An Alternating Treatments Comparison of Two Intensive Interventions for Food Refusal

Abstract

We compared two treatment packages involving negative reinforcement contingencies for 3 children with chronic food refusal. One involved physically guiding the child to accept food contingent on noncompliance, whereas the other involved nonremoval of the spoon until the child accepted the presented food. Subsequent to baseline, an alternating treatments comparison was implemented in a multiple baseline design across subjects. After each child had been exposed to at least nine sessions of each treatment condition and percentage of bites accepted had increased to at least 80%, the child's caregivers selected the preferred treatment package. The results indicated that both treatments were effective in establishing food acceptance. However, physical guidance was associated with fewer corollary behaviors, shorter meal durations, and parental preference.

A Practical Approach to Classifying and Managing Feeding Difficulties

“…Specialized techniques proven to be effective by behavioral therapists include distraction to avoid gagging, 49 use of a chaser to overcome "pocketing" (food retained in the cheeks), 72 following the mouth of the child with the spoon, or guiding the child physically to accept food. 73 Recently, medications to suppress visceral hyperalgesia have helped establish normal feeding in tube-fed children. 74 …”

Parental Use of Escape Extinction and Differential Reinforcement to Treat Food Selectivity

“…One intervention reported to be effective in such settings is escape extinction (i.e., nonremoval of the spoon) combined with differential reinforcement of acceptance (DRA; e.g., Ahearn, Kerwin, Eicher, Shantz, & Swearingin, 1996). Although previous studies have shown that parents can be trained to implement escape extinction after intervention gains are obtained by trained therapists (e.g., Ahearn et al), little research has systematically evaluated parents' ability to serve as initial change agents.…”

Treatment of Selective and Inadequate Food Intake in Children: A Review and Practical Guide

“…A multi-component treatment package consisting of positive reinforcement and escape extinction is the most commonly used intervention for this problem (e.g., Ahearn, Kerwin, Eicher, Shantz, & Swearingin, 1996;Babbitt et al, 1994;Cooper et al, 1995;Kerwin, Ahearn, Eicher, & Burd, 1995;Piazza, Patel, Gulotta, Sevin, & Layer, 2003). The positive reinforcement component typically involves providing the child with access to preferred stimuli (e.g., food, toys, praise, tokens) for desired eating behavior (i.e., accepting or swallowing bites).…”