An evaluation of motivating operations in the treatment of food refusal

Previous research on the assessment of pediatric feeding disorders has shown that negative reinforcement (escape) plays a major role in the maintenance of food refusal and that escape extinction (EE) may be necessary in the treatment of severe food refusal. The current study examined the influence of two potential motivating operations (MOs) on escape from bite presentations for 3 children with severe food refusal: (a) noncontingent positive reinforcement (NCR) and (b) food satiation (as a result of enteral nutritional support). The abolishing effects of NCR on negative reinforcement for refusal behaviors were demonstrated in Experiment 1 when escape was allowed for food refusal and in Experiment 2 during demand fading across a hierarchy of bite placements. The interactive effects of NCR and food satiation on negative reinforcement for escaping bite presentations (within a hierarchy of bite placements) were demonstrated in Experiment 3. NCR abolished escape as a reinforcer and food satiation established escape as a reinforcer. The combined MO effects of NCR and food deprivation resulted in decreased refusal behaviors and increased acceptance across all bite placements in Experiment 3 even though escape was allowed. Results extend the existing bodies of literature on the competition between positive and negative reinforcement and the effects of specific biological conditions on escape-maintained behavior. Implications for treatment and future research are discussed.