Differential Reinforcement Without Extinction and Stimulus Fading to Teach Tolerance of a Sleep Study

Sarah E. Martinez, Seth G. Walker, Amanda N. Zangrillo, Alicia N. Graham

Research output: Contribution to journalArticlepeer-review


There are a growing number of publications supporting behavior-analytic strategies to increase compliance with medical procedures. However, little research has been conducted on the application of applied behavior analysis to teach compliance with and completion of the setup required for an overnight sleep study (polysomnography). The client in this report presented with autism, cerebral palsy, epilepsy, strokes, and severe destructive behavior (i.e., aggression, property destruction, self-injury). These conditions combined with a poor sleep/wake schedule and gasping during the night necessitated a sleep study. The caregiver referred their child to behavioral outpatient services due to medical noncompliance and severe destructive interfering behaviors with similar procedures (e.g., failed electroencephalogram [EEG]). We evaluated the effects of differential reinforcement without extinction and stimulus fading on compliance and reduction of destructive behavior with a 25-step sleep study procedure. Our approach successfully taught tolerance of the procedure and reduced destructive behavior. The client completed the scheduled sleep study and received a diagnosis of mild obstructive sleep apnea.

Original languageEnglish (US)
Pages (from-to)518-533
Number of pages16
JournalClinical Case Studies
Issue number6
StateAccepted/In press - 2023


  • differential reinforcement without extinction
  • fading
  • function-based treatment
  • medical desensitization
  • sleep study

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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