Behavioral Assessment and Treatment of Aerophagia

Aerophagia is characterized by excessive air swallowing and can have serious negative effects on one’s health. We present the assessment and treatment of a 16-year-old girl, Khloe, with developmental disabilities and aerophagia. The initial assessment indicated that aerophagia occurred primarily to access attention in a divided attention context; however, our function-based treatment did not result in a clinically significant reduction in problem behavior. We then conducted a second assessment that indicated that Khloe’s aerophagia indeed occurred primarily in a divided attention context, but that it persisted independent of social consequences. We concluded that the divided attention context served as a motivating variable for aerophagia. Our second treatment consisted of differential reinforcement of other behavior, noncontingent access to competing stimuli, and graduated exposure to contextual variables (i.e., people and divided attention) that occasioned aerophagia. The treatment was successful in reducing rates of aerophagia. We discuss implications for assessment and treatment, as well as recommendations for clinicians and students.

Evaluation of a Graduated Exposure Procedure to Teach Extended Mask Wearing in Various Settings to Children With Autism

During the COVID-19 outbreak, the Center for Disease Control (CDC) recommended that everyone 2 years and older wear a face mask while in a community setting. However, children with autism may be reluctant to wear a mask, particularly for extended durations. In the current study, we implemented a graduated exposure procedure to teach mask wearing for a minimum of 1 hour in an early intensive behavioral (EIBI) intervention clinic to three children diagnosed with autism. We subsequently probed mask wearing, and if necessary implemented the graduated exposure procedure, in each participant’s home and in a mock physician’s office. Finally, we collected probe data on mask wearing in another community setting and 1 month post-treatment maintenance data in the EIBI clinic. During baseline, participants wore masks for 0 second to 5 minutes. After treatment, all participants wore the mask for at least 1 hour in each setting, with maintenance probes indicating 4 to 5 hour mask tolerance.

Developing tolerance to eye contact in autism: A feasibility study with adults using behavioral, interview, and psychophysiological data

Many individuals with autism report that eye contact makes them stressed or uncomfortable. Besides expressing their right to respect for neurodiverse ways of nonverbal communication, some autistic individuals also express the wish to improve their capacity to tolerate eye contact. In the current study, five autistic adults completed a 21- to 28-day computerized program that combines psychoeducation with graduated exposure to eye contact through photos. Interview data, questionnaires, gaze patterns, and psychophysiological measures indexing stress and arousal (pupillary and galvanic skin response levels) were collected to monitor and evaluate outcomes. At intake, discomfort resulting from eye contact in everyday life was described as overwhelming and multifaceted. Post-training data showed that observed increases in eye contact were not happening at the expense of heightened arousal. These results provide information about the (complex) nature of eye gaze discomfort in autism while pointing toward promising techniques to increase discomfort tolerance.

Starting Our Journey Together From the Same Place

This chapter helps clients understand more about their own anxiety in the context of the cognitive–behavioral model. The three components of anxiety (physiological, cognitive, and behavioral) are presented, as well as a thorough discussion of avoidance. Avoidance is often a big problem for people with social anxiety because avoiding a few situations that make a person anxious can quickly snowball into a general pattern of avoiding many situations. When people become anxious, they rarely experience just one of the components of anxiety. The cognitive, physiological, and behavioral components interact with each other, and an increase or decrease in one may cause increases or decreases in the other two. The three components of treatment are also discussed. These are systematic graduated exposure, cognitive restructuring, and homework assignments.

One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review

One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.

Children Refusing School to Escape Aversive Social and/or Evaluative Situations

Chapter 5 describes treatment procedures for children whose anxiety in social and evaluative situations is so distressing that they cannot tolerate these situations, and avoidance behavior takes over. Treatment for children who refuse school to escape aversive social and/or evaluative situations involves teaching them to identify what they tell themselves in anxiety-provoking situations and how to replace negative thoughts with coping, helpful statements. The child will experience graduated exposure to anxiety-provoking social or evaluative situations in session with the therapist and will gradually increasing school attendance. An important part of treatment for this population is practicing coping skills in real-life social and evaluative situations. Special topics covered in this chapter are panic attacks, extracurricular activities, teasing, gym class, and perfectionism.

Children Refusing School to Escape Anxious Social and/or Evaluative Situations

Chapter 5 outlines the treatment for children whose anxiety in social, performance, and/or evaluative situations is so distressing that they cannot tolerate these situations. Instead, avoidance behavior takes over. Treatment for such children involves teaching them to identify what they tell themselves in anxiety-provoking situations and then to use a method to change negative thoughts to coping, helpful statements. Treatment involves graduated exposure to anxiety-provoking social or evaluative situations in session with the therapist and gradually increasing school attendance. It is important for the child to practice coping skills in real-life social and evaluative situations.