A systematic literature review of antecedent and reinforcement‐based behavioral feeding interventions without the implementation of escape extinction

Clinical Outcomes from an Interdisciplinary Outpatient Feeding Treatment Pilot Program

Many children with developmental disabilities experience feeding challenges, including food refusal and food selectivity. Feeding concerns are often multifaceted and, therefore, an interdisciplinary approach to treatment is needed. A pilot of an interdisciplinary outpatient feeding program was conducted in a hospital medical center by psychologists and occupational therapists. The pilot program focused on caregiver training and improvements in targeted feeding goals in both the clinic and home settings. Treatment outcomes from this pilot program found increases in bite acceptance, decreases in inappropriate mealtime behaviors, increases in caregiver-reported number of foods consumed, and mastery of most individualized feeding goals for children who participated in the treatment program. Additionally, caregivers reported decreased concerns related to feeding and increased confidence in addressing their child's feeding concerns after participation in the treatment. Caregivers also reported high levels of satisfaction with this pilot program and reported the intervention to be feasible.

Increasing Food Consumption With an Antecedent and Reinforcement-Based Treatment Generalized Via Telehealth

We report a case with a 7-year-old girl with autism spectrum disorder and anxiety disorder who had severe restrictive eating leading to various medical concerns raised by her pediatrician. Following medical consultation and a descriptive functional assessment, a therapist implemented behavioral intervention consisting of a visual cue, choice, and differential reinforcement of alternative behaviors. The intervention was focused on both in-home meals and telehealth consultation during mealtimes, as the COVID-19 pandemic necessitated moving to remote consultation for continued treatment. The success of this study has long-standing implications for the benefits of positive feeding interventions and telehealth as well as parental training strategies.

An Evaluation of a Telehealth Caregiver Training Package to Treat Food Selectivity

Telehealth behavioral interventions are increasingly necessary when in-person services are not accessible (e.g., due to geographic location, time, cost, and health and safety restrictions). There is a growing evidence-base for the effectiveness of telehealth interventions but few demonstrations of telehealth interventions for pediatric feeding disorders. The purpose of this study was to evaluate a telehealth caregiver training package to teach caregivers to implement a feeding intervention, in their home as primary interventionists, to treat their children’s food selectivity. To address some previously documented caregiver concerns regarding some intervention procedures (e.g., nonremoval of the spoon or escape extinction) and ensure caregivers could safely/feasibility implement intervention, the intervention included differential reinforcement of bites consumed within a 3-minute opportunity. All three caregivers demonstrated high levels of correct performance following training and all children demonstrated increases in the number of bites consumed and decreases in disruptive behaviors. Findings suggest training caregivers via telehealth may be a viable option to treat some children’s food selectivity without first requiring in-person services.

On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis

Functional analysis is the primary assessment used to determine the function of inappropriate mealtime behavior in children with feeding disorders. Based on single-case experimental design studies and recent reviews, the prevalence of negative reinforcement alone in the maintenance of inappropriate mealtime behavior appears to be much greater than positive reinforcement alone. We conducted a retrospective consecutive-controlled case series to determine the generality of previous findings. Results of the epidemiological analysis support prior research in that negative reinforcement in the form of escape (44.8%), and multiple control (i.e., positive and negative reinforcement) in the forms of escape and attention (37.2%), are considerably more prevalent than positive reinforcement alone (2.5%). We discuss the relationship between functional analysis of inappropriate mealtime behavior and treatment utility. Further, we describe avenues of future research designed to advance the application of functional analysis in feeding disorders beyond inappropriate mealtime behavior.