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What is Graduated Exposure?

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At some point in our lives we have to do things that we don’t like. Maybe it is speaking in public, attending a crowded event, getting a shot or going to the dentist. For students with sensory issues these dreaded events can occur more often than for their peers. Simply getting a haircut can be so overwhelming that a meltdown ensues. So how do we help our students overcome these necessary tasks? Use Graduated Exposure.

Graduated Exposure

Graduated Exposure, sometimes called progressive exposure, is an ABA method that gently exposes the child to something that they are afraid of. This method breaks down the end goal into tiny steps or chunks and exposes the student to each piece separately. The gradual exposure systematically increases in both time and the level of exposure. For example, if we want a child to calmly let the dentist clean their teeth we would not start by forcing them into the chair for the cleaning. 

Keeping things Calm

The fear that the child feels about the scenario is very real to them, whether rational or not. For some reason they have focused on negative outcomes when they think about the scenario. It might be that they had a bad experience previously, saw something negative on tv, overheard part of a story that made things seem worse than they actually are, or they have just created their own outcome from the unknown. One of the key things about graduated exposure is to make sure that the child is calm through each of the gradual chunks so that those negative outcomes are recognized as unreal or false. We essentially want to rewrite the outcomes for that child by showing them that the worst doesn’t always happen.

Breaking It Down

Graduated exposure can be time-consuming depending on the necessary steps, but the results are deep and lasting. Let’s use our dentist example again. Before the child ever goes to the dentist, we might take some time to show them some dentist tools. Eventually we might let them touch the tools. Then we may progress to watching a video of the dentist or reading a book. After that we might tour a dentist office and just observe. Next we may have the child sit in the dentist chair and put on the bib. All of these steps would occur before the dentist ever even has the child open their mouth. Each of these steps would occur only when the child is calm and in control of their emotions. It is imperative that each occurrence ends on a happy note. 

Forward Chaining

It is important to implement positive experiences at every step of gradual exposure. If the student will look at the dentist tools without becoming stressed then they get to do a preferred activity immediately after. This may be something as simple as coloring or playing with playdough or getting to eat ice cream. Again, the idea is to rewrite those negative outcomes with positive ones. We replace the bad with something that the child thinks is good.

Other Uses for Graduated Exposure

Graduated exposure is mostly used for overcoming fears: like the dentist, getting a haircut or attending a large gathering. However, it can also be used in other areas of therapy as well. Many use it for increasing food preference issues. Children have shown great growth in the numbers and types of foods they will eat when they are exposed a little at a time and in a calm setting. It has also been used to expand wanted behaviors. No matter how graduated exposure is used, the benefits are obvious.

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