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Chaney, Clements, Landau, Bulsara and Watt's 2004 study is the contemporary study for the developmental theme of external influences on children's behaviour, and it makes a beautifully practical companion to Bandura. Where Bandura showed, in a laboratory, that an external influence (an observed model) can shape a child's behaviour, Chaney showed, in the real world, that a cleverly designed external influence (a toy that rewards a child for using an asthma inhaler correctly) can shape a child's health behaviour. The behavioural principle it exploits is not observational learning but operant conditioning — specifically positive reinforcement. If using an inhaler is made intrinsically fun, children will do it more often and better, and their parents will find the daily battle over medication far easier. The device that does this is the Funhaler, a redesigned spacer (the plastic holding-chamber that clips onto an asthma metered-dose inhaler) fitted with incentive toys.
This lesson tells the study in the OCR "tell the story" format: the background (why children's poor adherence to asthma medication is a serious problem, and how operant conditioning offers a solution); the aim; the method (its self-report design, the sample of asthmatic children in Perth, and the procedure comparing the Funhaler with the child's usual device); the results with their real figures; the conclusions; and a full evaluation of method, data, ethics, validity, reliability, sampling and cultural reach. It closes by linking the study to its theme, the developmental area, the behaviourist perspective and the relevant debates. Because Chaney is the applied, contemporary half of the external-influences pair, it is examined both in its own right and, constantly, in comparison with Bandura.
| This lesson covers | OCR H567 Component 02 element | AO focus |
|---|---|---|
| Background: children's poor adherence to asthma medication; operant conditioning as a solution | Section A — Developmental; theme: external influences on behaviour (contemporary) | AO1 knowledge |
| Aim (whether the incentive Funhaler improves adherence and technique) | Section A — Core study (Chaney) | AO1 |
| Method: field study; self-report questionnaire; sample (n and who); procedure | Section A — Core study | AO1; AO2 |
| Results (adherence figures; technique figures; parental and child measures) | Section A — Core study | AO1 |
| Conclusions (positive reinforcement improves a child's health behaviour) | Section A — Core study | AO1; AO3 |
| Evaluation: method, data, ethics, validity, reliability, sampling, ethnocentrism | Section A; Section B debates | AO3 |
| Links to theme, area (Developmental), behaviourist perspective, debates | Section B — Areas, perspectives, debates | AO1; AO3 |
The specification is referenced descriptively; consult the official OCR H567 specification document for its exact published wording. This lesson develops AO1 (aim, procedure, results, conclusions), AO2 (applying operant conditioning to novel cases of children's behaviour) and AO3 (evaluating the study's methodology, ethics and generalisability).
Asthma is one of the most common chronic conditions of childhood, and it is managed largely with inhaled medication: a preventer taken every day to keep the airways calm, and a reliever taken when symptoms flare. For young children, the medication is usually delivered from a pressurised metered-dose inhaler (MDI) through a spacer — a plastic chamber that holds the puff of aerosol so the child can breathe it in over several slow breaths rather than having to coordinate a single sharp inhalation with the press of the canister. Used correctly, this system works very well. The problem is that it is very often not used correctly, or not used at all.
Two failures matter. The first is adherence (also called compliance): whether the child actually takes the medication as prescribed, day after day. The second is technique: whether, on the occasions the child does use the device, they take the recommended number of slow, deep breaths so that the drug reaches the lungs rather than being swallowed or lost. Both failures are common in young children, and both have real consequences — poorly controlled asthma, avoidable symptoms, and in serious cases hospital admissions. Chaney and colleagues cite the discouraging background fact that adherence to asthma regimes in children is low, with many families falling well short of the prescribed routine.
Why is adherence so poor? Part of the answer is straightforwardly behavioural. From a child's point of view, using an inhaler is at best boring and at worst unpleasant: there is no immediate reward for doing it, the benefit (not having an asthma attack later) is invisible and delayed, and the whole business can become a daily source of conflict with a nagging parent. In the language of operant conditioning, the behaviour of "using the inhaler properly" is not being reinforced — nothing good happens to the child when they do it — so, predictably, the behaviour is not maintained. Meanwhile the avoidance of the inhaler is often negatively reinforced, because refusing brings the unpleasant episode to an end.
This behavioural analysis suggests an equally behavioural solution. If the reason children do not use inhalers well is that the behaviour is unrewarded, then adding a reward should increase it. This is the core idea of operant conditioning as developed by B. F. Skinner: behaviour that is followed by a pleasant consequence (a positive reinforcer) becomes more frequent. The Funhaler is an ingenious application of this principle. It is a spacer redesigned so that correct use is its own reward. Built into it are incentive toys — a spinning disc and a whistle — that are activated only when the child breathes through the device in the recommended way: slow, deep breaths. If the child breathes too shallowly or too fast, the toys do not work properly; when the child breathes correctly, the disc spins and the whistle sounds. The pleasant sensory feedback is an immediate positive reinforcer, delivered at the exact moment the desired behaviour occurs, and — crucially — it shapes not just whether the child uses the device but how well, because only good technique triggers the reward.
