A comparison of simultaneous versus sequential presentation of novel foods in the treatment of food selectivity

The present study extended the literature on feeding disorders by conducting a comparison of sequential and simultaneous food presentation in the treatment of food selectivity. In the simultaneous condition, a highly preferred food was presented in the same bite with a non‐preferred food (NPF), and during the sequential condition, a highly preferred food was delivered as a consequence for acceptance and consumption of NPFs. Generalization and maintenance of food consumption was assessed. Although results for two participants indicated that both presentation methods produced an increase in acceptance and consumption of NPFs when combined with an escape extinction procedure, anecdotal observations suggested that participants may have had a preference for eating foods in a sequential fashion. Copyright © 2010 John Wiley & Sons, Ltd.     

Increasing Vegetable Consumption in Students with Autism Spectrum Disorder Using Pre-meal Presentation: A Preliminary Analysis

This study examined the effect of pre-meal presentation on the consumption of vegetables in a sample of 16 students with autism spectrum disorder (ASD). These 16 students (75% male; mean age?=?13 years; age range 8–18 years) were enrolled in a private school serving children with autism. School staff offered participants 10 small pieces of two vegetables during lunch (baseline) or prior to lunch (pre-meal presentation). Observers recorded the number of bites students consumed. We used an A–B–A–B design to examine the effects of pre-meal presentation. Results were evaluated using a mixed-method, individual- and group-level, analysis. Pre-meal presentation resulted in increased vegetable consumption for 9 of the 16 participants. A reversal to baseline demonstrated expected decreases in bites consumed, and the subsequent return to intervention demonstrated expected increases in bites consumed. One-way repeated measures ANOVA compared bites consumed per session across 10 four-session study blocks and found significant differences between these two conditions. Paired comparisons revealed no change in bites consumed per session from baseline to intervention block #1, but significant increases from baseline to intervention #2 and all subsequent intervention blocks. Our results suggested pre-meal presentation can serve as a low-cost, low-effort intervention for increasing vegetable consumption for some children with ASD.

     

An evaluation of simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity

In the current investigation, we compared two methods of food presentation (simultaneous vs. sequential) to increase consumption of nonpreferred food for 3 children with food selectivity. In the simultaneous condition, preferred foods were presented at the same time as nonpreferred food (e.g., a piece of broccoli was presented on a chip). In the sequential condition, acceptance of the nonpreferred food resulted in presentation of the preferred food. Increases in consumption occurred immediately during the simultaneous condition for 2 of the 3 participants. For 1 participant, increases in consumption occurred in the simultaneous condition relative to the sequential condition, but only after physical guidance and re-presentation were added to treatment. Finally, consumption increased for 1 participant in the sequential condition, but only after several sessions. These results are discussed in terms of possible mechanisms that may alter preferences for food (i.e., establishing operations, flavor-flavor conditioning).     

Treating food selectivity as resistance to change in children with autism spectrum disorder

Change-resistant behavior, such as rigid and selective food consumption, is a core symptom of autism that can have significant negative consequences for the child (Flygare Wallén et al., 2018; Levy et al., 2019). In the current study, we used a matching-law-based intervention (Fisher et al., 2019) to treat the change-resistant feeding behavior of 7 young children with autism. The feeder gave the participant a choice between a change-resistant and an alternative food during free- and asymmetrical-choice conditions. Alternative-food consumption increased for 2 participants during asymmetrical choice when the feeder provided a preferred item for consuming the alternative food and no programmed consequence for consuming the change-resistant food. Alternative-food consumption increased for the other 5 participants after the feeder exposed at least 1 food to single choice in which the feeder guided the participant to put the bite of alternative food in his or her mouth if he or she did not do so within 8 s of presentation. Effects of the single-choice contingencies maintained during reversals and generalized to other alternative foods the feeder did not expose to single choice. These results are important because participants consumed alternative foods even when their change-resistant foods were present, which is similar to typical mealtime contexts in which children have choices among foods.     

An evaluation of emerging preference for non‐preferred foods targeted in the treatment of food selectivity

Several studies have shown that the acquisition of food consumption does not occur until after escape prevention is implemented. However, the mechanism responsible for the maintenance of food consumption may be due to participants contacting the reinforcing properties of food targeted during intervention such that the food naturally reinforces food consumption. The present study extended the literature on feeding disorders by conducting pre‐ and post‐treatment preference assessments to determine if preference for non‐preferred foods (NPFs) had developed after exposure to a treatment comparison of sequential and simultaneous food presentation; presentation methods were implemented alone and combined with escape prevention in the form of a non‐removal of the spoon (NRS) procedure. Results for three participants with food selectivity indicated that preference for NPFs developed after being exposed to those foods during either treatment sessions or generalization probes. Copyright © 2010 John Wiley & Sons, Ltd.     

