Association for Behavior Analysis International

Pediatric feeding disorders range in severity from mild selectivity to complete refusal. If left untreated, pediatric feeding disorders can result in serious health ramifications including malnutrition, growth delays, and developmental delays. In this symposium, we will describe treatments for disordered feeding that involve differential reinforcement, simultaneous presentation plus nonremoval of the spoon (NRS), synthesized reinforcement, and a variation of the finger prompt. Harrison and colleagues will present a study on the evaluation of how to best select an effective reinforcer for the treatment of food selectivity. McHugh and colleagues will present a study comparing a commonly used occupational therapy treatment (food chaining) to an empirically supported behavioral treatment (simultaneous presentation plus NRS) for the treatment of food selectivity in children with autism spectrum disorder. Gover and colleagues will present an extension of the use of shaping with synthesized reinforcers and partial extinction in treatment of pediatric food selectivity. Rubio and colleagues will present a study evaluating the efficacy and acceptability of a variation of the finger prompt to food refusal in children with feeding disorders.

Researchers and practitioners.

Differential reinforcement of alternative behavior is a widely used procedure to increase consumption of nonpreferred foods in children with food selectivity (e.g., Allison et al., 2012; Anderson & McMillan, 2001; Kern & Marder, 1996; Najdowski, Wallace, Doney, & Ghezzi, 2003). However, the types of reinforcing stimuli used varies across studies, including edibles, tangibles, attention, or a combination of edibles, tangibles, and attention. The purpose of the current study was to evaluate the use of a progressive ratio reinforcer assessment to identify a reinforcer that will most effectively increase the acceptance of nonpreferred foods. First, we conducted a progressive ratio reinforcer assessment using an arbitrary task. Then, we evaluated the effects of differential reinforcement using an edible, a tangible, a type of attention, or a combination of the stimuli as the reinforcer. We compared the effects of each reinforcer to the outcome of the progressive ratio reinforcer assessment to determine if this assessment accurately predicts the most effective reinforcer to be used during treatment for individuals with food selectivity. Preliminary results suggest the progressive ratio reinforcer assessment predicted the most effective reinforcer to be used during differential reinforcement with food selectivity for one participant.

Feeding disorders can range from mild (e.g., food selectivity by taste or texture) to severe (e.g., total food refusal). If left untreated, feeding disorders can result in serious health ramifications, including malnutrition, growth delays, and developmental delays. Recent studies comparing commonly used occupational therapy (OT) treatments and empirically supported applied behavior analysis (ABA) treatments found that the ABA treatments were effective for all participants while the OT treatments were ineffective for all participants. We used a multielement design to compare a modified version of commonly used OT treatment, Food Chaining, and an empirically validated ABA treatment, simultaneous presentation plus nonremoval of the spoon, to treat the food selectivity of 2 children with autism spectrum disorder (ASD). For both participants, consumption of the target foods only increased during the ABA-treatment condition. We subsequently faded the size of the preferred food within the simultaneous-presentation arrangement, moved to a sequential-presentation arrangement, and then thinned the schedule of reinforcement. We will discuss the results within the context of treatment implications, limitations, and suggestions for future research.

Gover, Hanley, Marcus, Ruppel, and Landa (in prep) described an assessment and treatment process addressing the food selectivity of five children with and without developmental disabilities. The process involved (a) indirectly and directly assessing food preference and problem behavior associated with mealtimes and (b) incorporating assessment results into a treatment process that relied on differential and synthesized reinforcement of successive approximates to eating. This paper extends that research by evaluating the process across novel populations including a group of three typically developing siblings using a group contingency and a young boy with autism who engaged in total food refusal and relied on a g-tube. Implications for practitioners and areas for future research will be discussed.