Use of Stimulus Fading and Functional Assessment to Treat Pill Refusal With an 8-Year-Old Boy Diagnosed With ADHD

Pharmacological treatments improve functioning for many of the core problems characteristic of attention deficit/hyperactivity disorder (ADHD). Pharmacological treatment is also useful when delivered in combination with behavior management procedures. However, many children find swallowing pills and capsules difficult, and many refuse treatment outright. There are limited resources available to parents confronted with their children's pill refusal behaviors, especially when these difficulties are not because of skills- or anxiety-related problems. This study describes the use of stimulus fading and functional assessment to eliminate pill refusal with an 8-year-old boy diagnosed with ADHD. The study is a replication and extension of procedures described by Anderson, Ruggiero, and Adams to facilitate pill swallowing for a child diagnosed with HIV. Completely independent pill swallowing was achieved after 12 sessions of stimulus fading supplemented by a functional behavioral assessment. Functional assessment suggested that pill refusal behavior was related to positive (attention) and negative (avoidance) reinforcement.