Stop Spitting!

By: Elizabeth Zeppernick, M.Ed., BCBA, LBA

Spitting can be a behavior of concern for individuals with intellectual and developmental disabilities.  It is addressed because it can lead to social alienation and is not only unappealing but it can be a health hazard given some infections and diseases are transmitted through saliva.  In addition, if caregivers and teachers avoid someone who spits, it can lead to reduced learning and a compromised education.  

Background: 

A study conducted by Hartz, et al. (2020) looked at a 12-year old boy with Autism Spectrum Disorder (ASD) in a special education classroom setting.  The boy was chosen for the study given he was spitting both at school and at home.  They started by recording how often he was spitting saliva onto surfaces like his desk, table, the floor, or into a tissue in which he had a history of then tucking into areas around the school and his home.  

Pre-Intervention: 

The study first conducted a Functional Analysis to determine what function spitting served the boy.  In Behavior Analysis it is vital to find out the context in which a behavior is both likely or unlikely to occur.  Behavior Analysts believe there is always a function which then should guide treatment.  

The study then sought to find out what it was that the boy liked by using what’s called a Preference Assessment.  They found his most preferred things were when classroom staff used particular words when talking to him, i.e. “Good job” rather than “Great job.”  He also liked it when he could ask the staff to change the topic of their conversation.  He also preferred when specific materials were not in his immediate vicinity such as pens, timers, and clipboards.  

Intervention: 

The staff used a technique called Differential Reinforcement which allowed the boy to access his preferences only when he was not spitting.  They used a visual board with the words “Student’s Choice” on it to indicate that, given he was not spitting he could ask them to use his preferred words, choose the topic of the conversation and decide what materials were in his immediate environment.   

If he was spitting, the staff changed the visual board to show the words, “Staff’s Choice” which meant he couldn’t control which words they used or the topic of the conversation or where objects were placed near him.  After the spitting occurred, the unpreferred setting would remain in place until the end of a ten-minute interval.  Once the timer ended the sign turned back to “Student’s Choice” to signal to him he had another chance to have his preferences.  Throughout the intervention, the staff did not give attention by commenting about the spitting, i.e. “Stop Spitting!”  

Results: 

By using this intervention, spitting was brought down to zero occurrences within any given week using their measurement procedures.  In later follow up, which was more than half a year after the behavior originally reached levels of non-occurrence, spitting was still not occurring which shows that the results were long-lasting.  

Given the significant risk of social isolation and health dangers associated with spitting, an effective intervention is vital.  This study demonstrated that this behavior can be addressed using the science and practice of Applied Behavior Analysis.  

Source: 

Hartz RM, Luiselli JK, Harper JM.  Behavioral treatment of spitting in a child with autism spectrum disorder: Functional analysis, intervention evaluation, and maintenance assessment.  Behavioral Interventions.  2020; 1-9. https://doi.org/10.1002/bin.1739

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