A Preliminary Assessment to Determine the Starting Point for Treatment of Pediatric Feeding Disorders

Escape extinction has been identified as an effective treatment for feeding problems. However, negative side effects, such as extinction bursts and emotional responding, may occur with escape extinction. In some cases, treatment without escape extinction may be unsuccessful. Therefore, the purpose of this study was to evaluate modifications that may optimize the effects of escape extinction while keeping inappropriate mealtime behavior low. First, an assessment was conducted to determine the starting point for treatment, which was different for each participant. The condition that produced higher levels of acceptance and lower levels of inappropriate mealtime behavior (low response effort) was identified as the starting point for the stimulus (bolus) fading plus escape extinction treatment. Acceptance increased for all three participants with a variety of foods using an antecedent-based intervention in combination with escape extinction. Although escape extinction was part of the final treatment, inappropriate mealtime behavior was relatively low at the onset of treatment. These data are discussed in relation to motivating operations and negative reinforcement.