Exposure Therapy and Counterconditioning Intervention for Acute Pain Management during Venipuncture in Children with Chronic Conditions: A clinical case series

Principal Investigator: Keith Slifer

Managing children’s distress during invasive medical procedures, including venipunctures, is challenging for health care providers. The venipuncture procedure is sometimes not well tolerated by children with developmental disabilities due to anxiety about anticipated pain, unfamiliar equipment, difficulty inhibiting motion (particularly in children with hyperactivity), and tactile defensiveness. The inability of children with developmental disabilities to tolerate venipunctures is especially problematic because of the need to undergo needle procedures frequently because of associated medical conditions. Sedation, anesthesia, and restraint are not viable interventions for increasing compliance as children with neurological abnormalities can be at increased risk for adverse effects.

A growing body of literature suggests that behavioral interventions, including exposure and counterconditioning, can effectively increase pediatric patients’ compliance with stressful medical procedures. This project will present de-identified clinical outcome data on a series of nine clinical cases treated in recent years in the Department of Behavioral Psychology at the Kennedy Krieger Institute. We wish to publish this case series describing the common features of the behavioral intervention provided to each child in order to demonstrate the efficacy of using behavioral intervention to teach children with developmental disabilities to cooperate with venipuncture procedures. Each case was pursued to assist the individual child with undergoing medically necessary and physician ordered venipunctures. These cases were not pursued to attempt to acquire generalizable knowledge, but for the individual benefit of the patients involved. Results indicated that behavioral training was successful in promoting venipuncture compliance without restraint, anesthesia, or sedation. This study therefore lends support to the use of behavioral interventions in the pediatric medical setting to increase compliance with venipuncture procedures.