Association for Behavior Analysis International

In this symposium, we will discuss the effects of escape extinction in the treatment of pediatric feeding problems and describe treatments for food selectivity that involve choices, progressively increasing eating requirements, and differential reinforcement of appropriate eating without nonremoval of the spoon. Our first presenter will discuss the effects of escape extinction and differential reinforcement on selective eating. Our second presenter will identify the prevalence of extinction bursts during escape extinction interventions for food refusal. The third presenter will discuss the effects of an intervention that involves offering choices and shaping appropriate eating using synthesized reinforcers. The last presenter will review a treatment package that incorporates choice, differential reinforcement, stimulus fading, and modified escape extinction (nonremoval of the plate).

Behavior analysts, graduate students, educators, practitioners

Repetitive and restricted response patterns are one of the core features of autism spectrum disorder (ASD), which includes "resistance to change," behavior. Children with ASD may display resistance to change in the form of food selectivity. In fact, Schreck, Williams, and Smith (2004) found that 72% of children diagnosed with ASD had these types of feeding difficulties. In the current study, we demonstrated that our behavior-analysis intervention reduced resistance to change in the form of food selectivity to clinically acceptable levels for two participants between the ages of 3 and 8 diagnosed with ASD. We were able to shift the participants' responding from resistive feeding responses (e.g., always selecting hot dogs and cheerios) to alternative, appropriate feeding responses (e.g., selecting healthier target foods like chicken and green beans) by using differential reinforcement of alternative behavior and escape extinction. The treatment effects maintained when escape extinction was no longer in place. These results have implications for the treatment of other symptoms of resistance to change as well as the generalization of treatment effects from one symptom to another.

Food selectivity is a pervasive problem and affects up to 45% and 80% of individuals with and without disabilities, respectively. Food selectivity and mealtime problem behavior have primarily been treated through differential reinforcement and various forms of escape extinction. Escape extinction, while efficacious, may result in increased aggression, gagging, or vomiting and, therefore, may not be feasible to implement under some conditions. In response, we describe a model for addressing food selectivity without extinction for five young children who were highly selective eaters. The model involved: (a) indirectly and directly measuring food preferences in order to identify foods that established mealtime problem behavior and other foods that could be used as reinforcers, (b) evaluating the variables maintaining mealtime problem behavior through an interview-informed synthesized contingency analysis (IISCA), and (c) incorporating the assessment results into a progressive treatment process that relied on choice making opportunities and differential and synthesized reinforcement of successive approximations to eating.

Food selectivity (eating a narrow range of foods) is a common problem in children with autism spectrum disorder (ASD). Common dietary patterns in children with ASD include strong preference for processed foods coinciding with a bias against fruits and vegetables. Food selectivity in ASD increases the risk of underlying nutritional deficiencies and related medical complications, underscoring the need to identify effective interventions. While behavioral intervention is well-established for food refusal in young children, relatively few studies have examined treatment of food selectivity in ASD - particularly among older children who may require adaptations to established methods (e.g., non-removal of the spoon). This study evaluated the use of a treatment protocol involving choice, stimulus fading, reinforcement, and a modified extinction procedure (non-removal of the plate). Four male children (8-13 years) with food selectivity and ASD admitted to an intensive multidisciplinary day program received intervention based on established inclusion criteria. Mean number of foods accepted increased from 8 at admission to 28 at the time of discharge. These results provide provisional support for the use of this treatment package as an alternative to more well-documented extinction-based procedures among older children with ASD who can engage in a choice-based treatment model.