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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.