Meeta R. Patel

Treatment of automatically reinforced object mouthing with noncontingent reinforcement and response blocking: experimental analysis and social validation ☆

A brief functional analysis indicated the object mouthing of a young girl diagnosed with autism was maintained independent of social consequences. Separate and combined effects of response blocking and noncontingent reinforcement (with preferred stimuli) were then evaluated as treatments for object mouthing. Although both interventions were unsuccessful when implemented separately, combining them resulted in generalized reductions that were socially valid.

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.

ESCAPE AS REINFORCEMENT AND ESCAPE EXTINCTION IN THE TREATMENT OF FEEDING PROBLEMS

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.

SPOON DISTANCE FADING WITH AND WITHOUT ESCAPE EXTINCTION AS TREATMENT FOR FOOD REFUSAL

Little is known about the characteristics of meals that serve as motivating operations (MOs) for escape behavior. In the current investigation, we showed that the distance at which a therapist held a spoon from a childs lips served as an MO for escape behavior. Based on these results, we implemented spoon distance fading, compared fading with and without escape extinction (EE), and compared fading plus EE to EE alone. Initially, inappropriate mealtime behavior decreased during fading, but this effect was not maintained as fading progressed. Inappropriate mealtime behavior was lower initially when we combined fading and EE relative to EE alone, but acceptance increased more rapidly with EE than with fading plus EE. These results suggest that a number of mealtime characteristics might function as MOs for escape behavior and that analyses of MOs may be useful for developing treatments for food refusal.

Functional Analysis of Erratic Body Movement Maintained by Visual Stimulation Incorporating Conjugate Reinforcement Into a Paired-Stimulus Preference Assessment

A concurrent-operantsdesign was used to analyze the repetitive behavior of observing reflective surfaces while simultaneously engaging in erratic gross-motor body movements (EBMs) exhibited by a young boy diagnosed with autism. The assessment involved an evaluation of preference for controlled (i. e., the participant controlled the visual activity on a TV screen) versus uncontrolled (i. e., the participant viewed a previously recorded tape from the controlled condition) TV footage of his EBMs. The analysis indicated that both observing and EBMs were maintained by the direct correspondence between the body movements and the visual stimulation they produced when controlled by the participant. Thus, the EBMs appeared to be maintained on a conjugate schedule of reinforcement.

Food Refusal and Selective Eating

Food refusal can be characterized as a severe feeding problem wherein an individual fails to eat sufficient quantity and/or variety of foods/liquids to maintain his or her weight and height (e.g., Babbitt et al. in Pediatric feeding and swallowing disorders: Pathology, diagnosis, and treatment. Singular Publishing Group, San Diego, 1994). In addition, food refusal may encompass selective eating where weight and growth are not of concern but where nutritional status may be compromised. Feeding problems can occur in about 25–45 % of typically developing children and up to 80 % of children with intellectual and developmental disabilities. The etiology of feeding problems is not well understood but may develop as a result of medical issues, anatomical abnormalities and/or oral-motor skill deficits, and behavioral/environmental factors (Rommel et al. in J Pediatr Gastroenterol Nutr 37:75–84, 2003). Given the complex etiology of feeding problems, assessment and treatment should be conducted by an interdisciplinary treatment team of professionals involving speech and language pathologists, registered dieticians, and physicians (Laud et al. in Behav Modif 33:520–536, 2009; Silverman in Nutr Clin Pract 25:160–165, 2010). This chapter reviews empirically-supported assessment and treatment of food refusal and selective eating and provides recommendations for practitioners.