Use of the High‐probability Instructional Sequence and Escape Extinction in a Child With Food Refusal

Abstract

We used the high‐probability (high‐p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high‐p sequence in the treatment of food refusal.

The Effects of Choice Between Nonpreferred Foods on the Food Consumption of Individuals with Food Selectivity

“…While positive reinforcement contingencies have been demonstrated to be effective for the treatment of individuals with food selectivity (Riordan, Iwata, Wohl, & Finney, 1980;Levin & Carr, 2001), several studies have also shown that positive reinforcement, when implemented alone, is ineffective in treating food refusal (Patel, Piazza, Martinez, Volkert, & Sanatana, 2002;Dawson, Piazza, Sevin, Gulotta, Lerman, & Kelly, 2003;Piazza, Patel, Gulotta, Sevin, & Layer, 2003). While the latter studies concluded positive reinforcement as being ineffective for the treatment of feeding problems, it is possible the stimuli used in these studies may not have functioned as potent reinforcers to effectively compete with the reinforcer produced by escaping the demand to eat non-preferred foods.…”

“…Seeing as food selectivity has been previously conceptualized as a form of noncompliance in which the child refuses and escapes eating a sufficient variety of foods (Dawson et al, 2003), interventions utilizing escape extinction (i.e., non-removal of the spoon; NRS) have been widely researched and empirically validated as being effective in increasing the food consumption of individuals with food selectivity and related food refusal.…”

“…Although some studies have demonstrated an increase in food consumption without the use of escape extinction, many other studies have found escape extinction to be a critical component in treating feeding disorders (Cooper et al, 1995) or have found reinforcement interventions when implemented without escape extinction to be ineffective in treating problematic mealtime behavior (Patel et al, 2002;Dawson et al, 2003). Patel et al attempted to examine the differences between differential reinforcement for acceptance and differential reinforcement for mouth cleans on the food consumption of three participants with feeding disorders.…”

Evaluating the High-Probability Instructional Sequence to Increase the Acceptance of Foods with an Adolescent with Autism

“…The high-p sequence is used in various ways and has produced inconsistent outcomes in the feeding disorders literature, however. Dawson et al (2003) evaluated the high-p sequence with a 3-year-old girl who engaged in total food refusal and found that the high-p sequence had no impact when used in isolation and, moreover, that the high-p sequence did not add to the effectiveness of escape extinction (EE). Patel et al (2006) evaluated the effects of the high-p sequence on the acceptance of foods and inappropriate behavior with three young children with feeding difficulties.…”

Escape Extinction and Negative Reinforcement in the Treatment of Pediatric Feeding Disorders: a Single Case Analysis

“…Vaz et al (2011) increased self-feeding by the removal of non-preferred food after one self-fed bite. The literature includes research that evaluates a variety of reinforcement procedures that have shown to be effective when treating feeding problems (Dawson et al 2003;Piazza et al 2004).…”