There is a subtle and elegant feature of this design that is worth drawing out, because it is exactly the sort of point that earns credit in an evaluation. In an ordinary reward scheme — a sticker chart, say — the reward is arbitrary: it has nothing to do with the behaviour except that an adult has decided to pair them, and an adult must be present to administer it. The Funhaler's reinforcement is intrinsic and automatic: the reward (the spinning disc, the whistle) is produced by the very behaviour it rewards, so no parent, sticker or supervision is required, and the reinforcement is perfectly contingent on correct technique. This makes it a purer and more reliable application of operant conditioning than a token economy, and it also sidesteps the problem that external rewards can undermine a behaviour once they are withdrawn. The behaviour and its reward are welded together.
The wider point, and the reason the study fits the "external influences on children's behaviour" theme so well, is that the Funhaler is an external influence deliberately engineered to change a child's behaviour for the child's own benefit. It sits at the opposite moral pole from Bandura's demonstration — there, an external influence (an aggressive model) produced an undesirable behaviour we would want to prevent; here, an external influence (a rewarding device) produces a desirable behaviour we want to encourage. Between them the two studies show that the same broad developmental principle — that children's behaviour is powerfully shaped by their environment — can be read as a warning or as an opportunity.
The aim of the study was to investigate whether a new spacer device incorporating incentive toys (the Funhaler) could improve children's adherence to their asthma medication and improve their inhalation technique, compared with the children's usual inhaler-and-spacer device. The researchers described it as a pilot study: a first, small-scale test of whether the incentive approach was worth pursuing, measured through parent-reported behaviour and attitudes.
The study was a field study carried out in families' own homes, using a self-report questionnaire completed by parents as its principal instrument. In effect it used a repeated-measures comparison: the same children were assessed while using their existing device and again while using the Funhaler, so that each child acted as their own control and the two devices could be compared directly. The data were largely quantitative (percentages of children showing various behaviours) drawn from structured questions about the child's medication use, technique and mood, and about the parent's own experience of the daily medication routine.
The participants were the parents of 32 children with asthma, from Perth, Western Australia. The children had a mean age of about 3.2 years and were a mix of boys and girls; all were already prescribed asthma medication delivered by a metered-dose inhaler and spacer, so all were established users of the existing system. The families were recruited through the researchers' clinical contacts — an opportunity/self-selected sample of asthmatic children whose parents agreed to try the new device.
Because the children were very young (pre-school age), it was appropriate that the parents, not the children, completed the questionnaires: at around three years old, children cannot reliably report on their own medication adherence or attitudes, so parental report was the practical route to the data. This reliance on parents is both a sensible design choice and, as we shall see, a source of one of the study's main methodological limitations.
The central material was the Funhaler itself — a spacer of the same essential type the children already used, but modified with two incentive toys: a spinning disc and a whistle, positioned so that they operate only when the child inhales through the device with the slow, deep breathing pattern that delivers the medication effectively. The other key material was a structured questionnaire for parents, asking about how often the child used the device, how many breaths they took, how easy or difficult the medication routine was, and the child's and parent's attitudes to it. Comparison data on the child's existing device were gathered so that "before" (usual device) and "after" (Funhaler) could be set side by side.
The procedure was designed to compare the two devices in ordinary home use. First, parents provided information about their child's medication behaviour and attitudes while using the existing inhaler-and-spacer, establishing a baseline. The families were then given the Funhaler to use with their child for a period of everyday home use — on the order of a fortnight — after which the parents completed the questionnaire again, now reporting on medication behaviour, technique and attitudes while using the Funhaler.
The questionnaire captured several kinds of information. It asked about adherence — for example, whether the child had taken the medication as prescribed on the previous day. It asked about technique — in particular whether the child took the recommended number of breaths (four or more) per "cycle" of medication, which is the standard advice for effective drug delivery. And it asked about attitudes and mood — whether the child was happy to use the device, and how the parent felt about the daily medication routine, since a device that reduces the parent's stress and the child's resistance is itself a valuable outcome. By comparing the parents' answers for the existing device with their answers for the Funhaler, the researchers could see whether the incentive device changed real behaviour in the home.
The results were strikingly favourable to the Funhaler across every measure the researchers reported: adherence, technique and attitude all improved when the incentive device replaced the usual one.
| Measure (parent-reported) | Existing device | Funhaler |
|---|---|---|
| Children who used the device the previous day (as prescribed) | About 59% | About 81% |
| Children taking the recommended four or more breaths per cycle | About 50% | About 80% |
| Children medicated while "happy" / without a problem | Lower | Higher |
Several specific findings matter for the exam:
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