Journal of Contextual Behavioral Science 3 (2014) 228235

Contents lists available at ScienceDirect

Journal of Contextual Behavioral Science

journal homepage: www.elsevier.com/locate/jcbs

Improving novel food choices in preschool children using acceptance

and commitment therapy
Abigail E. Kennedy, Seth W. Whiting, Mark R. Dixon n
Southern Illinois University Carbondale, USA

art ic l e i nf o

a b s t r a c t

Article history:
Received 23 August 2013
Received in revised form
8 September 2014
Accepted 13 October 2014

The present study examined the effects of a novel treatment package consisting of Acceptance and
Commitment Therapy (ACT)-based activities with and without contingent rewards on children's
consumption of low-preferred healthy foods. Participants were 6 children, age 35, who attended a
local day care center. The effects of the two treatment packages on children's tasting and approach of
foods were assessed using a multiple baseline design across food categories. During the ACT-based
mindfulness condition, the experimenter led a set of four ACT activities prior to the presentation of food.
This condition produced a mean increase in foods tasted of 7.4% for fruits but 0% for vegetables, and
mean increases in foods approached of 18.6% for fruits and 8.7% for vegetables. A second condition
consisting of the same ACT condition with an added emphasis on values and committed action. Through
the use of rewards delivered contingent upon tasting the foods produced mean increases in foods tasted
of 69.2% for vegetables, 25.3% fruits, and 43.2% for beans, and increases for foods approached of 54.7% for
vegetables, 16.2% for fruits, and 44.6% for beans. The results suggest that the values and committed
action components of ACT are critical for behavior change at young ages.
& 2014 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.

Keywords:
Consumption
Food avoidance
Acceptance and Commitment Therapy

1. Introduction
Over 60% of American children do not eat enough fruits,
vegetables, beans, and whole grains to satisfy nutritional guidelines, putting them at risk for nutritional deciencies (U.S.D.A &
U.S.D.H.H.S, 2010). A variety of factors impact what children eat at
any given opportunity. They include (a) genetic predispositions to
eat sweet and energy dense foods (Desor, Maller, & Andrews, 1975;
Birch & Ventura, 2009), (b ) avoidance of novel food items (Rozin,
1976), (c) selective eating (Levin & Carr, 2001), picky eating
(Carruth, Ziegler, Gordon, & Barr, 2003; Dubois, Farmer, Girard, &
Peterson, 2007), and (d) food refusal (Bandini et al., 2010).
Neophobia, or selective/picky eating, has been reported to affect
between 16% and 20% of all children 35-years-old (Carruth et al.,
2003). Considering children's predisposition to avoid novel foods
and their tendency to eat sweet and fatty foods, it is possible to see
how these predispositions interact to develop unhealthy eating
patterns that can cause lifetime health concerns.
Despite children's frequent avoidance of novel foods, research has
shown that children can learn to eat new and non-preferred foods.
Techniques have included peer modeling (Birch, 1980) and peermodeling coupled with social reinforcers (Hendy, 2002). However

n
Correspondence to: Behavior Analysis and Therapy Program, Rehabilitation
Institute, Southern Illinois University, Carbondale, IL 62901, USA.
E-mail address: abbie.kennedy@gmail.com (A.E. Kennedy).

caution needs to be taken to reduce the risk of negative peer-models

(Greenhalgh et al., 2009). Other interventions have included visual and
taste exposures (Birch, McPhee, Shoba, & Steinberg, 1987) and
contingent rewards (Horne, Lowe, Fleming, & Dowey, 1995; Horne,
Lowe, Bowdery, & Egerton, 1998; Horne et al., 2004, 2009, 2011; Lowe,
Horne, Tapper, Bowdery, & Egerton, 2004). The Food Dudes program
of Lowe and colleagues has received a fair amount of popular media
attention but several limitations may apply, including not employing a
systematic method to determine relative food preferences, and the
need for trained models and video production for incorporation into a
typical classroom (Hendy, Williams, & Camise, 2005). Albeit the
limitations, Horne et al. (1995, 1998, 2004, 2011) present an interesting
conceptualization of how the social inuence of language plays a part
in controlling behavior in the Food Dudes program. In particular, the
authors described how children's own verbalizations and categorization of stimuli into classes inuenced their behavior. Horne et al.
(1998) argue the following:
Once [they] are verbally adept, children no longer react to
foods merely as particular objects with inherent qualities of
taste, smell, appearance, etc., but respond to them as named
classes of items and respond to the verbalizations that they
themselves and others make about those named classes (p.133).
Horne et al. (1998) argued that by inserting positive verbalizations from peer models into the children's eating context, negative
conceptualizations occurring in children's eating contexts were

http://dx.doi.org/10.1016/j.jcbs.2014.10.002
2212-1447/& 2014 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.

