The Use of Behavior Modification Techniques to Accomplish Dental Treatment on a Retarded Boy : Two Case Studies
Stuntebeck, Claudia J.
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SubjectBehavior modification--Case studies; People with mental disabilities--Behavior; Dental hygiene--Examinations, questions, etc.
The Problem: To investigate the effectiveness of dentist-administered reinforcement in controlling the behavior of a retarded boy during dental treatment. Procedure: Case 1-A token reinforcement system was established. Tokens were contingent on the patient's compliance with dentist' requests and his toleration of treatment procedures. This reinforcement system was administered within an ABAB experimental design consisting of baseline, treatment (reinforcement), reversal and reinstatement of treatment conditions. Case 2 - Edible reinforcement was made contingent on the behaviors described in Case 1. During appointment nineteen selective physical restraints were introduced. These were used through appointment twenty six. The experimental design consisted of baseline, treatment, and treatment plus selective restraint conditions. Findings: Case 1 - Our results show that the patient's time in position in the dental chair, his positive expressions concerning dental treatment, and the number of restorations accomplished increased during the operation of reinforcement procedures and decreased with the suspension of these procedures. His number of negative expressions concerning dental treatment decreased during the application of reinforcement and increased with its suspension. Case 2 - The patient's time in position in the dental chair and his positive expressions concerning dental treatment increased during the treatment condition. His negative expressions decreased but no restorative treatment was accomplished. When selective restraint was used in addition to reinforcement the patient's time in position increased and some treatment was accomplished. However, positive expressions decreased and negative expressions increased. Conclusions. It was concluded that reinforcement procedures can be used by dentists to effectively manage the behavior of a retarded child and increase the amount of treatment which he is able to deliver. When necessary, the use of selective restraint can facilitate dental treatment but the effects of this on his expressions concerning treatment is negative. Recommendations. Further research is needed to develop specific behavior modification techniques for use in the dental setting and to provide training packages for dentists. Comparative research investigating currently used management techniques as well as these suggested here with respect to economic advantages, health risks to patients, and patient training is also recommended.