 pandemic, facemasks emerged as a new stimulus that may cause distress, especially for those who may not understand the need for a mask. Further, the inability to tolerate wearing a facemask could limit safe access to public locations for people with ID and ASD. Most approaches to increasing health routines involve some form of escape extinction, a practice that may not be feasible or safe for some individuals and in some settings. As an alternative, approaches based on adapting stimulus features, including preferences, and positive reinforcement, may produce equally effective interventions. To evaluate this, we first assessed preference of eight adults with ID living in a residential facility, for four different types of facemasks and the standard facility face masks. Access to a variety of masks increased mask-wearing for two participants. We then evaluated reinforcement schedule manipulations without escape extinction to increase mask wearing for four participants from Study 1. For all four participants, we successfully increased mask wearing using a reinforcement schedule that was sustainable in their everyday environment.