Examining extinction bursts in the treatment of pediatric food refusal

Abstract

Escape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly.Considerations for using escape extinction in interventions will be discussed. K E Y W O R D Sescape extinction, extinction burst, food refusal, pediatric food refusal

The extinction burst: Impact of reinforcement time and level of analysis on measured prevalence

“…On a session‐wide level, none of the eight rats showed an increase in response rate following the implementation of extinction within‐session, regardless of whether reinforcement consumption time was included in response rate calculations or not and regardless of whether baseline mean or maximum response rates were used as the relevant comparison. As in previous studies, we saw more evidence of an extinction burst when responding during only the first minute following the transition to extinction was considered (Katz & Lattal, 2020; Lattal et al, 2020; Woods & Borrero, 2019). Our analyses also compared the difference between within‐session analyses when calculated with or without reinforcer consumption time included and showed that inclusion of this time in baseline response rate calculations can increase the apparent prevalence of an extinction burst in the first minute of exposure to extinction.…”

“…Finally, when reinforcement time was included in rate calculations, the prevalence of the extinction burst was always greater than when it was excluded from such calculations. Overall, these findings correspond with previous research suggesting that the extinction burst is likely to be most apparent based on samples of time smaller than an entire session (e.g., Donny et al, 1995;Harris et al, 2007;Katz & Lattal., 2020;Lattal et al, 2020;Pushparaj et al, 2012;Salamone et al, 1995;Schramm-Sapyta et al, 2006;Woods & Borrero, 2019). Thus, when it occurs, the extinction burst appears to be a relatively short-lived phenomenon.…”

“…When reinforcement delivery time was included, any responses made to the target lever during the reinforcer delivery period were also included in the rate calculation. Second, given the findings of previous authors showing transitory rate increases during extinction on smaller, within-session timescales (e.g., Donny et al, 1995;Harris et al, 2007;Lattal et al, 2020;Katz & Lattal, 2020;Pushparaj et al, 2012;Salamone et al, 1995;Woods & Borrero, 2019), we also compared responding in the first minute of each of the last five baseline sessions to responding in the first minute of the first three extinction sessions. Following the analyses of Katz and Lattal (2020), in both the session-wide and first-minute analyses, we also considered both the means and maximums of response rates in the final five baseline sessions, both with and without reinforcement delivery time included in the rate calculations.…”

“…Like Lattal et al, Katz and Lattal found no evidence of extinction bursts according to the definition of Lerman and colleagues, but when 1-min bins of responding were considered, the prevalence of transient increases in response rate during extinction increased to at most 39.5%. Likewise, a clinical study conducted by Woods and Borrero (2019) reported a small difference in the frequency of bursts during pediatric food refusal based on their analyses. When analyzing within-session response rates, 4 of 10 patients showed an extinction burst, whereas only 3 of 10 did so when session-wide response rates were considered.…”

Behavior-Analytic Treatment Progression for a Child With Tube Dependence: Reaching Age-Typical Feeding

“…Simultaneously, the child learns that if he or she does not quickly accept what is presented or tries to push it away, it will not be removed and positive reinforcement will not be delivered. Extinction procedures are commonly associated with undesirable side effects such as extinction bursts; however, Woods and Borrero (2019) concluded that extinction bursts occurred for a small portion of children during escape extinction treatment for feeding problems (30%). Nevertheless, escape extinction to treat feeding problems may not be appropriate in typical settings and should be implemented by highly trained staff to ensure high integrity (Bachmeyer, 2009) 2 Case Introduction…”