A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

circumvented. Relational Frame Theory (RFT; Hayes, BarnesHolmes, & Roche, 2001) describes how language enables humans
to use derived learning to relate, evaluate, and compare events
without directly experiencing the contingencies of those events
(Hayes & Wilson, 2003). At times, this relational behavior is an
enormously adaptive trait, as it allows humans to quickly identify
possible outcomes of certain events and to behave to produce the
preferred outcome. At others times, rigid patterns of avoidance can
result from over-reliance on verbal rules based on derived learning
instead of learning based on direct-acting contingencies (Hayes &
Plumb, 2007). Procedures based in Acceptance and Commitment
Therapy (ACT; Hayes, Stroshal, & Wilson, 2012) may offer a novel
method for creating a context that undermines verbal rules and
negative conceptualizations that occur in the presence of
healthy foods.
ACT is a form of psychotherapy developed from the concepts of
behavior analysis and RFT whose goal is to create behavior change
in accordance with individual values. In ACT, mindfulness is
described as a collection of four inter-related processes: acceptance, defusion, contact with the present moment, and self as
context (Fletcher & Hayes, 2005). These processes function clinically to produce non-evaluative contact with stimuli and to help to
bring about responses under appropriate contextual control of the
present environment rather than verbal rules (Hayes & Wilson,
2003). Further, committed action and values, the other two
processes within ACT, are relevant to treatment contexts that
involve motivating individuals to engage in valued, but previously
avoided, behavior. Within ACT treatment, committed action
consists of engaging in deliberate acts towards goals that are
consistent with values (Fletcher & Hayes, 2005). ACT interventions
may be particularly relevant to young populations with food
selectivity behaviors for several reasons. First, children often
make verbalizations that attach verbal, rather than formal functions, to food (Horne et al., 1995, 1998, 2004, 2011). In the context
of ACT, children may be more likely to attend to the formal
features of the food, rather than any verbal rules or negative
conceptualizations about food, which in turn may result more
acceptance of previously avoided food. Second, rather than extrinsic contingent reinforcement for eating less preferred foods, an
ACT intervention with a focus on values and present moment
contact may better link current eating behavior to temporally
distant valued consequences such as greater health. For instance,
if eating spinach is maintained only by access to other edibles
or attention, when those contingencies are no longer in effect,
spinach may again be avoided, but if committed action is directed
by health-related values, eating spinach may be more likely
maintained.
Overall, ACT interventions in regard to food selectivity in a
younger population may be of value to proactively promote a
lifetime of healthy behavior before problems develop. However,
research with ACT and preschool populations has been sparse.
For example, three to ve year old children have demonstrated
increased attention, delay to gratication, and inhibitory control
following the introduction of a mindfulness yoga activity (Razza,
Bergen-Cico, & Raymond, 2013), but research and implementation
of ACT protocols featuring values and committed action are rare
with younger children, but have yielded positive results with older
school children and adolescents (see Coyne, McHugh, & Martinez,
2011). Despite this gap in the literature, ACT was derived from RFT
and behavioral principles, and, theoretically, such systems should
apply so long as children respond verbally to the environment. In
other words, once children develop a verbal repertoire and begin
to relate stimuli, which has been observed in children less than
two years old (Luciano, Becerra, & Valverde, 2007), they should
respond to interventions that target these relations similar to older
populations. As young children may experience negative effects of

229

verbal relations (e.g., Peas are sick!), ACT interventions should be

extended to young, verbally capable populations.
The purpose of the present study was to examine the effect of
mindfulness as conceptualized within ACT as an alternative to
modeling within a treatment package on children's consumption
of previously avoided healthy foods. To test this question, this
study examined a set of four ACT-based mindfulness activities
based on the processes identied by Fletcher and Hayes (2005)
with and without rewards on the percent of foods tasted and
approached.

