SIMULATION AND COUNTERCONDITIONING AS ADJUNCTS TO PHARMACOTHERAPY FORINVASIVE PEDIATRIC PROCEDURES

Behavioral counterconditioning was conducted during simulated medical routines to supplement medical management of five children's distress during invasive procedures (bone marrow aspiration, lumbar puncture, t racheostomy care, venipuncture, and finger pricks). Preferred activiti es were paired in vivo with medical stimuli, and differential positive reinforcement was provided contingent on engagement with the preferre d activities and on compliance with adult instructions, first during s imulations and later during actual procedures. Data on cooperation, es cape/avoidance, and negative vocalizations were evaluated using both s ingle-subject experimental methods and a baseline-treatment group stat istical comparison. Results support the benefits of this approach as a n adjunctive intervention to decrease behavioral distress in some chil dren requiring repeated invasive procedures. Discussion emphasizes the potential for training medical personnel to implement these technique s preventively, for decreasing or discontinuing sedation for some chil dren treated under local anesthesia, and for preparing children with d evelopmental disabilities for invasive procedures.