Association for Behavior Analysis International

The following presentations discuss current advances in the treatment of food selectivity and food refusal. Two intervention studies evaluate sequential presentation of preferred foods following acceptance of nonpreferred and novel foods. In one study, sequential presentation with repeated taste exposure is compared to sequential presentation with escape extinction. Another study examines the use of sequential presentation with and without feeder modeling. The third study evaluates the use of stimulus fading in the form of bolus size manipulation to increase acceptance of nonpreferred foods. The final study compares 2 methods of increasing volume of solids and liquids to increase caloric intake in children with feeding disorders.

Many children diagnosed with autism display severe and pervasive food selectivity and food refusal that impact their daily life (Ahearn, Castine, Nault, & Green, 2001). Interventions for these feeding problems are most often implemented in hospital and clinic settings (Williams & Foxx, 2007). Research has shown escape extinction, repeated taste exposure, and a Plate A/Plate B arrangement to be effective in treating feeding disorders (e.g., Paul, Williams, Riegel, & Gibbons, 2007). The purpose of the current study was to compare the effectiveness of the Plate A/Plate B intervention with and without taste exposure sessions for 2 children diagnosed with autism who also display severe challenging behavior. The intervention evaluation was conducted in an educational and campus residential setting. Preliminary results indicate that neither Plate A/Plate B nor Plate A/Plate B plus taste exposure intervention were effective. Increase in bite consumption occurred when escape extinction was added for all bite presentations. Possible explanations for the results obtained will be discussed as well as recommendations for future research.

The following study compared sequential presentation of preferred foods following acceptance of nonpreferred foods in a 4-year-old boy with food selectivity. Following acceptance of a bite of food on a plate of new and nonpreferred foods (Plate A), the child was presented with bite of food from a plate of preferred foods (Plate B). Child acceptance and disruptive behavior during the "Plate A-Plate B" intervention was compared with and without feeder modeling.

Stimulus fading procedures have long been documented to transfer the control of one behavior to that of another discriminative stimulus (Fields, et al., 1976). In terms of feeding behaviors, this has taken many forms. Antecedent manipulations have been shown to be effective in increasing positive mealtime behaviors by fading the texture of the food (Luiselli & Gleason, 1987; Shore, et al., 1998), the potency of food (Mueller, et al., 2004; Patel, et al., 2001), the utensil used (Johnson & Babbitt, 1993), and even the initial distance from spoon to mouth (Mueller; Rivas, et al., 2010). Another form of stimulus fading is the manipulation of the amount of food on the spoon. Little is known if this manipulation alone or in conjunction with other treatments can increase the consumption of nonpreferred foods and/or decrease any negative behaviors associated with feeding interventions. Additionally, research is thin regarding the proper method for successful fading in terms of efficiency. This current study looks at the use of bolus fading alone and in conjunction with other protocols to see if such effects occur in 2 young children who display disordered eating patterns. Discussion is made for the appropriateness of implementation in terms of time, cost, and positive benefits outside of acceptance.

Many children with feeding disorders are dependent on supplemental feeding (e.g., gastrostomy tube) or consume insufficient calories and nutrients for growth and weight gain. Investigators have described methods for increasing acceptance of solids and liquids for these children (e.g., Piazza, Patel, et al., 2003). What has not been described is a method for increasing volume (and calories) once the child is orally accepting solids and liquids. Therefore, the purpose of the current investigation was to identify the most efficient method for increasing volume in 2 children with food and liquid refusal once we had established acceptance of solids and liquids. First, we increased acceptance of solids and liquids. Currently, we are comparing 2 methods of increasing volume of solids and liquids. In one condition, we maintain the volume of food on the spoon or liquid in the cup (i.e., bolus size) and increase the rate at which the feeder presents the bites and drinks. In the other condition, we maintain the presentation rate and increase the bolus size of solids on the spoon and liquids in the cup. Preliminary findings suggest that the bolus size manipulation may result in the greatest increases in volume and calories.