AN EVALUATION OF A PROGRESSIVE HIGH-PROBABILITY INSTRUCTIONAL SEQUENCE COMBINED WITH LOW-PROBABILITY DEMAND FADING IN THE TREATMENT OF FOOD SELECTIVITY

Few studies have examined the effects of the high‐probability instructional sequence in the treatment of food selectivity, and results of these studies have been mixed (e.g., Dawson et al., 2003 ; Patel et al., 2007 ). The present study extended previous research on the high‐probability instructional sequence by combining this procedure with low‐probability demand fading with 2 boys with autism (9 and 10 years old) who had a history of food selectivity and engaged in active food refusal behaviors when presented with novel foods. Response requirements were faded gradually from responses the child would tolerate (e.g., touching the food) to the final requirement of chewing and swallowing the food. The antecedent‐based intervention was implemented in the absence of escape extinction and was effective in increasing food consumption for both participants. Possible mechanisms responsible for the effectiveness of the intervention are discussed along with directions for future research.     

Increasing variety of foods consumed by blending nonpreferred foods into preferred foods

A treatment with differential or noncontingent reinforcement and nonremoval of the spoon increased the acceptance of one or two of 16 foods for 2 participants with severe food refusal. These differential levels of acceptance were demonstrated empirically in an ABAB design in which A was the presentation of the accepted (preferred) foods and B was the presentation of foods the participants refused (nonpreferred foods). Subsequently, we implemented a blending treatment that consisted of mixing (blending) nonpreferred foods into preferred foods in various ratios (e.g., 10% nonpreferred/90% preferred, 20% nonpreferred/80% preferred). We then presented nonpreferred foods that had been exposed to blending to determine if consumption of nonpreferred foods would increase following the blending treatment. We also conducted periodic reversals in which we presented nonpreferred foods that had not been exposed to the blending treatment. Following initial implementation of the blending treatment, consumption was high for nonpreferred foods that had been blended and low for nonpreferred foods that had not been blended. Consumption increased for all foods (i.e., foods that had been exposed to blending and foods that had not been exposed to blending) after seven or eight foods had been exposed to the blending treatment. Thus, the variety of foods consumed by the participants increased from one or two to 16. These results are discussed in terms of stimulus fading, conditioned food preferences, and escape extinction. DESCRIPTORS: conditioned food preferences, food refusal, negative reinforcement, stimulus fading     

A pinch or a lesion: a reconceptualization of biting consequences in mice

Intruder and resident male colony mice exhibit an array of distinct defensive and offensive behaviors. Intruders typically show more boxing, flight, defensive sideways position, on the back position and general locomotion, while residents exhibit higher levels of attack, olfactory investigation, aggressive grooming, and biting, with a preference for dorsal bite locations. Here, analysis of bite locations on the body of the intruder mice showed that the majority of bites produced few lesions (i.e. actual puncturing of the skin) when compared to scrapes or no markings. Most bites were directed to the back of the opponent animal with very few bites directed towards the opponents' vulnerable ventrum. In particular, bites directed at the relatively hairless ventrum produced no lesions. These findings, along with previous work on mice and rats, suggest that intraspecific offense with preferred target sites for biting, facilitates an effective but largely nonwounding interaction between resident and intruder mice. Furthermore, bruise and wound analyses suggest an association between bite targets and tissue damage. The preference for specific bite locations may be complimented by a differential intensity of attack, with the back attracting the strongest bites and the ventrum the weakest. This apparent nonwounding fighting pattern contradicts the current evaluation of rodent wounding severity in this paradigm and can therefore refine the usage of this model and of the protocols associated with it.     

ASSESSMENT OF PREFERENCE FOR VARIED VERSUS CONSTANT REINFORCERS

One method that has been demonstrated to improve the effectiveness of reinforcement is stimulus (reinforcer) variation (Egel, 1980). Egel found that bar pressing increased and responding occurred more rapidly during varied reinforcement than during constant reinforcement when identical stimuli were used across phases for 10 individuals with autism. The purpose of the current investigation was to assess the preferences of 7 individuals for varied presentation of slightly lower quality stimuli relative to constant access to the highest quality stimulus. Varied presentation was preferred over constant reinforcer presentation with 4 participants, and the opposite was true for 2 participants. One participant did not demonstrate a preference. These results suggest that stimulus variation may allow less preferred reinforcers to compete effectively with a more highly preferred reinforcer for some individuals.     

Blending to Treat Expulsion in a Child with Food Refusal

The current study examined the effect of blending established foods and non‐preferred foods to treat expulsions in a three‐year‐old girl with food refusal and gastrostomy‐tube dependence. Treatment involving differential reinforcement of acceptance, non‐removal of the spoon, and re‐presentation increased consumption of 12 out of the 16 pureed foods; however, high levels of expulsion of four foods continued to disrupt meals. Results showed reduced rates of expulsion and increased mouth clean during blending, evaluated empirically using an ABAB design. Copyright © 2015 John Wiley & Sons, Ltd.     

Using negative reinforcement to increase self-feeding in a child with food selectivity

We examined the effects of a negative reinforcement-based treatment on the self-feeding of 1 child with food selectivity by type and texture. Self-feeding increased when the child could choose to either self-feed 1 bite of a target food or be fed 1 bite of the target food and 5 bites of another food. Possible mechanisms that underlie the effectiveness of the intervention and implications for future research are discussed.     

