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.     

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.     

Altering the timing of academic prompts to treat destructive behavior maintained by escape

Following a functional analysis showing that destructive behavior was reinforced by escape, we altered the aversiveness of task demands by interspersing easy and difficult tasks and by presenting a corrective prompt as an antecedent event the next time a previously failed item was presented; this procedure was compared with one in which the corrective prompt was provided as an immediate consequence. Results of a reversal design showed that the antecedent prompt acted as an establishing operation and reduced destructive behavior to zero.     

Assessment and treatment of escape from attention in the form of conversation

The purpose of this study was to evaluate treatment procedures for problem behavior maintained by escape from attention in the form of conversation for a child diagnosed with autism spectrum disorder. After conducting a functional analysis that confirmed this function, we implemented a preference assessment to identify some forms of attention that were not aversive. Treatment consisted of four conditions, implemented in a series of reversals. During each condition, the participant chose from some of the following concurrently available options: three forms of attention, escape from conversation, and escape from conversation with a 2‐min delay. We implemented the delay to reduce (devalue) the reinforcing value of escape from conversation. The participant preferred escape from conversation to social interaction when all four consequences were available immediately. When escape from conversation was possible with a delay, the participant's preference changed to social interaction. Implications for clinical practice and future research are discussed.     

Choices between positive and negative reinforcement during treatment for escape-maintained behavior.

Positive reinforcement was more effective than negative reinforcement in promoting compliance and reducing escape‐maintained problem behavior for a child with autism. Escape extinction was then added while the child was given a choice between positive or negative reinforcement for compliance and the reinforcement schedule was thinned. When the reinforcement requirement reached 10 consecutive tasks, the treatment effects became inconsistent and reinforcer selection shifted from a strong preference for positive reinforcement to an unstable selection pattern.     

From Glossy to Greasy: The Impact of Learned Associations on Perceptions of Food Healthfulness

We demonstrate that consumers have learned that unhealthy snacks such as potato chips tend to be sold in glossy packages, whereas healthier snacks such as crackers tend to be sold in matte packages (in studies 1–3). As a result, consumers who see a snack food package with a glossy [matte] surface will infer lesser [greater] healthfulness of its contents (study 4), consume less [more] of it (study 5), and be more likely to choose a glossy [matte] package from an assortment of snack packages if motivated to engage in tasty [healthful] eating (study 6). Theoretical and managerial implications as well as future research opportunities are discussed.     

Food preferences before and during treatment for a pediatric feeding disorder

Little is known about the food preferences of children with a feeding disorder and medical diagnoses. Therefore, we conducted repeated paired-stimulus-preference assessments with foods to which we either exposed or did not expose 3 children with a feeding disorder and medical diagnoses during clinical treatment. Responding was relatively equivalent for exposure and nonexposure foods throughout the preference assessments, suggesting that preferences for foods did not change due to exposure during treatment.     

Comparison of upright and flipped spoon presentations to guide treatment of food refusal

The current study examined the effects of bite placement with a flipped versus upright spoon on expulsion and mouth clean (product measure of swallowing) in the treatment of 3 children diagnosed with a pediatric feeding disorder and oral-motor deficits. For all 3 participants, extinction in the form of nonremoval of the spoon led to improvements in inappropriate mealtime behavior and acceptance of bites; however, re-presentation did not reduce expulsion or improve mouth clean. Results showed a lower level of expulsion and higher percentage of mouth clean during flipped spoon presentations and re-presentations for all participants. Findings from follow-up analyses supported transitioning back to an upright spoon in all 3 cases, although the time required for this to occur differed across participants.     

Using a flipped spoon to decrease packing in children with feeding disorders

We evaluated the effects of redistribution and swallow facilitation with a flipped spoon on packing in 2 children with a feeding disorder. For both participants, packing decreased when we implemented the flipped spoon treatment package. Mechanisms responsible for behavior change and areas of future research are discussed.     

Depressive realism and clinical depression

Depressive realism suggests that depressed individuals make more accurate judgments of control than their nondepressed counterparts. However, most studies demonstrating this phenomenon were conducted in nonclinical samples. In this study, psychiatric patients who met criteria for major depressive disorder underestimated control in a contingent situation and were consistently more negative in their judgments than were nondepressed controls. Depressed patients were less likely than their nondepressed counterparts to overestimate control in a noncontingent situation, but largely because they perceived receiving less reinforcement. Depressed patients were no more likely to use the appropriate logical heuristic to generate their judgments of control than their nondepressed counterparts and each appeared to rely on different primitive heuristics. Depressed patients were consistently more negative than their nondepressed counterparts and when they did appear to be more “accurate” in their judgments of control (as in the noncontingent situation) it was largely because they applied the wrong heuristic to less accurate information. These findings do not support the notion of depressive realism and suggest that depressed patients distort their judgments in a characteristically negative fashion.