A feeding disorder occurs when a child does not consume enough food to meet his or her caloric needs to gain weight and grow. Approximately 25% to 40% of infants and toddlers with normal development and 33% to 80% of infants and toddlers with developmental disabilities are affected by feeding problems. Types of treatments used to address feeding problems commonly include behavioral treatments that involve escape extinction or medical procedures that involve a gastrostomy tube. Both types of treatments are associated with negative side effects.
The purpose of the current study was to evaluate the individualistic and interactive effects of response effort and quality of reinforcement on bites accepted within an outpatient clinic program with five children diagnosed with feeding problems. The effects of effort and quality were studied as motivating operations, meaning that their presence altered the child's motivation to eat. Response effort was defined based on the oral-motor manipulations required to consume different types and textures of food. Quality of reinforcement was defined as the individual choosing to consume a food of a similar type and/or texture over another food. Interobserver agreement (IOA) was assessed across at least 30% of feeding sessions for all children with an average IOA of 98.2% for bites accepted/mouth closures and 96.9% for problem behavior for one child. For each child, three evaluations were conducted: (a) an analysis of the independent effects of quality or effort, (b) an analysis of the interaction of quality and effort, and (c) implementation of a reinforcement-based treatment matched to the results of the assessments. The assessment and treatment evaluations were conducted within single case designs.
The results of the current study demonstrated that the influence of effort and quality alone or together (i.e., exclusive or interactive) functioned in a highly individualistic way as motivation operations. Effort influenced bites accepted for one child, quality influenced mouth closures for one child, quality and effort both influenced bites accepted for two children, and the interaction of effort and quality influenced bites accepted for one child. The treatment matched to these assessment results showed improvement in bites accepted with a reinforcement-based treatment that did not rely on escape extinction for three of the children. For all three children, total food consumption increased sufficiently that either the G-tube feedings were reduced or bottle feedings with a high caloric liquid (e.g., Pediasure) were decreased or eliminated. Treatment consisted of escape extinction for one child because he did not respond to the manipulations of quality and effort. Overall, the results of the current study demonstrated that specific dimensions of reinforcement function as motivating operations for food refusal and could be altered for four of the five children to improve eating without relying on escape extinction.