Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Behavioral Analysis

First Advisor

David Wilder

Second Advisor

Elbert Blakely

Third Advisor

Christopher Podlesnik

Fourth Advisor

Vida Tyc


All individuals, regardless of age, race, gender, or diagnosis, must learn to tolerate and/or participate in routine medical procedures (e.g., wellness exams, dental cleaning, blood draws). For some individuals, tolerating medical procedures can be a particularly onerous task. Specifically, individuals with intellectual disabilities (ID) experience more frequent difficulties with treatment adherence. With this population, a variety of techniques have been empirically demonstrated to increase cooperation with medical routines. However, no studies have reported changes in physiological behavior throughout training, and only a few studies have reported data on problem behavior. Several studies used graduated exposure or a hierarchy of the medical procedure with a series of steps; participants learned to tolerate the sequence of steps (i.e., the hierarchy), one by one, over time. However, the extent to which this step-by-step approach is needed is unclear. In the current study, we evaluated the hierarchy across dental cleaning, dental x-ray, and needle tolerance procedures, and collected data on physiological behavior and problem behavior throughout. We conducted assessment probes after training the first three steps in each medical procedure and after every second step thereafter; probes were terminated at the onset of problem behavior and training resumed at that step number. Results showed that participates were able to skip as many as 48 steps in dental cleaning. Results show that the assessment protocol increased efficiency by eliminating unnecessary steps across all three procedures. All participants learned to tolerate all three procedures and experienced less problem behavior and stress, as measured by physiological indices, throughout treatment.


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