2. Method
2.1. Participants and setting
Six typically-developing 35-year-old children who attended a
full-day pre-kindergarten classroom at a local day care participated in this study. One participant (Lizzie) stopped attending the
center after session 20; her data remained in the presented data,
as she had been present for the majority of the sessions. Participants included four girls and two boys: Monroe was a 3-year-old
boy; Lizzie, Petra, and Eva were 4-year-old girls; Ariel was a
5-year-old girl, and Joey was a 5-year-old boy. Consent was
obtained from the parent or guardian of each participant prior to
the start of the study, as well as assent from each participant.
Sessions took place two to four afternoons each week between
3:003:30 p.m., which was 1545 min after students' afternoon
snack. During sessions participants sat at one long table in an
assigned order that stayed constant throughout the study. Sessions
were conducted as a small group exercise that included all
participants who were present that day in the classroom. The
number of participants present each session varied from three to
six (M 5). Nineteen students were regularly scheduled to be in
the class. The pre-kindergarten room was lled with two long
tables for seat work, a corner with carpet and pillows for group
time, with children's toys throughout the room. Students in the
class who were not participants in the study engaged in teacherled small group or station-based activities at the time of the
sessions.
2.2. Materials
Food stimuli in this study were fruits, vegetables, and beans
supplied and prepared on site by the experimenter. Foods selected
for the study had to be available in area stores at the time of the
study and reported by parents to be novel or refused 50% or more
of the time by each participant. A parent questionnaire was
developed by the author and lled out by parents at the same
time as the consent form. This survey indentied an initial pool of
13 fruits, 11 vegetables, and 10 beans that met the above criteria.
Of these foods, seven in each category were selected for the
preference assessments based on their novelty or history of
refusal.
During preference assessments and experimental sessions,
food servings were a mean of 25 g. Fruits and vegetables were
cut into small pieces approximately 2.5 cm  2.5 cm. Foods were
presented to participants in 4 oz transparent, single-portion containers. To help students discriminate among their foods, containers were labeled with a small colored sticker: the sticker for the
vegetable container was yellow, the fruit container was pink, and
the bean container was orange. All fruits, as well as red pepper and
water chestnuts, were prepared raw and then frozen and defrosted
prior to sessions. Rutabaga, beets, zucchini, turnip, and yellow
squash were heated in a microwave oven until al dente, and were
also frozen and defrosted prior to presentation. All beans were

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A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

Table 1
Preference assessment results.
Preference
rank

Fruits

Preference
rank

Vegetables

Preference
rank

Beans

NS

NS

1
2

Rutabaga
1
Red pepper 2

Kiwi
Dragon
fruit
Raspberry

Papaya

5
6

Dates
Star fruit

5
6

Water
chestnut
Yellow
squash
Zucchini
Turnip

Mango

NS

Beet

Eva
NS

NS

2
3
4
5
6
NS

Dragon
fruit
Kiwi
Mango
Star fruit
Raspberry
Papaya
Dates

Joey
1
NS

Ariel
NS
Lizzie
1
2

Pinto
Blackeyed
Butter

Black

5
6
7

Garbanzo
Great
northern
Kidney

NS

NS

NS

Raspberry

NS

NS

Monroe
1

Mango

Pinto

Dates

Black

Raspberries 3

Water
chestnut
Red bell
pepper
Beet

Zucchini

Dragon
Fruit
Papaya

Blackeyed
Butter

Kidney

NS

Star fruit

Yellow
squash
Rutabaga

NS

NS

Dates

Turnip

NS

Great
northern
Garbanzo

Petra
1

Note: NS no selection occurred. no food item was identied as a result of a

no selection.

canned beans. Foods included in the preference assessment are

listed in Table 1.
2.3. Design, response measurement, data collection
A multiple baseline design across categories of food was used
to evaluate the effect of two treatment packages on children's
consumption of low-preferred foods. The rst intervention consisted of four ACT-based mindfulness activities (hereafter, referred
to as ACT). The second intervention was the same except for the
addition of a reward delivered contingent upon eating the targeted
food (hereafter, referred to as ACT PLUS).
The primary dependent variable was the percentage of foods
tasted each session. This measure was selected because it detected
even small amounts of consumption, which could be indicative of
an increased acceptance of a food. Tasting was dened as food
passing the plane of the child's lips and ingested. The percentage
of foods tasted each session was determined by dividing the
number of foods that were tasted in each category by the total
number foods presented in that category and multiplying by 100.
A second measure, approach of foods, was also measured to

