The Behavioral Observations Podcast with Matt Cicoria

Improving Health Routines for Adults with Disabilities Using Synchronous Reinforcement Strategies: Inside JABA 24

Aug 28, 2025

Guest

John Borrero

Join Katie McHugh, a dedicated researcher in health routines, Claudia Dozier, a reinforcement schedule expert, and John Borrero, JABA's Editor-in-Chief, as they delve into innovative strategies for enhancing health routines for adults with disabilities. They discuss synchronous reinforcement schedules that occur in real-time, making activities like toothbrushing and bathing more manageable. The trio emphasizes the importance of collaboration with medical professionals and exploring emotional responses to improve outcomes. Tune in for insights into overcoming behavioral challenges and future research directions!

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INSIGHT

Synchronous Reinforcement Is Non-Episodic And Potent

Synchronous reinforcement pairs ongoing access to a preferred stimulus with target behavior, pausing access when the behavior lapses.
This non-episodic relation often outperforms delayed or end-of-session rewards for duration-based behaviors.

ANECDOTE

VHS Movies Paused To Reinforce Exercise

Claudia used VHS-era movies that played only while participants met exercise targets to motivate sustained effort.
Participants preferred the live, continuous movie access over equivalent end-of-session rewards.

INSIGHT

Graduated Exposure Dominates Health-Routine Research

Graduated exposure is the most common method in the literature for building tolerance to health routines.
It often includes stepwise task analyses with contingent or noncontingent reinforcement and sometimes escape extinction.

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In this episode of the Inside JABA Series podcast, we dive into a fascinating discussion on health-related routines for adults with intellectual and developmental disabilities (IDD). Dr. Katie McHugh, Dr. Claudia Dozier, and Editor-in-Chief Dr. John Borrero share insights from their recent study, Synchronous Reinforcement Schedules Promote Tolerance of Health-Related Routines for Adults with Disabilities.

The conversation explores how synchronous reinforcement schedules—where reinforcement occurs in real time alongside behavior—can improve tolerance for essential routines like toothbrushing, bathing, wearing medical devices, and more. The research team highlights case studies, methodological considerations, and the broader implications for clinical practice.

Key Topics Covered

✅ Synchronous reinforcement schedules and why they may be more effective (and preferred) than delayed reinforcement.
✅ Applications for health routines such as toothbrushing, bathing, mask-wearing, GPS bracelets, helmets, and pulse oximeters.
✅ Collaborative service delivery with nursing and medical professionals.
✅ Challenges in participant consent and maintaining experimental control.
✅ Importance of measuring both behavioral outcomes and affective states.
✅ Future research directions, including reinforcer assessments, continuous vs. discontinuous schedules, and maintaining treatment effects.

Next Steps and Future Directions

Editorial updates for broader keyword usage to increase accessibility outside of behavior analysis.
Comparing graduated exposure with contingent vs. synchronous reinforcement interventions.
Implementing more systematic preference and reinforcer assessments in future studies.
Exploring hybrid approaches (e.g., combining graduated exposure with synchronous reinforcement).
Collecting more comprehensive data on participant affect and treatment integrity.

Resources & References

Dr. Dozier's lab website.
Dr. Dozier's KU faculty page.
KU ABS online and on-campus graduate programs.
DeLeon, I. G., Hagopian, L. P., Rodriguez-Catter, V., Bowman, L. G., Long, E. S., & Boelter, E. W. (2008). Increasing wearing of prescription glasses in individuals with mental retardation. Journal of Applied Behavior Analysis, 41(1), 137–142.
Diaz de Villegas, S. C., Dozier, C. L., Jess, R. L., & Foley, E. A. (2020). An evaluation of synchronous reinforcement for increasing on-task behavior in preschool children. Journal of Applied Behavior Analysis, 53(3), 1660–1673.
Hardesty, E. M., Lerman, D. C., & Hardee, J. L. (2023). A comparison of synchronous and noncontingent stimulus delivery on task engagement. Journal of Applied Behavior Analysis, 56(3), 664–673.
Leslie, S. C., Dozier, C. L., Kamlowsky, M. E., McHugh, C. L., Diaz de Villegas, S. C., & Kanaman, K. C. (2024). Using synchronous reinforcement to increase mask wearing in young children. Behavioral Interventions, 39(1), 1–29.
McHugh, C. L., Dozier, C. L., Diaz de Villegas, S. C., & Kanaman, N. A. (2022). Using synchronous reinforcement to increase mask wearing in adults with developmental disabilities. Journal of Applied Behavior Analysis, 55(4), 1157–1171.
Williams, D. C., & Johnston, J. M. (1992). Continuous versus discrete dimensions of reinforcement schedules: An integrative analysis. Journal of the Experimental Analysis of Behavior, 58(1), 205–228.
Ellis, E. M., Ala’i-Rosales, S. S., Glenn, S. S., Rosales-Ruiz, J., & Greenspoon, J. (2006). The effects of graduated exposure, modeling, and contingent social attention on tolerance to skin care products with two children with autism. Research in Developmental Disabilities, 27(6), 585–598.
Halbur, M., Kodak, T., McKee, M., Carroll, R., Preas, E., Reidy, J., & Cordeiro, M. C. (2021). Tolerance of face coverings for children with autism spectrum disorder. Journal of Applied Behavior Analysis, 54(2), 600-617.
Richling, S. M., Rapp, J. T., Carroll, R. A., Smith, J. N., Nystedt, A., & Siewert, B. (2011). Using noncontingent reinforcement to increase compliance with wearing prescription prostheses. Journal of Applied Behavior Analysis, 44(2), 375-379.
Stark, L. J., Allen, K. D., Hurst, M., Nash, D. A., Rigney, B., & Stokes, T. F. (1989). Distraction: Its utilization and efficacy with children undergoing dental treatment. Journal of Applied Behavior Analysis, 22(3), 297-307.

About the Guests

Dr. Catherine (Katie) McHugh – Researcher focused on health-related routines and intervention strategies for adults with disabilities.
Dr. Claudia Dozier – Expert in reinforcement schedules and their applications across populations.
Dr. John Barrero – Current JABA Editor-in-Chief and behavior analyst contributing to dissemination and accessibility of applied research.