APBA Journal Club

Article: McHugh CL, Dozier CL, Kamlowsky ME, Simmons BA. Synchronous reinforcement schedules promote tolerance of health-related routines for adults with disabilities. J Appl Behav Anal. 2025 Jul;58(3):504-521. doi: 10.1002/jaba.70020. Epub 2025 Jul 4. PMID: 40614120.

Abstract: Failure to engage in or tolerate health-related routines is a major barrier to good health for individuals with intellectual and developmental disabilities (IDD). In the current study, we evaluated the effects of a synchronous schedule of reinforcement (SSR) for five adults with IDD across eight health-related routines (e.g., toothbrushing, handwashing, tolerating wearing health-related devices). The results showed that SSR alone effectively increased tolerance for five of eight health-related routines. Additional modifications were necessary for two other routines, and no effects were observed for one participant. We successfully trained direct-care staff to implement the effective treatment. Social validity outcomes showed higher levels of positive affect and lower levels of negative affect during treatment relative to baseline for all participants as well as staff acceptance of the procedures and training. The current study adds to the literature supporting SSR as an alternative to graduated exposure; however, further research on the efficacy of SSR alone is needed.

Presenter Expertise: Catherine L. McHugh, PhD, BCBA, LBA, is a Clinical Director at Atlas Autism Health with extensive experience in the assessment and treatment of challenging behavior and the application of behavior-analytic interventions to improve socially significant outcomes for individuals with autism and developmental disabilities. Dr. McHugh's research has focused on the use of synchronous schedules of reinforcement (SSR) to increase tolerance of health-related routines. She is the first author of Using Synchronous Schedules of Reinforcement to Promote Tolerance of Health-Related Routines in Adults with Disabilities, published in the Journal of Applied Behavior Analysis (2025). This presentation is based on her published research and draws from her experience designing, implementing, and evaluating SSR interventions. In addition to this publication, Dr. McHugh has previously contributed to the literature on synchronous schedules of reinforcement, providing her with a strong foundation in the conceptual and applied use of SSR. Her combined research and clinical experience informs the practical recommendations discussed throughout this presentation.