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.     

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.     

Evaluation of empirical pretreatment assessments for developing treatments for expulsion in pediatric feeding disorders

A common problem among children with feeding disorders is expulsion (removing or spitting food or drink from the mouth), which interferes with treatment success when the goal is consumption. Previous research has identified effective treatments to reduce expulsion, most commonly—re-presentation (presenting the expelled bite or a new bite of the same food immediately following the expulsion). However, there is not currently an assessment model in place to inform treatment decisions with a goal to reduce expulsion. In the present study, we used a multielement design to identify conditions under which little or no expulsion occurred with three children with feeding disorders. The results of the assessment were then used to inform treatment selection aimed to eliminate expulsion. The comparisons of the assessment included physical prompt, bite number, texture, preference, bite presentation style, and size of the bite. Results suggest that this assessment was useful for the design of individualized treatments for children who frequently expel food.     

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.     

BEHAVIORAL ASSESSMENT OF FEEDING PROBLEMS OF INDIVIDUALS WITH SEVERE DISABILITIES

As many as 80% of the individuals with severe or profound mental retardation exhibit feeding problems. Although behavioral interventions have been used to treat these problems, no assessment procedure for determining a functional relationship between a person's acceptance of food and the type and texture of that food has been reported. The purpose of this study was to test a behavioral assessment procedure for a feeding problem of limited intake. Five individuals with severe or profound mental retardation were fed 10 to 12 types of foods with one or more textures. Behavioral categories of acceptance, rejection, expulsion, and other negative behavior were recorded. Results indicated that each subject fit into one of four categories of feeding problems: (a) total refusal, (b) type selectivity, (c) texture selectivity, or (d) type and texture selectivity. Thus, although all 5 subjects exhibited limited intake, the food characteristics correlated with the problem were different for each individual. Results suggest that treatments for limited intake may be based on assessments that show the association of food type or texture to a person's rejection or expulsion of food.     

An evaluation of food type and texture in the treatment of a feeding problem

An evaluation of food type and texture indicated that both variables affected the expulsions of a 3-year-old with feeding problems. The results of the evaluation were used to prescribe a treatment (reducing the texture of one food type) that reduced expulsion.     

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.     

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.     

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.     

Social Information Guides Infants' Selection of Foods

Two experiments investigated the influence of socially conveyed emotions and speech on infants' choices among food. After watching films in which two unfamiliar actresses each spoke while eating a different kind of food, 12-month-old infants were allowed to choose between the two foods. In Experiment 1, infants selected a food endorsed by a speaker of their native language who displayed positive affect over a food endorsed by a foreign-language speaker who displayed negative affect. In Experiment 2, both actresses displayed positive affect, but they spoke in different languages, and infants again selected the food associated with the speaker of their native language. The findings contrast with previous research in which infants and toddlers have shown little selectivity when presented with foods that differ in their intrinsic properties such as color, texture, and familiarity. Although infants may lack capacities for evaluating foods on their own, they do look to other people for guidance in food selection.     

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.     

Use of a multicomponent treatment for food refusal

We examined the use of a multicomponent treatment for food refusal exhibited by a 5-year-old boy who had been diagnosed with mild to moderate mental retardation. Treatment consisted of access to highly preferred tangible items, which were removed contingent on problem behavior or not accepting a bite, and differential reinforcement of alternative behavior. Treatment resulted in an increase in food acceptance to 100% of bite offers and near-zero rates of problem behavior. In addition, the participant's caregivers were successfully trained to implement the treatment.     

A systematic evaluation of food textures to decrease packing and increase oral intake in children with pediatric feeding disorders

This study examined packing (pocketing or holding accepted food in the mouth) in 3 children who were failing to thrive or had inadequate weight gain due to insufficient caloric intake. The results of an analysis of texture indicated that total grams consumed were higher when lower textured foods were presented than when higher textured foods were presented. The gram intake was related directly to levels of packing. That is, high levels of packing were associated with higher textured foods and low gram intake, and low levels of packing were associated with lower textured foods and high gram intake. All participants gained weight when texture of foods was decreased. Packing remained low during follow-up for 2 participants even when the texture of food was increased gradually over time. These data are discussed in relation to avoidance, response effort, and skill deficit.     

