An Evaluation of Multi-Component Exposure Treatment of Needle Phobia in an Adult with Autism and Intellectual Disability

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Fear of medical procedures in general and needles in particular can be a difficult clinical challenge to providing effective health care for individuals with intellectual and developmental disabilities.


A changing criterion design was used to examine graduated exposure treatment for blood-injury-injection phobia in an adult male with autism and intellectual disability and a history of medical noncompliance. The additional contributions of differential reinforcement and a safety signal were also evaluated during treatment.


Compliance with needle-to-skin contact was achieved by the final criterion phase, and the behavior was maintained on follow-up. Differential reinforcement and a safety signal added to the quality of treatment but were successfully faded as treatment progressed.


An exposure approach was effective in reducing phobic behavior and may be flexible enough to accommodate component changes and leaner reinforcement schedules applicable to real-world settings.

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