This book introduces the reader to the theoretical basis of applied behavioral analysis generally and more specifically how these principles apply in practical ways to support children receiving medical care. It serves a broad audience, including medical providers, behavior therapists, trainees in these fields, and caregivers of children receiving medical care. As all children access medical care, and because early experiences can shape future perceptions, responses, and willingness to access medical care, this book serves an important purpose. It provides practical tools and guidance on how to help children cooperate and cope in these settings. This work also includes special emphasis on how to use and modify the strategies discussed for individuals and developmental or intellectual disabilities.
Introductory chapters orient the reader to overarching concerns such as the principles of applied behavior analysis, parent-child interactions in medical settings, and general behavior management. It then focuses on a variety of specific medical concerns as diverse as routine vaccinations, hearing and vision testing, breathing treatments, diagnostic tests, and pill swallowing. Each chapter follows a uniform structure, listing the major points included, defining the target population, summarizing supporting literature, and providing case examples. Each chapter ends with identifying key concepts and a list of references. The content is easy to navigate, particularly with Dr Slifer's effective use of outcome data graphs, figures of assessment and intervention tools, and links to further resources.
The author intentionally draws clear links between the research base and clinical application. The need to approach each case as its own empirical endeavor is highlighted. This may require modifying aspects of the intervention such as the activities used for contingent reinforcement or the coping skills introduced, which are based on each individual's response. Knowledge gained from the author's clinical experience is also included typically in areas in which empirical data are limited or lacking.
Limitations of this work are few, but some concepts could have been discussed in more depth. For example, the author mentions in several instances that caregivers can be trained in how to support their child if a behavioral therapist is not present for the procedure but does not address caregivers' roles when a behavioral therapist is present. This deemphasizes parents' role in their child's care. Similarly, it is a common recommendation within the book that medical providers (e.g., nurses, respiratory therapists) be included in the final stages of training children to cooperate with medical care, but it is unclear at what point in the process to include these providers and when and how to transfer the behavior therapist's role to the medical provider. Although these considerations would likely vary depending on the specific medical procedure and on the child herself, the reader would be better prepared to implement the final stages of training protocols if specific examples had been included in the work from which to extrapolate. Finally, although individual factors such as the child's age and cognitive ability are discussed as influencing care, little attention is given to other areas that could influence a child's or family's expectations for medical care or the acceptability of various approaches, including cultural background, socioeconomic status, or religion. Moreover, when considering cooperation with medical care from a behavior-analytic approach, evaluating the acceptability of treatment goals, procedures, and outcomes needs to occur with all the stakeholders.1
Dr Slifer has presented a cohesive and accessible work clearly describing how the principles of applied behavioral analysis can be used to successfully provide needed medical care to children and to increase the effectiveness of such care. This book is an important addition to the library of providers of any discipline working with children receiving medical care, caregivers of children with chronic medical conditions, and trainees seeking to understand how to become effective pediatric providers.
1. Wolf MM. Social validity: the case for subjective measurement, or how behavior analysis is finding its heart. J Appl Behav Anal. 1978;11:203–214.