Parental use of escape extinctionand differential reinforcement to treat food selectivity.

Escape extinction combined with differential reinforcement for acceptance has been demonstrated to be an effective treatment for food selectivity when implemented by trained professionals in clinic settings. This study evaluated the efficacy of parent-implemented escape extinction in the child''s natural environment using video monitoring to train parents and assess intervention efficacy. Parents were able to use intervention to significantly increase bites accepted and decrease problem behavior.     

A further refinement of procedures addressing food selectivity

Individuals with autism and/or developmental disabilities are more likely than their typically developing peers to be food selective. Evidence‐based treatment packages for food refusal and selectivity include the use of reinforcement, escape extinction, and manipulation of antecedent events . In the current study, the variety of foods consumed by two adolescent males with food selectivity were systematically increased to include a variety of foods across all of the food groups. A changing criterion design was used to systematically increase the expectation of the amount and variety of foods that were consumed.     

Parental assessment and treatment of food selectivity in natural settings

This study evaluated the effects of a parent-conducted functional analysis and treatment consisting of differential reinforcement of an alternative behavior, escape extinction, and demand fading on food selectivity in a young child with autism. Increases in food acceptance at home and in a restaurant were obtained.     

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.     

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).     

A COMPARISON OF DIFFERENTIAL REINFORCEMENT AND NONCONTINGENT REINFORCEMENT TO TREAT FOOD SELECTIVITY IN A CHILD WITH AUTISM

We compared differential reinforcement plus escape extinction to noncontingent reinforcement plus escape extinction to treat food selectivity exhibited by a young child with autism. The interventions were equally effective for increasing bite acceptance and decreasing problem behaviors. However, a social validity measure suggested that noncontingent reinforcement was preferred by the child's caregiver.     

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.     

Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder

Food selectivity is a common problem for children with autism spectrum disorder (ASD; Schreck, Williams, & Smith, 2004). Behavior‐analytic interventions have the most empirical support for feeding disorders (Sharp, Jaquess, Morton, & Miles, 2011). However, there are no randomized controlled trials that have evaluated its effects with a well‐defined cohort of children with ASD. In the current investigation, we randomly assigned 6 young children with ASD and food selectivity to either an applied behavior analytic intervention or a wait‐list control. We used a crossover randomized controlled trial to evaluate the effects of a multicomponent applied behavior analytic intervention on independent acceptance and mouth clean of 16 novel foods. We subsequently exposed the wait‐list control group to the intervention. We also evaluated the effects of the intervention on individual participants with single‐case designs. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait‐list control group until we implemented the intervention.     

An evaluation of preference for video and in vivo modeling

We assessed preference for video or in vivo modeling using a concurrent-chains arrangement with 3 children with autism. The two modeling conditions produced similar acquisition rates and no differential selection (i.e., preference) for all 3 participants.     

FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function‐based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.     

Examining extinction bursts in the treatment of pediatric food refusal

Escape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly. Considerations for using escape extinction in interventions will be discussed.     

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

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.     

Evaluating video modeling and video modeling with video feedback to enhance the performance of competitive dancers

This study evaluated the use of video modeling and video modeling plus video feedback to enhance four adolescents' performance of a dance movement. Intervention was evaluated in a multiple baseline across participants design. This study found that video modeling enhanced performance from baseline, but the addition of video feedback produced further increases. For one participant, improvement was dependent on the perspective of the video model. Implications of these findings and suggestions for future research are discussed.     

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.     

Additional-delay schedules: A continuum of temporal contingencies by varying food delay

Pigeons performed on discrete-trial, temporally defined schedules in which the food delay (D) was adjusted according to the latency of the key peck (X) and two schedule parameters (t and A). The schedule function was D = A(t − X), where D is the experienced delay between a response and a reinforcer. The schedule parameter t is the maximum value below which the present contingencies occur. A is the additional delay to reinforcement for each second the response latency is shorter than the t value. When A = 0 s, the schedule is a continuous reinforcement schedule with immediate reinforcement. When A = 1 s, the schedule is a conjunctive fixed-ratio 1 fixed-time t-s schedule. When A approaches infinity, the schedule becomes a differential reinforcement of long latency schedule. The latencies for subjects with t = 10 s and t = 30 s were observed with the present schedules having seven values for A between 0 s and 11 s. In addition, the latencies for subjects for which t = 30 s were observed at an A value of 31 s to 41 s. As the A value increased, the latencies approached the t value for subjects for which t = 10 s. The latencies for 30-s-t subjects did not approach t, even when the A value was 41 s. The latencies for 10-s-t subjects at 11-s A value were longer than those under yoked conditions having exactly the same delays/interreinforcement intervals. These results demonstrated a continuum of latency related to the schedule continuum (value of A) at a small t value.     

An evaluation and comparison of time-out procedures with and without release contingencies

A common recommendation for implementing time‐out procedures is to include a release contingency such that the individual is not allowed to leave time‐out until no problem behavior has occurred for a specific amount of time (e.g, 30 s). We compared a fixed‐duration time‐out procedure to a release contingency time‐out procedure with 4 young children (3‐ and 4‐year‐olds) using a reversal and multielement design. Results demonstrated that both time‐out procedures were effective at reducing problem behavior outside time‐out, problem behavior occurred in time‐out during both procedures, and problem behavior in time‐out was not predictive of problem behavior outside time‐out.     

Escape as reinforcement and escape extinction in the treatment of feeding problems

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.     

An experimental analysis of negative reinforcement contingencies for adult-delivered reprimands

Seven adults participated in simulated teaching sessions with an experimenter who role played as a student with developmental disabilities. The experimenter engaged in problem behavior and either (a) terminated problem behavior contingent on participant reprimands (negative reinforcement) or (b) did not terminate problem behavior contingent on reprimands (extinction). Results suggested that reprimands were sensitive to negative reinforcement in the form of the immediate cessation of problem behavior. These preliminary findings support role play as a potentially viable laboratory model for analyzing behaviors of typical adults.     

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory‐integration‐based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.