The Effects of Choice Between Nonpreferred Foods on the Food Consumption of Individuals with Food Selectivity

Previous research has concluded that presenting individuals with the opportunity to choose is a viable treatment for escape‐maintained behavior. Considering that food refusal behavior has been generally described as avoidant behavior, the present study aimed to evaluate the role of choice between nonpreferred foods on the food consumption and problematic mealtime behavior of two children with food selectivity. Each participant was allowed to choose between four nonpreferred foods in the choice condition and was not allowed to choose in the no‐choice condition. Further, the role of choice as an antecedent manipulation in mediating extinction‐induced responding was evaluated when choice alone was demonstrated to be ineffective in increasing consumption and a nonremoval of the spoon procedure was introduced. Results indicated that providing choices was effective in increasing the food consumption of one participant and was advantageous in decreasing emotional responding when a nonremoval of the spoon procedure was introduced for the second participant. Copyright © 2015 John Wiley & Sons, Ltd.     

Comparison of bite-presentation methods in the treatment of food refusal

The current study examined the rate of expulsions and mouth cleans across 3 presentation methods (upright spoon, flipped spoon, Nuk brush) for a 3-year-old girl with a feeding disorder. The participant expelled all bites presented on an upright spoon. Results showed reduced rates of expulsions and increased mouth cleans during the flipped spoon and Nuk brush presentation methods.     

Using high-probability foods to increase the acceptance of low-probability foods

Studies have evaluated a range of interventions to treat food selectivity in children with autism and related developmental disabilities. The high-probability instructional sequence is one intervention with variable results in this area. We evaluated the effectiveness of a high-probability sequence using 3 presentations of a preferred food on increasing acceptance in a child with autism who refused a few specific foods. The high-probability sequence increased acceptance of 3 foods. We then systematically faded the intervention for 2 foods.     

Sound attenuation and preferred music in the treatment of problem behavior maintained by escape from noise

We examined the extent to which different sounds functioned as motivating operations (MO) that evoked problem behavior during a functional analysis for two participants. Results suggested that escape from loud noises reinforced the problem behavior for one participant and escape from arguing reinforced problem behavior for the other participant. Noncontingent delivery of preferred music through sound‐attenuating headphones decreased problem behavior without the use of extinction for both participants. We discuss the results in terms of the abolishing effects of the intervention.     

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

We used behavioral skills training with general‐case training to teach 3 caregivers to implement a behavioral feeding intervention with their children. The percentage of correctly performed steps of the feeding intervention increased for all 3 caregivers and was maintained at follow‐up. For all 3 children, the number of bites consumed increased and the number of bites with inappropriate mealtime behavior decreased across treatment. Increases in bites consumed and bites without behavior problems were maintained for 2 participants at follow‐up.     

Noncontingent reinforcement as treatment for food refusal and associated self-injury

We examined the use of noncontingent reinforcement to decrease self-injury and increase bite acceptance in a child who exhibited food refusal. First, a brief functional analysis suggested that self-injury was maintained by escape from food presentation. Next, we evaluated an intervention that involved noncontingent access to a video during feeding sessions. Results of the intervention showed a decrease in self-injury and an increase in bite acceptance.     

AN INDIVIDUALIZED LEVELS SYSTEM TO INCREASE INDEPENDENT MEALTIME BEHAVIOR IN CHILDREN WITH FOOD REFUSAL

An individualized levels system was implemented to increase independent eating in two children with food refusal. Participants earned access to different status levels associated with varying availability of preferred items/activities outside of meals according to criteria based on low levels of prompting throughout the meal. A reversal design was implemented to evaluate the effects of the intervention on independent mealtime behavior. Results demonstrated that the levels system was effective in increasing independent eating and in decreasing prompted bites for both participants. Although the effectiveness of an individualized levels system has been previously demonstrated in the treatment of severe problem behavior, it has not been empirically evaluated in the context of increasing appropriate behavior or with children with food refusal. These findings provide support for such a treatment to promote mealtime independence during an intensive feeding program and at two months follow‐up. Copyright © 2013 John Wiley & Sons, Ltd.     

THE EFFECT OF THE AVAILABILITY OF A SIMILAR TOY ON COMPLIANCE WITH INSTRUCTIONS TO SURRENDER A TOY AMONG PRESCHOOL CHILDREN

We evaluated the effect of the availability of a similar toy on compliance with an instruction to surrender a toy among three preschool children. First, high‐preference and medium‐preference toys were identified for each participant. During the treatment evaluation, reversal designs were used to examine compliance with an instruction to surrender these toys when a toy similar to the target toy was added to the environment. The results indicated that, for two participants, the similar toy intervention increased compliance to moderate levels; a consequence‐based intervention was then added to the similar toy intervention and resulted in high levels of compliance. For the third participant, the similar toy intervention did not increase compliance. A separate consequence‐based intervention was necessary to increase compliance and to demonstrate experimental control. Copyright © 2011 John Wiley & Sons, Ltd.