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Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea

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Recent research suggests supine positioning for sleeping infants is the safest position to prevent breathing related difficulties; however doing so can significantly increase obstruction in apneic infants resulting in decreased sleep quality. We implemented a multi-component treatment package compromised of antecedent interventions and parent-mediated social reinforcement to increase lateral positioning in a premature infant with obstructive sleep apnea. Results indicate that the intervention increased lateral positioning in the participant by over 80 % in the final phase of the study, indicating efficacy of the intervention. Limitations and suggestions for future research are discussed.

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We would like to thank our young participant as well as his family for their continued participation.

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Correspondence to Harry Voulgarakis.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from the parents of all individual participants included in the study.

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Summary for Clinicians

• A single case analysis was completed with a premature infant suffering obstructive sleep apnea using a rigorous, multi-element treatment package.

• Antecedent manipulations such as placement of a stimulus are generally simple to implement, yet effective in increasing socially valid behavioral outcomes while, in this study, also increasing physiologically necessary outcomes.

• Utility of behavioral methods is effective in various populations and can be advantageous beginning in early infancy.

• Parent attention when combined with other manipulations is effective for shaping sleeping posture in infants.

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Voulgarakis, H., Forte, S., Giacomelli, C. et al. Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea. Behav Analysis Practice 10, 83–86 (2017).

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