Behavioral Assessment and Treatment of Noncompliance: A Review of the Literature

Abstract

Abstract Noncompliance is a common behavior problem exhibited by typically developing children, as well as individuals with intellectual disabilities, and is correlated with a number of psychiatric diagnoses later in life. We begin this manuscript by describing the definition and prevalence of noncompliance. We then review the assessment procedures that can be used to identify the variables contributing to noncompliance among children. Finally, we describe recent research on both antecedent and consequence-based treatments for noncompliance. A number of specific interventions, including advance notice, the high-p instructional sequence, prompting precursor behaviors, guided compliance, and differential reinforcement, are highlighted. Throughout the review, we provide specific recommendations for practice. Keywords: assessment, compliance, noncompliance, treatment ********** Noncompliance is defined as doing anything other than what has been requested by a parent or other adult authority figure within a specific time frame (Kalb & Loeber, 2003). Compliance is the inverse of this definition. Although the term noncompliance does not pass the dead man's test (i.e., "if a dead man can do it, it's not behavior"; Malott & Suarez, 2004, p. 9), it has a long history of use and will, therefore, be described in this review. Persistent noncompliance is correlated with a number of psychiatric diagnoses later in life (Kalb & Loeber, 2003), and has been consistently rated as a primary reason for referral by parents who seek outpatient behavioral or mental-health services (McMahon & Forehand, 2003). Even at pediatrician's offices, where parents seek general medical services, noncompliance is often a parent's top concern (McMahon & Forehand, 2003). Furthermore, noncompliance may be even more worrisome for parents of children with special needs (e.g., autism spectrum disorders) because it is correlated with poor academic progress among these children (Wehby & Lane, 2009). Finally, noncompliance is important because learning to comply with instructions is regarded by many as a behavioral cusp (Bosch & Fuqua, 2001), in that it is a skill that makes learning other skills possible. A post-instruction interval is typically included in the definition of compliance, which describes when children must initiate a response for their behavior to be considered compliant (Forehand, Roberts, Doleys, Hobbs, & Resick, 1976). Wruble, Sheeber, Sorensen, Boggs, and Eyberg (1991) analyzed the behavior of 15 nonreferred preschool children-mother pairs during parent-directed interaction and cleanup. The experimenters determined that on 85% of opportunities, children initiated compliance within 5.4 s of the parental instruction, and suggested the time of 5.4 s as the threshold for a child to be considered compliant. A more recent study by Shriver and Allen (1997) used procedures similar to Wruble et al. (1991), albeit with both referred (i.e., children who have received behavioral health services) and nonreferred children-mother pairs, and identified average initiation latencies of 5.9 s for the total sample, 5.4 s for referred children, and 6.71 s for nonreferred children. Taken together, the results from Wruble et al. (1991) and Shriver and Allen (1997) underscore the difficulty in determining a standard initiation latency for compliance. Due to this, many authors now use 10 s as the post-instruction interval. Although the prevalence of noncompliance has not been well documented, estimates suggest it is common. A review by Kalb arid Loeber (2003) estimated the prevalence of noncompliance in children and adolescents to be between 25% and 65%. Approximately 50% of parents of nonreferred 4- to 7-year-olds report noncompliance at home and approximately 85% of parents of referred 4- to 7-year-olds report noncompliance at home (McMahon & Forehand, 2003). These data suggest that noncompliance is ubiquitous, particularly among young children. …