Clicca qui per scaricare

Condividi
Aumentare l’aderenza terapeutica in un paziente adolescente con disabilità intellettiva attraverso l’utilizzo di strategie comportamentali
Titolo Rivista: PSICOLOGIA DELLA SALUTE 
Autori/Curatori: Luca Vascelli, Vanessa Artoni 
Anno di pubblicazione:  2019 Fascicolo: 3  Lingua: Italiano 
Numero pagine:  17 P. 137-153 Dimensione file:  221 KB
DOI:  10.3280/PDS2019-003008
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più:  clicca qui   qui 


Nel presente intervento sono stati valutati gli effetti di un pacchetto di trattamenti combinati composto da de-sensibilizzazione in vivo (Conyers et al., 2004) e da un training di comunicazione funzionale (Durand e Carr, 1992) con riduzione dello schema di rinforzo (Hagopian et al., 2011), al fine di aumentare l’aderenza terapeutica in un adolescente con disabilità intellettiva moderata durante una serie di sedute presso uno studio odontoiatrico. L’intervento è stato pianificato attraverso la conduzione di sessioni di misurazione prima del training e al termine dello stesso. I risultati sembrano evidenziare che la procedura di de-sensibilizzazione in vivo sia stata utile principalmente durante le fasi preliminari delle visite, mentre il training di comunicazione funzionale ha permesso di insegnare un comportamento di comunicazione adeguato che andasse a sostituire i comportamenti problematici e potenzialmente pericolosi del partecipante. L’obiettivo correlato di ridurre lo schema di rinforzo durante il training di comunicazione funzionale a livelli ragionevolmente gestiti dai caregiver è stato raggiunto insegnando al partecipante ad attendere un periodo di tempo concordato in precedenza prima di poter richiedere una pausa dalla terapia in corso. L’uso delle procedure derivate dai principi dell’analisi del comportamento applicata potrebbe quindi aiutare i dentisti a gestire i comportamenti problematici in modo efficace e sistematico, quando ci si trovi in presenza di un trattamento odontoiatrico di routine.


Keywords: Aderenza terapeutica, odontoiatria, disabilità intellettiva, de-sensibilizzazione, training di comunicazione funzionale, ABA

