Noncontingent and differential reinforcement in the treatment of pediatric feeding problems.

We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.

A comparison of functional analysis methods of inappropriate mealtime behavior.

Investigators have evaluated two procedural variations for conducting a functional analysis of inappropriate mealtime behavior exhibited by children with feeding problems. One method involves prompting bites only in the escape condition (e.g., Najdowski et al., 2008). Another method involves prompting bites across all conditions (e.g., Piazza et al., 2003). We assessed the food refusal of 3 children diagnosed with a feeding disorder by comparing the two variations. The two methods resulted in different outcomes for 2 of 3 children. Prompting bites only in the escape condition identified a single function (i.e., escape). Prompting bites across all conditions identified multiple functions (i.e., escape and attention). We then examined the relative effects of extinction procedures (individually and in combination) to determine the validity of each method. Results of the treatment evaluation suggested that the procedural variation that failed to identify an attention function for 2 of 3 children produced false negative findings.