A Clinician's Guide to Helping Children Cope and Cooperate with Medical Care: An Applied Behavioral Approach

CHAPTER 7. Cooperation and Motion Control for Diagnostic Tests and Treatments

103 chapter 7 Cooperation and Motion Control for Diagnostic Tests and Treatments in this chapter • This chapter discusses how children with chronic health conditions often require medical diagnostic tests for which they must cooperate and hold still. • Task analysis methods are reviewed and discussed with regard to how they can be used for both teaching and measuring the behavior required for a child to cooperate and hold still for medical tests and treatments. • The chapter elaborates on behavioral principles and strategies used to teach general child compliance and how they can be applied to teaching cooperation and control of movement during medical procedures. • Illustrative examples from the author’s clinical experience and research are presented. • Some ways in which behavior analysis procedures can be used to avoid sedation for medical tests are highlighted. 7.1. patient population and target problem(s) Diagnostic tests such as X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalograms (EEGs), polysomnography (PSG), and sonograms (ultrasound) require the child to assume a specified physical position and to hold still for the duration of the procedure. Although these tests are not common in the lives of most typically developing children, those with chronic health conditions often experience them repeatedly. 104 helping children cope with medical care The medical procedures discussed in this chapter are not painful, and given appropriate introduction and training, most children can learn to cooperate with them. Medical procedures are difficult for children because they are exposed to unusual physical sensations (sights, sounds, smells, positions, touch with sensors, etc.), and because the child cannot move freely. As discussed earlier in this book, these characteristics of the medical situation may be experienced by the child as nonpreferred or aversive, and the child may become distressed and attempt to avoid or escape them. Therefore, the primary objectives of behavioral intervention to prepare children for nonpainful diagnostic procedures are (1) to provide information to the child about the sensations she or he will experience and the behavior that will be required during the test; (2) to use real or simulated equipment to gradually expose the child to these sensations and behavioral demands; (3) to teach the child to cooperate by following instructions, getting into and remaining in position, and inhibiting movement that would distort the test results; and (4) to provide and teach the child to use a distracting activity to help cope with any aversive aspects of the procedure. The techniques presented in this chapter are applicable to children with or without intellectual and developmental disabilities (IDD) having any type of health problem requiring technological diagnostic testing or treatments . The training protocols described here are most important for preschool-age children (ages 3–5) and early-school-age children (ages 6–9). Although by age 9 most children will not need special training for diagnostic tests, children and youth with IDD or those with neuromotor disorders, anxiety disorders, or attention deficit hyperactivity disorder (ADHD) may continue to benefit from these behavioral interventions at older ages. 7.2. assessment procedures The concept of task analysis was introduced briefly in chapter 2. To review, it refers to breaking a complex behavior or task into component steps and then prompting the child to perform them, one step at a time, documenting his or her success at each point. These data are recorded during each session to document behavior change as a result of training or other behavioral intervention. By carefully noting the child’s performance and behavioral reactions at each step in the task analysis, it is possible to determine where more (or different) training is required to achieve progress and, ultimately, success. As will be shown later in this chapter, it is helpful cooperation for diagnostic tests and treatments 105 to track the child’s performance across training sessions in graphic format to evaluate progress over time. In preparing a child for any type of medical procedure, it is critical to evaluate the degree to which the child is under the instructional control of the caregiver (parent, medical staff, or behavior therapist). If the child does not follow caregiver instructions for basic behavioral demands (e.g., “come here,” “sit down,” “hold my hand,” “use a quiet voice”), then he or she is unlikely to cooperate with more challenging demands for positioning and motion control in the context of a nonpreferred medical activity. Therefore , initial behavioral intervention may need to include an emphasis on...