Prioritizing choice and assent in the assessment and treatment of food selectivity

Abstract

Food selectivity affects up to 72% and 45% of individuals with and without disabilities, respectively, and there is a need for interventions that rely on positive, unrestrictive strategies. We evaluated an assessment and treatment package for food selectivity for young children with developmental disabilities that prioritized caregiver collaboration, client autonomy, and did not rely on restrictive procedures (e.g. escape extinction). The process involved: (a) collaborating with caregivers on the selection of foods and design of the children's functional analyses; (b) indirectly and directly measuring food preferences prior to treatment; (c) evaluating the sensitivity of mealtime problem behavior to environmental variables through an interview-informed synthesized contingency analysis (IISCA); and (c) incorporating the assessment results into a progressive treatment process consisting of choice-making opportunities and differential reinforcement of successive approximations to consumption. Children also had the ability to opt in and out of treatment sessions. The treatment was effective in increasing consumption of nonpreferred foods and successfully extended to caregivers. Practical implications and directions for future research are discussed.

Keywords: choice; food selectivity; shaping; synthesized reinforcement.

Figure 1.

Preference analysis results for Liam, Ali, and Luke. Note: IMB: inappropriate mealtime behavior, SPB: severe problem behavior.

Figure 2.

Results from the functional analyses. IMB: inappropriate mealtime behavior, SPB: severe problem behavior.

Figure 3.

Treatment results for Luke. Note: Lines connecting data points in top graph denote when Luke consumed multiple foods in one trial. Horizontal dotted line represents terminal criterion of consumption. SR = reinforcement.

Figure 4.

Treatment results for Liam. Note: ‘R’ and corresponding data point denote when that food was removed from the bite shaping phase of treatment. Horizontal dotted line represents terminal criterion of consumption. SR = reinforcement.

Figure 5.

Treatment results for Ali. Note: ‘R’ and corresponding data point denote when that food was removed from the bite shaping phase of treatment. Horizontal dotted line represents terminal criterion of consumption. SR = reinforcement.

Figure 6.

Results from the mealtime observation pretreatment and posttreatment. Note: Bars represent the total number of bites available for consumption; gray represents the number of bites that were consumed.