capture changes in response to foods that did not include eating

but were indicative of changes in the acceptance of that food.
Approach was dened as touching (contacting the food item with
the hand or ngers), licking (contacting the food item with the
tongue), or smelling the foods (positioning the food within 7 cm of
the nose and inhaling). The percent of foods approached was calculated each session by dividing the number of foods approached in
each category by the total number of foods presented in that category
and multiplying this amount by 100.
Data collection was completed by ve behavior analysis graduate students. Data collectors were trained to carry out the data
collection procedures prior to the start of the study. Data collectors
were trained with simulated role-plays and video examples until
they achieved 90% reliability. During sessions, foods tasted and
approached were recorded by data collectors who sat at the end of
the table or 1 m from the table where they could simultaneously
observe participants and their foods.
2.4. Interobserver agreement and treatment integrity
A second observer simultaneously recorded interobserver
agreement (IOA) data during 37.5% of preference assessment
sessions and for 37.940.9% of participants during each session
in experimental conditions. Agreement was dened as both
observers recording the same response for each trial or session
observed. The interobserver reliability was calculated by dividing
the number of trials with agreements by the total number of trials
and multiplying the quotient by 100%. Mean agreement was 98.4%
during the preference assessments, and 95.5% for taste and 96.7%
for approach (range, 80100%) of foods in all three categories
during experimental sessions.
During each condition, data collectors scored procedural steps
as implemented correctly or incorrectly according to treatment
integrity checklists. Treatment integrity was calculated by dividing
the total number of steps performed correctly by the total number
of steps possible in each condition and multiplying this total by
100. During preference assessments, treatment integrity was
recorded during 79.1% of sessions, and treatment integrity was
100%. During the multiple baseline conditions, treatment integrity
data were collected during 96.3% of baseline conditions and 100%
of ACT and ACT PLUS conditions. Treatment integrity was recorded
as correct for 99% of steps during baseline, 98.5% of steps during
the ACT condition, and 98.9% of steps during ACT PLUS.
2.5. Preference assessments
Preference assessments were conducted prior to the start of the
baseline condition to identify a lowest-preferred (i.e., most
avoided) food in each category. Participants completed one multiple stimulus without replacement (DeLeon & Iwata, 1996) preference assessment for each category of food for a total of three
preference assessments per participant. Each category's assessment began with the same seven food stimuli identied by the
parent survey. Sessions for the MSWO took place at a small table
within the regular classroom and were implemented using the
procedure outlined in DeLeon & Iwata. Food stimuli were presented in 6 g servings.
The order of the selection of foods was recorded to create a
hierarchy of preference for each participant. A percentage score
was determined by dividing the number of trials in which the food
was selected by the number of times the item was presented and
multiplying the quotient by 100. The food in each category that
was selected the least was included in that participant's food set.
If more than one food that was tied for the least-preferred, the
food stimulus for this category was then selected randomly by

A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

writing all of the names of the least preferred on slips of paper and
drawing one of these slips from a hat.
2.6. Procedure
2.6.1. General
Sessions were conducted as a group exercise to reect natural
eating circumstances, during which the eating and verbal behavior
of peers can impact consumption. Regular behavior management
techniques were used to prevent problem behaviors during sessions, including a picture schedule, reward contingency for following
rules, and non-contingent attention. Rules were described prior to
the rst session and reviewed every 23 sessions. The rules
described how students could earn a sticker if they remained in
their seat, had 0 instances of yelling, and 0 instances of playing with
their food (dened as putting food on the table, oor, or chair, or
throwing it in the air). The picture schedule (which visually
represented the session's activities using pictures taped to the inside
of a le folder) was introduced at the start of session 13 in response
to problem behavior shown by two of the participants. Noncontingent attention was also delivered to the group at least once
every 30s throughout sessions in the form of praise (e.g., Everyone
is doing a great job sitting) and comments about topics other than
the targeted food. After sessions, participants were instructed to
wash their hands and return to the table to receive their stickers.
Each participant had a sticker card that kept in a second le folder.
Stickers were delivered to each participant if they followed the rules
during that session.
Throughout the study, conditions continued until stable
responding (i.e., a three or more data points showing an increasing,
decreasing, or at trend) occurred for foods tasted by the group of
participants. At this point, the intervention was applied to the next
baseline with stable responding.
2.6.2. Baseline
During baseline, sessions were ve minutes in length and
consisted of a food presentation only. To start, the author presented food sets by showing each participant their individual food
container while labeling the specic food and its category (e.g.,
This is a fruit. It is a dragon fruit). The session time began after all
participants had their food containers in front of them with the
lids removed. Experimenters did not deliver praise for the consumption of these foods, but did answer questions regarding
the names of the foods, and responded with neutral language
(e.g., Okay) to other comments regarding these foods. After
ve minutes, participants were thanked for sitting and told to
return to classroom activities while containers were collected for
weighing.
2.6.3. ACT
In this condition, the author conducted a set of four ACT-based
activities for 1015 min prior to the food presentation. Activities
were completed in the following xed order each session: Silent
Game; Look, Feel, Smell; Picture Time; and the Name Game. These
activities targeted one food category at a time. When more than
one category of food was under this condition, this set of activities
was completed rst with one category of food before doing the
same activities with food from another category. The order of
categories was randomly selected each session.
Acceptance and self-as-context, the other two processes identied by Fletcher and Hayes (2005) as related to mindfulness, were
not targeted with specic activities, but due to the interrelatedness of the processes were nonetheless involved. Students
were asked to practice acceptance by maintaining proximity to
and interacting with previously avoided foods. Self-as-context was

231

addressed when students made comments indicating that they

had fused to a version of a conceptualized self regarding the
particular food. For example, the experimenter responded to
students who made statements like, I never eat this, by labeling
this as a thought, and asking students to notice thoughts that
occur to them over time. Furthermore, values and committed
action were also indirectly addressed throughout all activities by
having participants interact physically and verbally with their
foods as a way of creating a pattern of behavior directed toward
ultimately eating the food. This pattern of behavior would be
consistent with the values of being healthy (Fletcher & Hayes,
2005).
2.6.3.1. Silent Game. The rst activity was called the Silent Game.
This exercise was completed once each session. The purpose of the
Silent Game was to introduce mindfulness to the students by
having them notice events occurring in their environment during
a period of silence. For this game, students were instructed to stay
still, with their closed eyes or looking downward, and show good
posture. Once students were showing this set of behaviors, the
experimenter started the Silent Game by saying, Ready, begin.
The duration of this exercise was 30 s. After 30 s had expired,
participants were asked to share what they had noticed during the
silence. The author acknowledged and praised participants when
they reported events they had noticed. When participants
reported something that had not been an event in the classroom
during this period (e.g., Today I'm going to my grandma's house),
this was labeled as noticing a thought and the students were
redirected to notice events occurring in the room.
2.6.3.2. Look, Feel, Smell. The next activity was called the Look, Feel,
Smell game. The purpose of this activity was to have participants
describe and interact with the food's formal properties. At the
beginning of this game, participants received one piece of food
from their food set in the targeted food category (e.g., one piece of a
beet) in a small plastic cup. This game was introduced to
participants during the rst session with the following instruction:
Now we are going play the Look, Feel, Smell game. The
purpose of this game is to learn to talk about food in another
new way. This new way involves noticing how today's food
looks, feels, and smells. For this game, I will ask you some
specic questions. First, let's talk about the color of your food.
What colors do you see in your food?
During subsequent sessions, the experimenter initiated this
activity by saying Now we are going to play the Look, Feel, Smell
game. What colors do you notice in your [targeted food]? If students
did not independently respond to the question, the experimenter
provided additional prompts asking questions such as Is the color
dark or light? This same procedure was repeated with the food's
texture and smell. As before, additional prompts were provided as
needed by asking such questions as whether the surface was smooth
or bumpy, or whether the smell was sharp or sweet, etc.
2.6.3.3. Picture Time. This third activity was a defusion exercise.
The purpose of this game was to undermine literal language
related to the previously avoided foods in students' foods sets by
attaching previously unrelated stimuli to the foods. To start,
students were given a pencil and a paper with a picture of their
food from the targeted food category. Eva, for example, received a
picture of a zucchini during the ACT PLUS with vegetables
condition, and Monroe received a picture of a turnip. The author
then instructed students to add specic stimuli to their food
pictures. These items changed each session, but always consisted
of three items. These items included drawing one object (e.g., a

