Using stimulus fading without escape extinction to increase compliance with toothbrushing in children with autism

Routine toothbrushing is an essential part of good oral hygiene. This study investigated the use of stimulus fading without escape extinction to increase compliance with toothbrushing with three children with autism spectrum disorder (ASD). A 30-step stimulus fading hierarchy was implemented; gradually increasing the proximity of the toothbrush to the child's mouth, the duration of exposure to the toothbrush, and finally the duration of toothbrushing. Results demonstrated increased compliance with clinician implemented toothbrushing and generalization to caregivers for all participants. Systematic probes, conducted throughout the intervention, eliminated approximately 50% of the stimulus fading steps for each participant, with the specific steps omitted varying across participants. This study extends the generality of stimulus fading without escape extinction to oral hygiene practices for children with ASD.

► Stimulus fading without escape extinction increased compliance with toothbrushing.
► Compliance generalized to caregivers.
► Systematic probes reduced the number of fading steps needed to gain compliance.