The efficacy of noncontingent escape for decreasing children's disruptive behavior during restorative dental treatment

Abstract

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff s use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.

Figure 1. Percentage of 15-s intervals containing disruptive behavior per 3 min of treatment for each child across subsequent visits.

Figure 2. Percentage of verbally disruptive behavior (light shaded bars) and physically disruptive behavior (dark shaded bars) per visit for each child across baseline and treatment.

Figure 3. Average number of restraints per visit in baseline (light shaded bars) and in treatment (dark shaded bars) for each child.