Cueing,Demand Fading,and Positive Reinforcement to Establish Self-Feeding and Oral Consumption in a Child with Chronic Food Refusal

Abstract

A3-year-old child with multiple medical disorders and chronic food refusalwas treated successfully using a program that incorporated antecedent control procedures combined with positive reinforcement. The antecedent manipulations included visual cueing of a criterion number of self-feeding responses that were required during meals to receive reinforcement and a gradual increase in the imposed criterion (demand fading) that was based on improved frequency of oral consumption. As evaluated in a changing criterion design, the child learned to feed himself as an outcome of treatment. One year following intervention, hewas consuming a variety of foods and had gained weight. Advantages of antecedent control methods for the treatment of chronic food refusal are discussed.

Get full access to this article

View all access options for this article.

References

Ahearn, W. H. , Kerwin, M. E. , Eicher, P. S. , Shantz, J. , & Swearingin, W. (1996). An alternating treatments comparison of two intensive interventions for food refusal. Journal of Applied Behavior Analysis, 29, 321-332.

Barlow, D. H. , & Hersen, M. (1984). Single-case experimental designs: Strategies for studying behavior change. New York: Pergamon.

Illingworth, R. S. , & Lister, J. (1964). The critical or sensitive period, with reference to certain feeding problems in infants and children. Journal of Pediatrics, 65, 839-848.

Iwata, B. A. , Vollmer, T. R. , & Zarcone, J. R. (1990). The experimental (functional) analysis of behavior disorders: Methodology, applications, and limitations. In A. C. Repp & N. N. Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 301-330). Sycamore, IL: Sycamore.

Johnson, C. R. , & Babbitt, R. L. (1993). Antecedent manipulation in the treatment of primary solid food refusal. Behavior Modification, 17, 510-521.

Luiselli, J. K. (1994). Oral feeding treatment of children with chronic food refusal and multiple disabilities. American Journal of Mental Retardation, 98, 646-655.

Luiselli, J. K. , & Evans Luiselli, T. (1995). A behavior analysis approach toward chronic food refusal in children with gastrostomy-tube dependency. Topics in Early Childhood Special Education, 15, 1-18.

O’Brien, S. , Repp, A. C. , Williams, G. E. , & Christophersen, E. R. (1991). Pediatric feeding disorders. Behavior Modification, 15, 394-418.

Repp, A. C. , Felce, D. , & Barton, L. E. (1988). Basing the treatment of stereotypic and selfabusive behaviors on hypotheses of their causes. Journal of Applied Behavior Analysis, 21, 281-290.

10.

Repp, A. C. , & Karsh, K. G. (1994). Hypothesis-based interventions for tantrum behaviors of persons with developmental disabilities in school settings. Journal of Applied Behavior Analysis, 27, 21-31.

11.

Sugai, D. , & Luiselli, J. K. (1989). Behavioral medicine consultation. In J. K. Luiselli (Ed.), Behavioral medicine and developmental disabilities (pp. 199-225). New York: Springer.

12.

Werle, M. A. , Murphy, T. B. , & Budd, K. S. (1993). Treating chronic food refusal in young children: Home-based parent training. Journal of Applied Behavior Analysis, 26, 421-433.

13.

Zarcone, J. R. , Iwata, B. A. , Vollmer, T. R. , Jagtiani, S. , Smith, R. G. , & Mazaleski, J. L. (1993). Extinction of self-injurious escape behavior with and without instructional fading. Journal of Applied Behavior Analysis, 26, 353-360.