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.

Background People with multiple sclerosis (MS) have varied experiences and approaches to self‐management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. Methods A meta‐synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge‐users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. Results Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health‐care sector; and work, social and family life). Conclusion The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.

The authors evaluated the responsiveness of 4 preschool-aged children to positive reinforcers within a concurrent operants paradigm during mealtimes. The children were presented with two identical, concurrently available sets of food. Each set differed in quantity and quality of positive reinforcement paired with acceptance of each bite of food or in the number of bites of food required to obtain positive reinforcement. Experiment 1 evaluated 1 child's responsiveness to positive reinforcement while permitting escape from bite offers. Experiment 2 evaluated 2 children's responsiveness to positive reinforcement when escape extinction occurred. Results from these experiments suggested that the children were responsive to positive reinforcers and chose more often the bites paired with the greater quantity and/or quality of reinforcement. Experiment 3 evaluated 1 child's responsiveness to positive reinforcement both without and with escape extinction. Results suggested that positive reinforcement affected choice behavior and that escape extinction affected amount of food consumed.

A forced-choice preference assessment was conducted in which two dependent measures were used to select preferred stimuli: (a) approach responding and (b) latency to the first aberrant response. Stimuli identified as preferred based on both dependent measures were then evaluated during treatment. The results suggested that latency may be a useful measure in the selection of preferred stimuli during forced-choice assessments.DESCRIPTORS: forced choice, preference assessment, hand mouthingOne method that has been successfully used to identify reinforcers for persons with disabilities is the forced-choice procedure (Fisher et al., 1992). This procedure involves two steps. First, stimuli are presented in pairs, and preferred stimuli are selected based on the relative frequency of an approach response. Second, the results obtained during Step 1 are validated by demonstrating that stimuli approached most frequently serve as potent reinforcers for other responses. In the present investigation, we examined an additional dependent measure for identifying preferred stimuli during forced-choice assessments: the latency between stimulus presentation and the first occurrence of aberrant behavior. We provide two case examples in which approach behavior and latency were used to select preferred stimuli. The stimuli selected as preferred were then used as positive reinforcers during treatment.METHOD: Subjects and settings. The participants were Rick, a 7-year-old male, and Trina, a 3-year-old female, both diagnosed with profound mental retardation. Rick was also diagnosed with significant hypotonia and was legally blind. Both children engaged in hand-and object-mouthing behavior, and Rick also engaged in eye gouging and repetitive hand wringing. For both children, aberrant behavior occurred throughout the day, and a maintaining consequence was not identified during functional analyses.For Rick, sessions were conducted by unit staff in a classroom located on a hospital inpatient unit. For Trina, sessions were conducted in the living room of her home. Trina's evaluation was completed by her mother with direct consultation from the first author.Forced choice. Sessions were videotaped and data were collected on approach to stimuli and latency to first aberrant response. Interobserver agreement was computed by dividing agreements by agreements plus disagreements and multiplying by 100%. Interobserver agreement was assessed during 80% of the stimulus presentations. For latency, an agreement was scored if the time recorded across observers was within 1 s. Interobserver agreement for both measures was 100%.The children were exposed to four stimuli (Rick: ball, vibrator, radio, and stuffed animal; Trina: See & Say®, pop-up toy, houseshaped block sorter, and ball-shaped block sorter) using a modification of the forced-choice method described by Fisher et al. (1992). At least 15 presentations of each stimulus were completed (range, 15 to 25). The children were provided with access to the stimuli they approached until either an aberrant r...