A Review of the Literature on the Functional Analysis of Inappropriate Mealtime Behavior

Abstract

A functional analysis is a well-established and widely used assessment in the treatment of challenging behavior. Given the fact that functional analysis results can inform treatment selection and procedures, a review of the current literature regarding functional analysis of inappropriate mealtime behavior (IMB) is warranted as it may guide researchers in conducting a functional analysis prior to treating IMB. This review summarizes the literature regarding functional analysis of IMB. Fourteen studies that implemented a functional analysis of IMB were identified and summarized based on procedural components of the functional analysis, results, and treatment selection. Results indicate functional analysis of IMB to be effective in the identification of variables maintaining IMB. Although functional analysis of IMB has been found to be helpful, several areas for further research and evaluation are identified.

An evaluation of trial‐based functional analyses of inappropriate mealtime behavior

“…In addition, the trial‐based functional analysis identified a similar percentage of cases to be multiply maintained by escape and attention (29% compared to 20% ‐ 48%), whereas the extended functional analysis identified more cases to be multiply maintained by escape and attention (71% compared to 20% ‐ 48%). Unlike previous studies, which found attention to be the sole maintaining variable in 0% ‐ 2% of cases (Hodges et al, 2020; Saini, Jessel, et al, 2019; Saini, Kadey, et al, 2019), the trial‐based functional analysis in this study found attention to be the sole maintaining variable for 29% of cases. It is important to note that this study and previous studies evaluating the maintaining variables of inappropriate mealtime behavior may not be representative of the overall pediatric feeding disorders population.…”

“…In comparison to other studies reviewing the maintaining variables of inappropriate mealtime behavior (Hodges et al, 2020; Saini, Jessel, et al, 2019; Saini, Kadey, et al, 2019), we found a lower percentage of children's inappropriate mealtime behavior was maintained by only escape (14% from trial‐based and extended functional analyses compared to 33% ‐ 80%). In addition, the trial‐based functional analysis identified a similar percentage of cases to be multiply maintained by escape and attention (29% compared to 20% ‐ 48%), whereas the extended functional analysis identified more cases to be multiply maintained by escape and attention (71% compared to 20% ‐ 48%).…”

“…Researchers have modified traditional analog functional analyses to test the effects of relevant consequences for a child's inappropriate mealtime behavior (Bachmeyer et al, 2009; Girolami & Scotti, 2001; Najdowski et al, 2003; Piazza, Fisher, et al, 2003). Recent reviews of published functional analyses with children with pediatric food refusal have found that escape (i.e., breaks from eating) maintains inappropriate mealtime behavior, exclusively or in part, in 81%‐100% of cases (Hodges et al, 2020; Saini, Jessel, et al, 2019; Saini, Kadey, et al, 2019). The high likelihood of identifying an escape function has led some researchers to suggest that functional analyses for inappropriate mealtime behavior may be unnecessary (e.g., Saini, Jessel, et al, 2019).…”

“…Although extended functional analyses can accurately identify reinforcers, the majority of practitioners report they do not use functional analyses due to limited resources and acceptance of the procedure (Oliver et al, 2015; Roscoe et al, 2015). Specific to inappropriate mealtime behavior, researchers have reported that the total time required to run the analysis is one of the largest barriers (e.g., Hodges et al, 2020). In a review of functional analyses among children with food refusal and selectivity, Saini, Kadey, et al (2019) found published functional analyses took an average of 290 min (range 55‐850 min) based on the reported data.…”

Further evaluation of contingency modeling to increase consumption of nutritive foods in children with autism and food selectivity

“…NRS increases consumption of nutritive foods by eliminating the negative reinforcement contingency (i.e., escape from the bite or meal) that maintains IMB. This is accomplished by keeping the spoon at the midline of the child's lips until they accept the bite (e.g., Hodges et al, 2020). However, NRS may produce short-term increases in IMB such as extinction bursts (e.g., Piazza et al, 2003;Woods & Borrero, 2019) and aggression (e.g., Bachmeyer, 2009).…”