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A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

hat) and a human or animal body part (e.g., eyes), and having the
food item make a sound (e.g., a squeak). Afterwards, participants
were asked to discuss what their food looked like. This discussion
provided an opportunity for participants to observe changes in the
functions of their food.
2.6.3.4. Name Game. The nal activity was a defusion exercise
called the Name Game. The purpose of this game was to
establish a context that weakened verbal functions related to the
name of the food. Prior to the rst time this activity was
conducted, the author gave the following instructions:
Now we are going to play the Name Game. For this game we are
going to say the name of the [targeted category of food] over and
over for 30 s. I will tell you when to start and when to stop. Ready,
start. During subsequent sessions, this activity was initiated by
saying, Okay, it's time for the Name Game. We're going to do it
for [the targeted food category.] Ready, begin.
The experimenter and students proceeded to repeat the name
of the food over and over for 30 s. At the end of this exercise,
students were asked what the word sounded like while they were
repeating it. These thoughts, and any changes to the functions of
the word, were discussed.
2.6.3.5. Food presentation. The procedure for the food presentation
during the ACT condition was the same as in the baseline condition
2.6.4. ACT PLUS
The procedure for this condition was the same as during the ACT
condition except for the inclusion of an added emphasis on committed action and values via the addition of a reward contingency for
eating any amount of the target food/s. These added components
included discrete events that occurred following behavior. These
events provided participants with more immediate contact with
outcomes related to their food choices, which may bridge the gap
between the eating and the delayed health outcomes associated
with eating. These events also made valued items more tangible so
as to link the present behavior together with a greater pattern of
action toward temporally distant outcomes, which may be more
relevant to child populations. The ACT PLUS condition was implemented to increase children's motivation to taste the foods, which, if
effective, would allow participants the opportunity to eat the foods
and live in accordance with their desire to be healthy. During ACT
PLUS, the following statement was read at the end of the picture
schedule script: Today, if you eat any amount of the [vegetable], you
can choose one sticker from the special sticker box to put on your
sticker card. If you do not eat any of this [food category] but sit
calmly during the food activity, you will earn a sticker that I choose
for you. In addition, arrows were added to the picture schedule,
which pointed from a picture of a treasure box to a picture of the
target food item/s. At the end of sessions, participants who had been
observed eating the target food/s were instructed to choose the
corresponding amount of stickers from the sticker box and to put
their stickers on their sticker card (the number of stickers it was
possible to earn depended on the number of food categories
operating under the reward contingency). Participants were given
brief social praise at the same time as their stickers (e.g., You earned
one sticker for eating vegetables. Good job!). Participants could
continue to earn a sticker that the author chose for sitting without
problem behavior if they did not eat any of a targeted food group.
3. Results
The MSWO preference assessment was conducted to identify a
low-preferred fruit, vegetable, and bean for each participant. These

stimuli were selected by identifying the item in each category with

the lowest-preference rank. Table 1 shows participants' preference
rank orders. Results showed that two participants made no
selection during any of the three MSWO's (i.e., Ariel and Eva),
while Joey made only one selection during the fruit MSWO and no
selections during the vegetable or bean MSWO. Two participants
made a selection during each trial of at least one food category's
assessment (Lizzie for fruits and beans, and Monroe for vegetables). Table 2 shows the lowest-preferred foods identied for each
participant. These foods comprised participants' food sets for the
duration of the study.
Fig. 1 shows the effect of the interventions on the percent of
foods tasted by the group of participants across sessions. In
baseline, the data revealed varied patterns of food tasting. The
percent of vegetables tasted occurred at zero levels, while fruits
were tasted at a moderate, stable level throughout baseline
(M 38.8%). Participants also tasted beans at a higher level than
vegetables in baseline, and over the course of the condition
showed a variable but decreasing trend (M 28.5%). Once stable
responding was observed across baselines, the ACT condition was
introduced rst to vegetables and then fruits. This condition
produced zero tasting of vegetables. Following the introduction of
the ACT condition for the fruits baseline, foods tasted showed
increases in level and variability (M 46.2%). During a second baseline condition, the percent of vegetables tasted remained at zero.
With the introduction of ACT PLUS, the mean vegetables tasted
increased to 69.2%. For fruits, the mean percent of fruits tasted
increased to 71.5%. For beans, the introduction of ACT PLUS produced
a change in the level of the data from zero-levels to 75% of beans
tasted. The mean percent of beans tasted during ACT PLUS was 71.7%.
Fig. 2 shows participants' average approach of foods across
sessions. Approach of vegetables occurred at zero or near-zero levels
during baseline (M6.3%). For fruits, participants approached a mean
of 39.8% of stimuli. Participants' approach of beans was variable with
an overall decreasing trend during baseline (M35.4%). During the
ACT condition, an average of 15% of vegetables and 58.4% of fruits
were approached. In addition, the data increased in variability for
both baselines. The approach of vegetables increased during a second
baseline condition (M21.1%). In ACT PLUS, the approach of foods
increased across all three food categories. For beans, the increase was
from 0% to 100%. Overall in ACT PLUS, a mean of 75.6% of vegetables,
75.7% of fruits, and 80% of beans were approached.
Individual data for each participant are displayed in Table 3.
During ACT, the percent of foods that were tasted increased over
baseline for Lizzie, Eva, Petra, and Monroe (M increase17.8%;
range, 1.4337.18%), decreased for Ariel (30.6% reduction), and
produced no change for Joey. In ACT PLUS, the percent of foods
tasted increased over levels observed during ACT for all participants (M increase47.8%; range, 2595%) except Monroe (19.07%
reduction). Similar results were obtained for percent of foods
approached. Specically, during ACT, the percent of foods approached by Lizzie, Eva, Petra, and Monroe increased over baseline by
a mean of 26.7% (range, 5.742.8%), remained unchanged for Joey,

