An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal

Consumption of solids and liquids occurs as a chain of behaviors that may include accepting, swallowing, and retaining the food or drink. In the current investigation, we evaluated the relative effectiveness of differential reinforcement of the first behavior in the chain (acceptance) versus differential reinforcement for the terminal behavior in the chain (mouth clean). Three children who had been diagnosed with a feeding disorder participated. Acceptance remained at zero when differential reinforcement contingencies were implemented for acceptance or mouth clean. Acceptance and mouth clean increased for all 3 participants once escape extinction was added to the differential reinforcement procedures, independent of whether reinforcement was provided for acceptance or for mouth clean. Maintenance was observed in 2 children when escape extinction was removed from the treatment package. The mechanism by which consumption increased is discussed in relation to positive and negative reinforcement contingencies.     

USE OF COMPONENT ANALYSES TO IDENTIFY ACTIVE VARIABLES IN TREATMENT PACKAGES FOR CHILDREN WITH FEEDING DISORDERS

We evaluated the separate components in treatment packages for food refusal of 4 young children. First, treatment packages were implemented until food acceptance improved. Next, a component analysis was conducted within a multielement or reversal design to identify the active components that facilitated food acceptance. The results indicated that escape extinction was always identified as an active variable when assessed; however, other variables, including positive reinforcement and noncontingent play, were also identified as active variables for 2 of the children. The results suggest that the component analysis was useful for identifying variables that affected food acceptance.     

USE OF TEXTURE FADING IN THE TREATMENT OF FOOD SELECTIVITY

Children with feeding disorders often display severe food selectivity. For many of these children, consuming highly textured foods may be aversive or potentially dangerous because of frequent gagging. The purpose of this study was to demonstrate the efficacy of texture fading in the treatment of food selectivity displayed by 4 children. Treatment involved the gradual addition of higher textures based on the results of periodic probes. In addition, food acceptance and swallowing were reinforced, while food refusal and food expulsion were placed on extinction. Results showed that all participants successfully advanced to consumption of age-appropriate texture and volume. The results suggest that texture fading with intermittent probes at higher textures may be an effective method for the treatment of food selectivity by texture.     

Further generalization technology: Accounting for natural covariation in generalization assessment

In recent years, the assessment of generalization effects has become a major priority of applied behavior analysis. In this paper we propose a set of procedures to increase the accuracy of generalization assessments by accounting for the degree of natural covariation between treated and untreated behaviors. Scatterplot analyses were used (a) to assess the amount of baseline and postbaseline covariation between behaviors, (b) to determine if the observed generalization effect was due to a preexisting covariation between the behaviors, and (c) to assess if there is a significant change in the strength of the relationship between the behaviors as a function of the intervention. Six hypothetical sets of data are used to demonstrate how these procedures provide more accurate and detailed generalization assessment.     

On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal

We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. However, the addition of positive reinforcement to escape extinction was associated with beneficial effects (e.g., greater decreases in negative vocalizations and inappropriate behavior) for some participants.     

Identification and modification of a response-class hierarchy

We evaluated the effects of extinction and negative reinforcement on the latency of response-class members following requests made to a 15-year-old female with moderate mental retardation and autism. A functional analysis showed that the class members (screams, aggression, and self-injury) were escape maintained. Informal observations suggested that these topographies generally occurred in the sequence listed above and therefore may have been hierarchically related. A therapist provided escape from demands contingent on a specific member of the class to determine the effects on the latency of the members' occurrence. Results showed that the latencies occurred in a predictable order. In addition, we expanded the response class to include a vocal response that was functionally equivalent to other members. Findings are discussed regarding the covariation and sequence of response-class members and treatment development.