Running head: RESEARCH ARTICLE SUMMARY

Research Article Summary Assignment EPSE 549

Tracy Pham

The University of British Columbia

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Research Article Summary Assignment EPSE 549

Rationale for choosing the topic:

Some of the clients I work with are selective with the food they consume. Food

selectivity is a problem that I deal with from time to time and I am always interested in an

opportunity to research more interventions and techniques I could use to improve food

consumption for my picky clients. I have experienced the significant effects food selectivity can

have on a child in terms of when the child is not receiving enough nutrients from food, the child

is constantly sick which results in missing therapy sessions. When food selectivity is addressed

and improved, all aspects of the child’s quality of life will be improved.

Article #1 Summary

Seiverling, L., Kokitus, A., & Williams, K. (2012). A clinical demonstration of treatment

package for food selectivity. The Behaviour Analyst Today, 13, 11-16.

The purpose of study was to evaluate the effects of a treatment packing on food selectivity.

The treatment package included escape extinction from non-preferred food and contingent access

to preferred food. The study evaluated if escape extinction to address food selectivity is

necessary and if so, how to determine when escape extinction is not needed any longer.

The participant in the study was a 3-year-old boy named Jeremy who was diagnosed with

autism spectrum disorder who experienced gastroesophageal reflux and chronic constipation.

The participant engaged in disruptive behaviour while eating such as self-injury, aggression,

negative vocalizations, and head turning. All sessions were completed over five days in a

treatment room, and the sessions ran 8 hours a day (from 8:30 am to 4:30 pm). Meals ended after
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10 minutes and at least 7 meals were complete during a session. The participant did not eat

breakfast or lunch meals away from the treatment meals. Parents were also involved in the

treatment and required to complete two treatment meals during dinner time that followed the

same treatment procedure used during the day.

Before the baseline condition began, Jeremy’s parents identified 17 foods preferred foods

and 12 target foods he could be taught to eat. During baseline meals, praise was given if Jeremey

consumed a pea-sized bite of target food on a spoon. The pea-sized bite of target food on a spoon

was removed if Jeremy did not accept the bite within 5 seconds and another target food was

presented instead. Meals were ended after 10 minutes whether or not Jeremy accepted the target

bites presented and all 12 target foods were presented in over many baseline meals.

During treatment conditions, Jeremy was presented with a pea-sized bite of food from “Plate

A” for 5 seconds. Jeremy was informed that if he took a bite from “Plate A” (non-preferred

foods), he could take a bite from “Plate B” (preferred foods). If Jeremy did not accept a bite from

“Plate A”, the next target food on “Plate A” was presented and the contingency was repeated.

Meals were ended after 10 minutes whether or not Jeremy accepted the target bites presented.

After five treatment sessions, Jeremy refused all bites of target foods. Escape extinction was

introduced and Jeremy needed to accept a single bite from “Plate A” within 30 seconds before he

could earn a 3-minute break from the meal and refusing food did not result in the meal ending.

All disruptive behaviours were ignored during treatment conditions. The size of the bites of

target food required was slowly increased as Jeremy was able to accept three consecutive bites of

target food (and target size of bite) without engaging in disruptive behaviours. Contingent access

to preferred foods from “Plate B” resumed without escape extinction, once the four target Plate

A foods reached mastery criteria with escape extinction.

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During baseline, Jeremy did not accept any bites of target food and engaged in disruptive

behaviour during all bites presented. Contingent access to preferred foods also resulted in no

acceptance of target food bites and Jeremy engaged in disruptive behaviour during these

conditions too. After escape extinction was introduced alongside contingent access to preferred

foods, disruptive behaviours decreased significantly and accepted bites of target food increased

significantly. Jeremy was able to maintain the progress at 1 month and 3 month follow up.

This study showed how escape extinction can be successful at increasing the number of foods

consumed by a child with food selectivity, even when implemented temporarily. Although

escape extinction has been shown by research to be a necessary for treating food refusal and food

selectivity, this study suggests that escape extinction may only be needed temporarily and

contingent access to preferred food can be resumed as the sole intervention.