Table 2
Food sets for each participant.
Participants

Fruits

Vegetables

Beans

Ariel
Lizzie
Eva
Petra
Joey
Monroe

Dragon fruit
Mango
Star fruit
Dates
Papaya
Star fruit

Beet
Beet
Zucchini
Turnip
Zucchini
Turnip

Pinto
Kidney
Pinto
Black
Pinto
Great northern

A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

233

Fig. 1. Percent of foods tasted by group of participants across vegetables (top panel), fruits (middle panel), and beans (lower panel). Data points represent the percent of
foods tasted across the group of participants each session. ACT ACT-based mindfulness treatment package. ACT PLUS the same condition plus a reward contingency.

and decreased for Ariel by 36.7%. In ACT PLUS, an increase in foods

approached over ACT levels was observed for all participants
(M 50.5%; range, 25100%) except for Monroe, whose percent
of foods approached decreased by 17%.

4. Discussion
The current results provides support for the effectiveness of
ACT activities in increasing children's taste and approach of
healthy foods, and is consistent with previous research showing
that the use of rewards can be used within treatment packages to
increase children's healthy food consumption (Horne et al., 1995,
1998, 2011). One possible reason why the initial ACT activities did
not produce more signicant changes in foods tasted and only
some changes in foods approached, is that the mindfulness
component of the treatment package may not have produced
non-evaluative contact with stimuli or defusion from verbal
functions previously attached to foods. For example, at times

throughout the study, due to the group format children may have
failed to be mindful or attend closely to the stimuli when a
number of other children were present, or because another child
would begin making potentially disruptive noise, walking around,
or making negative comments about food. Additionally, young
children may have limited experience with temporally distant
consequences. Children in the age group may have limited time
perspective which might disrupt efforts to target values attainable
after a long delay. Furthermore, it may have been possible that
many of the children in the present study did not possess an
advanced relational repertoire sufcient for ACT to effect a change
in behavior. That is, participants may have avoided turnips because
they had eaten this food previously and experienced an aversive
taste, rather than avoiding turnips due to this vegetable's relation
to other aversive stimuli and subsequent internal judgments. If
this was the case, ACT, which targets faulty relations and problematic rule-control, would likely create no effect. Additional research
would be required to address these questions, and future investigations with younger populations may wish to more thoroughly

234

A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

Fig. 2. Percent of foods approached by group of participants across vegetables (top panel), fruits (middle panel), and beans (lower panel). Data points represent the percent
of foods approached across the group of participants each session. ACT ACT-based mindfulness treatment package. ACT PLUS the same condition plus a reward
contingency.

