THE COSTS OF EATING: A BEHAVIORAL ECONOMIC ANALYSIS OF FOOD REFUSAL

Behavioral economic concepts were applied to the analysis and treatment of pediatric feeding disorders in a clinical setting. In Experiment 1, children who chronically refused food were presented with varying amounts of food on a spoon (empty, dipped, quarter, half, and level). Each child exhibited a different but orderly demand function of response (acceptance, expulsion, and mouth clean) by cost (increasing spoon volume) for a constant pay-off of toys and social interaction. In Experiment 2, physical guidance or nonremoval of the spoon for food refusal was initiated at the smallest spoon volume with low levels of acceptance, and was subsequently introduced at the largest spoon volume with moderate levels of acceptance. Treatment was effective in increasing acceptance, and these effects generalized hierarchically across untargeted spoon volumes. The results of both studies provide preliminary support that increasing spoon volume can be equated conceptually with increasing response effort, and that the change from differential reinforcement to physical guidance or nonremoval of the spoon appears to have altered the elasticity of each child's demand function.     

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.     

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a child's school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.     

饮酒期望、饮酒拒绝自我效能与青少年的饮酒行为:有中介的调节效应分析

以544名初一、初二、高一和高二的学生为研究对象,考察在控制了相关人口学变量后,消极饮酒期望对积极饮酒期望与青少年饮酒行为关系的调节作用,以及饮酒拒绝自我效能对消极、积极饮酒期望及两者交互作用与饮酒行为关系的中介作用。结果发现:(1)28.31%的中学生在过去一个月中曾饮酒,其中13.60%在过去一个月中曾大量饮酒,8.27%曾醉酒;(2)积极饮酒期望能正向预测青少年的饮酒行为,消极饮酒期望在积极饮酒期望与青少年饮酒行为关系中发挥调节作用;(3)饮酒拒绝自我效能在消极饮酒期望与饮酒行为关系中起部分中介作用,在积极饮酒期望与饮酒行为的关系以及消极饮酒期望的调节作用中发挥了完全中介作用;(4)调节效应的中介机制表明,低消极期望组中,随着积极期望的提高,饮酒拒绝自我效能呈直线下降的趋势;而在高消极期望组中,无论积极期望高或者低,饮酒拒绝自我效能均较高。研究结果对青少年饮酒行为的干预有重要的指导意义。     

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.     

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.     

Use of the high-probability instructional sequence and escape extinction in a child with food refusal

We used the high-probability (high-p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high-p sequence in the treatment of food refusal.     

Modular Treatment for Children and Adolescents With Problematic School Absenteeism: Development and Description of a Program in Germany

Problematic school absenteeism is defined as absence from school occurring with a clinical-level mental disorder. It represents a higher-order term for school refusal, school truancy, and the combination thereof and is associated with an increased risk for school dropout, prolonged mental disorders, and unemployment. This article describes the manualized modular treatment of problematic school absenteeism (MT) by a multiprofessional team. The manual was developed to target a broad spectrum of mental disorders characterized by internalizing but also externalizing behavior. The therapeutic focus is on the reintegration into school and on the cognitive behavioral treatment of the mental disorder. The MT is based on a multilevel model of problematic school absenteeism. The treatment is informed by an extensive case-conceptualization and addresses motivational aspects by offering a low-threshold therapeutic design and motivational interviewing. Core interventions are represented in four modules: cognitive behavioral therapy, family counseling, school counseling, and a psychoeducational physical exercise program. A case vignette provides an illustration of the treatment and the specific graduated approach for school reintegration. The current modular approach is discussed in relation to other cognitive-behavioral manuals targeting a broad spectrum of mental disorders or school refusal.     

Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors

A student’s academic and social-emotional development is increasingly jeopardized with mounting absence from school. School refusal (SR) is one type of school attendance problem (SAP) that is often associated with absence from school. Once established, it can sometimes be difficult to treat. To prevent established SR and associated problems, indicators of emerging SR and risk for SR should be efficiently identified and acted upon. Risk factors are often discussed in relation to SAPs generally rather than considering risk for specific types of attendance problems. Based on literature review, this paper provides an account of the likely signs and risks for emerging SR. A school-based framework is provided to support school personnel and parents in working together to identify these signs and risks. Several challenges associated with the implementation of the framework are discussed.     

Developing an Online Early Detection System for School Attendance Problems: Results From a Research-Community Partnership

School refusal and other school attendance problems are vexing problems for school-aged youth, families, school personnel, and clinicians. However, few resources exist to detect problematic attendance. The current report describes three steps of a research-community partnership to develop an early identification program to detect youth at risk for problematic attendance. First, a survey was conducted to estimate the scope and cost of school refusal across grades K–12. School administrators estimated relatively few youth exhibiting significant school refusal (missing 5 or more days per year) but estimated the costs associated with services for these youth to be very high (mean cost of in-district programs: $94,052; mean cost of out-of-district placements: $496,657). Second, elementary school counselors were tasked with tracking absenteeism among at-risk youth using an online attendance tracking prototype. Counselors identified a high number of youth who showed elevated absences, lates, or early departures (17.2% of enrolled students), and counselor ratings were significantly related to whether the student (a) had received an individualized education plan or 504 plan, (b) had a sibling with similar attendance problems, (c) was older, or (d) had divorced or separated parents. In a final step, counselor feedback was sought and revisions were incorporated in the attendance tracker. Findings reinforce the prevalence and cost of school attendance problems, provide guidance for using technology to monitor attendance and related indices (tardies, early departures), and direct attention to youth factors that may be useful in identifying youth at risk for poor attendance.