Article #2 Summary

Bui, L., Moore, D., & Anderson, A. (2013). Using escape extinction and reinforcement to

increase eating in a young child with autism. Behaviour Change, 30, 48-55.

This study assessed the effects of escape extinction combined with positive reinforcement to

reduce food refusals and increase appropriate eating behaviour. A treatment package was used in

this study because treatment packages have been shown to produce results quicker.

The participant was a 2-year-old girl named Anne (pseudonym) diagnosed with autism and

pervasive developmental delay (PDD). The dependent variable was food acceptance, measured

by the number of times Anne accepted the food that was offered to her (i.e. putting food into her

mouth and chewing/swallowing food without spitting it out). Anne’s food refusal (i.e. turning

her face and body away from the food, covering her mouth when the spoon was near her lips,
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pushing the spoon away or spitting out the food that was in her mouth) was also measured to

calculate food acceptance rates. Escape extinction and positive reinforcement in the form of

verbal praise and encouragement were used in combination to help increase Anne’s food

acceptance. The intervention was implemented by Anne’s mother (after being trained). Anne’s

mother also kept the spoon in front of Anne face and did not pull the spoon away until Anne

accepted the bite (escape extinction). Anne’s mother would also say verbal encouragements such

as “good girl”, “very good” and ‘that’s good” after every bite that Anne accepted (positive

reinforcement). Frequency was used to collect data. Specifically, the number of spoons of food

that Anne accepted and the number of times Anne refused to take a bite were measured to

calculate acceptance and refusal rates. Sessions were also videotaped to help with data

collection.

The rate of food acceptance was low during the baseline phase across all 3 settings of

breakfast (mean = 59%), lunch (mean = 58%) and dinner (mean = 46%). Once the intervention

of escape extinction and positive reinforcement were introduced into each setting successively,

the data showed a distinct increase in the rate of food acceptance and a reduction in the

variability of each phase (breakfast = mean of 87%, lunch = mean of 88% and dinner = mean of

75%). Food acceptance rates after intervention were maintained at follow-up sessions for each

setting. Anne’s mother reported post-intervention that she was very satisfied with escape

intervention combined with positive reinforcement as a treatment package and she found the

intervention to be very effective and beneficial.

The study found that the combination of escape extinction and positive reinforcement was

effective in increasing as a treatment package in increasing food acceptance for Anne across 3

different settings. The changes in behaviour also maintained during follow up. The authors
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suggested that more research is needed to see if the results of the study can be generalized to

other children with food selectivity.

Application:

Both articles investigated the effects of a treatment package on children with food

selectivity. Both the treatment package used in both articles in included escape extinction and

some form of positive reinforcement. For Article 1, the positive reinforcement was preferred

foods and for Article 2, the positive reinforcement was praise and verbal encouragement. Both

studies collected the data using frequency and both studies included parents’ involvement as part

of the intervention. The same results were found for both studies, in which escape extinction and

positive reinforcement combined were effective in increasing food consumption for a child with

autism and food selectivity. Article 1 also found that escape extinction is not required for the

entire duration of treatment and can be faded out to leave contingent consumption of preferred

foods (positive reinforcement) as the sole intervention. Both studies also demonstrate that the

techniques are straight forward enough for parents (after training) to implement on their child

who may also experience feeding problems and a behaviour professional is not necessary to

directly implement the intervention on the child.

As a behaviour consultant and behaviour interventionist, I have and will probably continue to

work with clients who experience food selectivity. The research provided from these two studies

helps immensely in providing interventions that could be used to promote food acceptance. One

of the clients I currently work with is a 3-year-old boy who experiences feeding problems of

food refusal and food selectivity. He will only eat chips (different types), French fries, cereal and

fruit snacks. His current intervention for food acceptance involves a combination of high-
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probability sequence and positive reinforcement. If his current intervention is unsuccessful in

increasing food acceptance, I will try implementing escape extinction in combination with

positive reinforcement (i.e., contingent access to preferred food) to increase food acceptance in

my 3-year-old client.

Both studies conducted the intervention package on only one participant. More participants

are needed to observe if the successful results can generalize to other children with food

selectivity and to other settings (i.e., in a school environment).