Table 3
Total percent of foods tasted and approached for individual participants.
Participant

Ariel
Lizzie
Eva
Petra
Joey
Monroe

Percent tasted

Percent approached

Baseline

ACT

ACT plus

Baseline

ACT

ACT plus

30.61
55.17
7.89
48.57
0
16.67

0
75
18.18
50
0
53.85

95
100
60
94.74
60.87
34.78

36.73
55.17
2.63
51.43
0
30.95

0
75
45.45
57.14
0
69.23

100
100
70
100
60.87
52.17

Note: The total percent of sessions when fruits, vegetables, and beans were tasted
by individuals across conditions. ACT was applied to fruits and vegetables only.
Lizzie left the day care center after session 20.

evaluate the presence or absence of various relational operants and

rule-governed behavior in order to determine the requirements for
appropriate applications of ACT.
The increases in tasting found in the ACT PLUS condition,
however, may suggest that under the control of rewards and

verbal descriptions of upcoming rewards, participants were motivated to repeatedly taste foods and, in doing, so, contact their
value of healthy living in the form of eating fruits, and vegetables,
and beans. The results show that once participants tasted foods in
ACT PLUS, they maintained high levels of tasting for the remainder
of the condition, particularly for vegetables and beans. Follow-up
data would be needed to determine whether participants would
continue to taste the foods in the absence of rewards. From the
present study it was not possible to assess the relative strength of
the reinforcement alone and ACT alone. Though the ACT condition
did not produce clear increases in tasting by itself, it is possible
that ACT may have augmented the reward component. Future
research should also consider this question.
This study has implications for future research on improving
children's healthy food consumption. For one, use of the MSWO
preference assessment improved upon previous research by
describing which systematic procedure was used to identify
children's lowest-preferred food. Secondly, this study provides
additional evidence supporting the use of contingent rewards
within treatment packages to increase the consumption of healthy
foods. It is noteworthy that a rather simple and inexpensive reward

A.E. Kennedy et al. / Journal of Contextual Behavioral Science 3 (2014) 228235

(i.e., a sticker) was sufcient to motivate a group of participants who

had completely avoided vegetables to taste a vegetable, as well as to
produce generally high and consistent fruit and bean tasting. Such a
small reward would be feasible for a teacher to deliver in a classroom
setting. Similarly, simply providing choices is often reinforcing for
young populations. For example, Tiger, Hanley, and Hernandez (2006)
found that ve out of six preschool children preferred choosing a
reinforcer rather than simply earning a preferred stimulus, and that
children in this demographic will often complete greater work
requirements to earn the opportunity to choose a reinforcer in lieu
of lesser requirements to earn a reinforcer with no choice. Thus, in the
present study, the reinforcing contingency may have had a greater
effect, as the children selected a sticker from an array rather than the
experimenter providing one at random. Adding this one step will
likely require only several additional seconds, and will make rewardbased interventions no less feasible, but likely more effective.
One methodological limitation of this study was that the
second baseline condition began during the same session in which
the ACT condition was introduced for the fruits baseline, which
permitted only one comparison during the ACT condition between
the fruit and beans baseline, rather than between all three baselines. Also, motivating operations were not explicitly controlled,
which could have resulted in some variation. Due to the slightly
inconsistent classroom schedule, snack time may have been 15 to
45 minutes before sessions were conducted, and thus satiation
may have affected the intervention differentially across days.
Furthermore, the rewards in this study were not faded to examine
whether the increased levels of tasting would maintain in the
absence of the contingency, and no formal observations were
conducted as to whether the intervention produced any generalized or maintained effects. We also employed the use of a multiple
baseline design to demonstrate experimental control across food
types. However, in studies of this type, the repeated measures may
pose problems in interpreting the effects of the intervention.
Repeated exposure to food has been shown to result in more
positive judgments of food (Birch et al., 1987), so participants may
be more likely to approach or taste food due to its presence in
sequential sessions. Finally, the inuence of the presence of peers
cannot be determined from the present results. Future research
should examine whether a reward contingency applied alone
rather than within a treatment package would also produce
similar increases in foods tasted, whether ACT can augment the
effect of rewards, if the intervention produces enduring, generalized changes in the eating habits of the participants, and whether
the group setup produces peer modeling effects that are therapeutically desirable (e.g., Yum!) or harmful (e.g., Gross!) and if
such a conguration enhances the intended effect. As our culture
continues to see childhood obesity rates on the rise, novel
interventions such as those employed in the current study appear
to have great utility.
Acknowledgments
The authors would like to extend their thanks to Jacob Daar,
Hannah Buck, Sara Buitrago, Ashley Shayter, and Ryan Speelman
for their assistance in the project, and the Haven of Love Daycare
Center for their cooperation and support. This research received
nancial support from the Graduate and Professional Student
Council, Southern Illinois University.
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