Effects of Lag Schedules and Response Blocking on Variant Food Consumption by a Girl with Autism

Food selectivity by individuals with autism spectrum disorder (ASD) is often viewed in the behavioral literature as a problem with compliance and treated accordingly. However, when viewed as a problem with invariance, it may be appropriate to treat the problem by using procedures that increase variant food consumption. Lag schedules of reinforcement have been shown to increase variability in verbal and play behavior of children with ASD. Therefore, we attempted to evaluate the effects of a lag schedule of positive reinforcement on variant food consumption by a girl with ASD and food selectivity. Ultimately, a lack of baseline variability in consumption precluded an evaluation of the programmed lag schedule but suggested that a discovery research approach may be informative. Thus, additional treatment components were added and evaluated in a component analysis. Response blocking of invariant consumption appeared to establish a lag schedule of reinforcement that increased variability and variety in food consumption, which was maintained across changes in the value of the lag schedule. Some potential behavioral processes responsible for the effects and implications for future research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

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.     

Effect of two methods of introducing foods during feeding treatment on acceptance of previously rejected items

The effects of using a single food item (e.g. bread) versus using multiple items (e.g. bread, pasta, and rice) when establishing food acceptance via an escape prevention procedure were investigated with six children who presented with food selectivity. Eating was exposed to a differential reinforcement of food acceptance treatment package but food acceptance did not improve. Criterion levels of appropriate eating (> 80% acceptance, < 20% expulsion, and < 20% disruption) were subsequently established with either nonremoval of the spoon or physical guidance for each of the participants. Three of the children were presented with only one food item during acquisition of acceptance. The other children were presented with three different food items from the same food group. It was found that acquisition of acceptance was more rapid for the single‐item group but that food acceptance was more likely to generalize to previously rejected items for the multi‐item group. The implications for clinical intervention are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Assessment and treatment of object mouthing in a public school classroom

Little research has been conducted to evaluate the most effective treatments for object mouthing in school or classroom settings. The current case example illustrates the process for conducting a functional assessment and implementing treatment for object mouthing in a public school special education classroom. Teacher and parent interview, direct observations, and functional analysis were used to determine that the object mouthing of a 4‐year‐old girl with severe developmental disabilities was maintained by automatic reinforcement. Free operant preference assessments determined physical parameters of objects that were highly mouthed. Paired choice preference assessments determined which competing items to use in a treatment evaluation. Initial treatment consisted of fixed‐time delivery of a competing food item that reduced object mouthing to very low levels. To completely eliminate the mouthing, physical response blocking was added. Data are presented demonstrating the success of the treatment for up to 15 weeks of follow‐up after the initial treatment evaluation. Copyright © 2006 John Wiley & Sons, Ltd.     

SOME RELATIONS BETWEEN CLASSICALLY CONDITIONED AGGRESSION AND CONDITIONED SUPPRESSION IN SQUIRREL MONKEYS

During three experiments with squirrel monkeys, stimulus and shock pairings were given in the presence of a bite tube. Experiments 1 and 2 used a conditioned-suppression procedure in which bar pressing was reinforced with food. A transparent shield prevented biting of the bar. When the stimulus was paired with shock, bar pressing decreased (conditioned suppression) and tube biting increased during the stimulus (classically conditioned aggression). When the bite tube was removed on alternate sessions in Experiment 2, there was more suppression when the tube was present, thus suggesting that biting competed with bar pressing. However, this simple competing-response interpretation was complicated by the findings of Experiment 3 where, with naive monkeys, bar pressing was never reinforced with food, yet bar pressing was induced during the stimulus and was highest when the bite tube was absent. The fact that stimulus-induced bar pressing developed indicates that bar pressing in conditioned-suppression procedures, suppressed or not, may be maintained by two types of control—the food reinforcer and induced CS control. The higher rate of induced bar pressing during the stimulus with the bite tube absent confounds a simple competing response interpretation of conditioned suppression. It suggests that shock-induced responses during conditioned suppression could be both contributing to and competing with responding maintained by food, with the net effect depending on specific but ill-defined features of the situation.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.