Accumulated‐ and distributed‐reinforcer arrangements in the treatment of challenging mealtime behavior

Abstract

Treatment for inappropriate mealtime behavior often includes extinction and differential reinforcement of alternative behavior (DRA) in a distributed arrangement in which delivery of brief reinforcer access immediately follows each appropriate mealtime response. Alternatively, DRA may be arranged using accumulated reinforcement wherein delivery of longer, continuous access to reinforcers follows the consumption of multiple consecutive bites. Research has suggested that individuals prefer and perform better under accumulated arrangements in academic settings; however, no research to date has evaluated the efficacy of accumulated arrangements with children with feeding disorders. We compared preference for and efficacy of distributed and accumulated (with and without tokens) reinforcement with nonremoval of the spoon. All three treatments effectively reduced inappropriate mealtime behavior and increased acceptance for two participants and decreased packing and increased mouth clean for one participant. Two participants preferred distributed reinforcement and one preferred accumulated reinforcement without tokens. Findings differ from some previous research, which demonstrated that participants favored accumulated arrangements in academic contexts.

A review of the concurrent‐chains arrangement to assess intervention choice: 2018–2023

“…Other studies included concurrent‐chains assessments that researchers implemented to identify preference for interventions targeting challenging behavior. These include evaluating preference for different interventions (e.g., Owen et al, 2021), different reinforcers within similar treatments (e.g., Irwin Helvey et al, 2023), schedule‐thinning procedures (e.g., Briggs et al, 2018), or reinforcer distribution (e.g., Chen et al, 2022; Fulton et al, 2020). Overall, the literature suggests that concurrent‐chains arrangements have been a simple yet beneficial way to objectively measure intervention choice among recipients of behavior‐change programming.…”

“…When preference was evaluated, researchers commonly conducted a brief preference assessment (e.g., multiple stimulus without replacement). In some studies, moderately preferred colored stimuli were used as initial‐link stimuli (e.g., Chen et al, 2022; Markham et al, 2020b). In other studies, highly preferred colored stimuli were assigned to the control condition (e.g., Holmes et al, 2022; Owen et al, 2021).…”

“…For example, Fulton et al (2020) presented initial‐link stimuli for accumulated and distributed reinforcement conditions in addition to a baseline control during which challenging behavior resulted in escape from instruction and compliance resulted in praise. Similarly, Chen et al (2022) included a baseline‐control condition in which inappropriate mealtime behavior resulted in escape. Although arranging a baseline control condition may offer important information regarding preference for treatments for challenging behavior, using baseline contingencies as a control condition may not be feasible in some cases (e.g., if challenging behavior is too dangerous to reinforce).…”

Teaching behavior analysts in an early intensive behavioral intervention setting to conduct a structured mealtime protocol

“…Components like these are common in the procedures of published feeding studies. For example, Chen et al (2022) described how feeders conducted mouth checks and Haney et al (2021) included information about the bolus size for each study participant. Clinically, the structure is added because these components represent a consistent stimulus condition from which changes are systematically made.…”

“…For example, Chen et al. (2022) described how feeders conducted mouth checks and Haney et al. (2021) included information about the bolus size for each study participant.…”