No 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.

Behavioral economic concepts were applied to the analysis and treatment of pediatric feeding disorders in a clinical setting. In Experiment 1, children who chronically refused food were presented with varying amounts of food on a spoon (empty, dipped, quarter, half, and level). Each child exhibited a different but orderly demand function of response (acceptance, expulsion, and mouth clean) by cost (increasing spoon volume) for a constant pay-off of toys and social interaction. In Experiment 2, physical guidance or nonremoval of the spoon for food refusal was initiated at the smallest spoon volume with low levels of acceptance, and was subsequently introduced at the largest spoon volume with moderate levels of acceptance. Treatment was effective in increasing acceptance, and these effects generalized hierarchically across untargeted spoon volumes. The results of both studies provide preliminary support that increasing spoon volume can be equated conceptually with increasing response effort, and that the change from differential reinforcement to physical guidance or nonremoval of the spoon appears to have altered the elasticity of each child's demand function.

An ABAC comparison of two treatment packages for food refusal, physical guidance and nonremoval of the spoon, was conducted with two children with limited food acceptance. Both of these treatment packages included prevention of escape from presented food. Subsequent to baseline, one of the two treatment packages was implemented for each child. The treatment packages were implemented ABAC for one child and ACAB for the other child. Once the percentage of bites accepted had increased to at least 75% with the initial exposure to a treatment package, that treatment was withdrawn with a subsequent exposure to the second treatment package. The results indicated that both treatment packages were effective in establishing food acceptance. Also, initial exposure to either of the two treatment packages facilitated acquisition of food acceptance during the second exposure. Parental preference of the treatment package may have been influenced by the order of exposure to the treatment conditions.

No abstract