A Comparison of Positive and Negative Reinforcement to Decrease Disruptive Behavior During Medical Demands

Medical demand tolerance is imperative for improving and maintaining physical health, but a disproportionate number of intellectually disabled individuals do not readily cooperate with medical procedure demands. Research suggests that although function-based treatments can be effective, in some contexts nonfunctional interventions can also produce therapeutic results (Briggs et al., 2019; Carter, 2010; Dowdy et al., 2018; Gardner et al., 2009; Lalli et al., 1999; Piazza et al., 1997). The purpose of this study was to compare the treatment effects of using functional and nonfunctional reinforcement to decrease escape-maintained medical demand noncooperation with intellectually disabled children. A reversal design embedded within a multielement design was used to compare the rate of disruption between the negative reinforcement and positive reinforcement conditions. The results indicated that the delivery of preferred edibles contingent on demand tolerance produced a substantial decrease in disruption. Escape from demands contingent on tolerance produced a less significant change as compared to the positive reinforcement condition. These results demonstrated that contingent positive reinforcement to nonpainful medical demands was more effective at suppressing disruptive behavior as compared to contingent negative reinforcement. The results from this study can inform future treatments for different medical procedures.