A translational evaluation of renewal of inappropriate mealtime behavior

Abstract

The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function-based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function-based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function-based extinction with high levels of integrity.

A review of investigations of operant renewal with human participants: Implications for theory and practice

“…However, some authors have used different criteria for determining if renewal occurred. For example, in Case 66 described by Ibañez et al (), target responding increased during the fourth renewal‐test session and the authors described this as renewal despite responding being low during the three preceding renewal sessions. Liddon et al () did not describe this as renewal for a similar delayed effect in Case 23.…”

“…Another difference between renewal studies using humans compared to nonhuman animals is that experiments are often conducted across calendar days wherein participants are exposed to different contexts and contingencies between and within experimental phases. Ibañez et al () indicated that their investigation of ABA renewal of inappropriate mealtime behavior took between 5 to 10 business days to complete and in their results indicated when a new day began. For the majority of participants, increases in inappropriate mealtime behavior were observed on the first session of a new day, both in the elimination phase (i.e., therapists implementing extinction) and in the reintroduction of the original context in the final phase (i.e., caregivers implementing extinction).…”

“…When examining the five studies (Ibañez et al, ; Kelley et al, ; Mitteer et al, ; Pritchard et al, ; Saini et al, ) that evaluated renewal of clinically meaningful behavior, three reported fidelity results. Of those three studies (Ibañez et al, ; Mitteer et al, ; Saini et al, ), only Saini et al () described fidelity during the renewal test specifically. That is, Ibañez et al () and Mitteer et al () described fidelity only collapsed across experimental phases and did not describe the form of errors when fidelity was imperfect (e.g., reinforcer omission vs. delivery; phase in which error occurred).…”

“…Of those three studies (Ibañez et al, ; Mitteer et al, ; Saini et al, ), only Saini et al () described fidelity during the renewal test specifically. That is, Ibañez et al () and Mitteer et al () described fidelity only collapsed across experimental phases and did not describe the form of errors when fidelity was imperfect (e.g., reinforcer omission vs. delivery; phase in which error occurred). Future studies should aim to report fidelity across all phases, especially during the renewal test if other variables besides the context change might be responsible for relapse.…”

“…This objective method of determining a renewal effect is consistent with that used in previous research (Berry et al, ; Kelley et al, ; Liddon, Kelley, Rey, Liggett, & Ribeiro, ; Nakajima et al, ; Sweeney & Shahan, ). We also assessed the correspondence of renewal prevalence when using this definition compared to (a) when a relative increase in target behavior responding was observed during any session of the renewal test compared to the final session of the response elimination phase (e.g., Ibañez, Piazza, & Peterson, ) and (b) the conclusions of whether a renewal effect was observed based on the interpretation of the authors of each respective study.…”