  1. AlHumaid J., Tesini D., Finkelman M. and Loo C.Y. (2016). Effectiveness of the D-TERMINED program of repetitive tasking for children with autism spectrum disorder. Journal of Dentistry for Children, 83 (1): 16-21.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). Washington, DC: American Psychiatric Association.
  3. Anders P.L. and Davis E.L. (2010). Oral health of patients with intellectual disabilities: A systematic review. Special Care Dentist, 30 (3): 110-117.
  4. Beavers G.A., Iwata B.A. and Lerman D.C. (2013). Thirty years of research on the functional analysis of problem behavior: thirty years of functional analysis. Journal of Applied Behavior Analysis, 46 (1): 1-21.
  5. Beck M.H., Cataldo M., Slifer K.J., Pulbrook V. and Guhman J.K. (2005). Teaching children with attention deficit hyperactivity disorder (ADHD) and autistic disorder (AD) how to swallow pills. Clinical Pediatrics, 44 (6): 515-526., DOI: 10.1177/00099228050440060
  6. Center D. (1989). Curriculum and Teaching Strategies for Students with Behavioral Disorders. Englewood Cliffs, NJ: Prentice Hall.
  7. Connick C., Pugliese S., Willette J. and Palat M. (2000). Desensitization: strengths and limitations of its use in dentistry for the patient with severe and profound mental retardation. ASDC journal of dentistry for children, 67 (4): 250-255.
  8. Conyers C., Miltenberger R.G., Peterson B., Gubin A., Jurgens M., Selders A., Dickinson J. and Barenz R. (2004). An evaluation of in vivo desensitization and video modeling to increase compliance with dental procedures in persons with mental retardation. Journal of Applied Behavior Analysis, 37 (2): 233-238.
  9. Cooper J.O., Heron T.E. and Heward W.L. (2014). Applied behavior analysis. London, UK: Pearson.
  10. Cuvo A.J., Godard A., Huckfeldt R. and DeMattei R. (2010). Training children with autism spectrum disorders to be compliant with an oral assessment. Research in Autism Spectrum Disorders, 4 (4): 681-696.
  11. Dunlap G. and Fox L. (2011). Function-Based Interventions for Children With Challenging Behavior. Journal of Early Intervention, 33 (4): 333-343., DOI: 10.1177/105381511142997
  12. Durand V.M. and Carr E.G. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25 (4): 777-794.
  13. Fox C. and Newton J.T. (2006). A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dentistry and Oral Epidemiology, 34 (6): 455-459.
  14. Geiger K.B., Carr J.E. and LeBlanc L.A. (2010). Function-Based Treatments for Escape-Maintained Problem Behavior: A Treatment-Selection Model for Practicing Behavior Analysts. Behavior Analysis in Practice, 3 (1): 22-32., DOI: 10.1007/BF0339175
  15. Greer B.D., Fisher W.W., Saini V., Owen T.M. and Jones J.K. (2016). Functional communication training during reinforcement schedule thinning: An analysis of 25 applications: FCT SCHEDULE THINNING. Journal of Applied Behavior Analysis, 49 (1): 105-121.
  16. Hagopian L.P., Boelter E.W. and Jarmolowicz D.P. (2011). Reinforcement Schedule Thinning Following Functional Communication Training: Review and Recommendations. Behavior Analysis in Practice, 4 (1): 4-16., DOI: 10.1007/BF0339177
  17. Hällström T. and Hailing A. (1984). Prevalence of dentistry phobia and its relation to missing teeth, alveolar bone loss and dental care habits in an urban community sample. Acta Psychiatrica Scandinavica, 70 (5): 438-446.
  18. Hanley G.P., Iwata B.A. and Thompson R.H. (2001). Reinforcement schedule thinning following treatment with functional communication training. Journal of Applied Behavior Analysis, 34 (1): 17-38.
  19. Hernandez P. and Ikkanda Z. (2011). Applied behavior analysis. The Journal of the American Dental Association, 142 (3): 281-287.
  20. Horwitz S.M., Kerker B.D., Owens P.L., Zigler E. (2000). Dental health among individuals with mental retardation. The health status and needs of individuals with mental retardation. Department of Epidemiology and Public Health, Yale University School of Medicine. Washington: Special Olympics, Inc.
  21. Kroeger R.F. (1986). The dental fear control program: a behavioral model to treat dental phobia. Journal of the Massachusetts Dental Society, 35 (4): 175.
  22. Kuhaneck H.M. and Chisholm E.C. (2012). Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Special Care in Dentistry, 32 (6): 229-233.
  23. Loo C.Y., Graham R.M. and Hughes C.V. (2009). Behaviour guidance in dental treatment of patients with autism spectrum disorder. International Journal of Paediatric Dentistry, 19 (6): 390-398.
  24. Luscre D.M. and Center D.B. (1996). Procedures for reducing dental fear in children with autism. Journal of Autism and Developmental Disorders, 26 (5): 547-556., DOI: 10.1007/BF0217227
  25. Maguire K.B., Lange B., Scherling M. and Grow R. (1996). The use of rehearsal and positive reinforcement in the dental treatment of uncooperative patients with mental retardation. Journal of Developmental and Physical Disabilities, 8 (2): 167-177., DOI: 10.1007/BF0257844
  26. Nelson T., Chim A., Sheller B.L., McKinney C.M. and Scott J.M. (2017). Predicting successful dental examinations for children with autism spectrum disorder in the context of a dental desensitization program. The Journal of the American Dental Association, 148 (7): 485-492.
  27. Nelson T.M., Sheller B., Friedman C.S., and Bernier R. (2015). Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder. Special Care in Dentistry, 35 (3): 105-113.
  28. Obler M. and Terwilliger R.F. (1970). Pilot study on the effectiveness of systematic desensitization with neurologically impaired children with phobic disorders. Journal of Consulting and Clinical Psychology, 34 (3): 314-318.
  29. O’Callaghan P.M., Allen K.D., Powell S. and Salama F. (2006). The Efficacy of Noncontingent Escape for Decreasing Children’s Disruptive Behavior During Restorative Dental Treatment. Journal of Applied Behavior Analysis, 39 (2): 161-171.
  30. Orellana, L. M., Martínez-Sanchis, S., and Silvestre, F. J. (2014). Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach. Journal of Autism and Developmental Disorders, 44 (4): 776-785.
  31. Shapiro M., Melmed R.N., Sgan-Cohen H.D., and Parush S. (2009). Effect of sensory adaptation on anxiety of children with developmental disabilities: a new approach. Pediatric Dentistry, 31 (3): 222-228.
  32. Traci M.A., Seekins T., Szalda-Petree A. and Ravesloot C. (2002). Assessing secondary conditions among adults with developmental disabilities: a preliminary study. Mental Retardation, 40 (2): 119-131.
  33. U.S. Department of Health and Human Services (2000). Oral health in America: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.
  34. Wang Y.-C., Lin I.-H., Huang C.-H. and Fan S.-Z. (2012). Dental anesthesia for patients with special needs. Acta Anaesthesiologica Taiwanica, 50(3): 122-125.
  35. Wolpe J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press.
  36. Wyne A.H. (2002). Dental management of mentally retarded patients. Pakistan Oral & Dent Jr, 22: 3-8.

Luca Vascelli, Vanessa Artoni, in "PSICOLOGIA DELLA SALUTE" 3/2019, pp. 137-153, DOI:10.3280/PDS2019-003008

   

FrancoAngeli è membro della Publishers International Linking Association associazione indipendente e no profit per facilitare l'accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche