Contingency contacting. Combining positive reinforcement and escape extinction procedures to treat persistent food refusal

Abstract

Chronic food refusal has traditionally been treated with forced feeding and other physical prompting-based procedures when positive reinforcement procedures prove inadequate. Potential problems with such procedures, however, include exacerbation of feeding difficulties and health risks, as well as low parental approval and probability of implementation. Contingency contacting maximizes contact between oral acceptance and positive reinforcement, prevents escape functions of inappropriate behaviors, and requires minimal physical contact between feeder and child. Performances of two children exhibiting chronic food refusal were observed under baseline, positive reinforcement, and contingency contacting conditions. Positive reinforcement increased acceptance only slightly and did not change negative vocalization or interruption for one child. Contingency contacting rapidly increased acceptance and grams of food consumed, and decreased negative vocalization and interruption for both children. Withdrawal to positive reinforcement decreased acceptance for both children and grams consumed for one. Reinstituting contingency contacting rapidly increased acceptance and recovery of grams consumed for one child. Parental approval ratings and treatment and research implications are discussed.