Using counterconditioning to treat behavioural distress during subcutaneous injections in a paediatric rehabilitation patient.

A counterconditioning-based intervention was conducted to supplement topical anaesthesia during repeated parent-administered subcutaneous injections performed on a 7-year-old girl for anticoagulation post-stroke. Preferred activities were paired with in vivo exposure to medical stimuli, first during simulated, then actual injections. Differential positive reinforcement was provided contingent on engagement with preferred activities, button pressing in response to an auditory stimulus, and general compliance with adult instructions. Child distress was measured by direct observations and intervention effects examined using an A-B, single-subject case study design with an interrupted time-series statistical analysis for brief single-subject data. Child distress decreased significantly when behavioural intervention was provided. Parent ratings indicated that treatment effects were maintained after the intervention was turned over to the mother and continued at home. Heart rate data provided physiological evidence of counterconditioning. The results are discussed in relation to the application of conditioning and counterconditioning theory in the paediatric rehabilitation setting.