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White Paper: Comparison of Escape Extinction and Differential Reinforcement for Treating Food Refusal
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Studies have shown that at some point, 25% of children and infants and 33% of persons with developmental disabilities display some form of eating problem (Hoch et al, 2001). These include food selectivity by texture and type, mealtime tantrums, and food refusal (Hoch et al, 2001). If left untreated, eating problems can result in serious health problems such as severe growth and developmental delays (Kern & Marder, 1996), impaired intellectual and academic development, malnourishment, and death (Hoch et al, 2001). behavioral literature initially described positive reinforcement procedures to treat food refusal (Hoch et al, 2001). However, this method has shown to be effective if food refusal is maintained only by lack of positive reinforcement (Hoch et al, 2001). If food refusal is maintained by negative reinforcement contingencies then positive reinforcement alone would not be an effective intervention strategy. Escape and avoidance responses may be inadvertently strengthened by removing the presentation of the food upon refusal and food acceptance may occur infrequently and so there are few opportunities to reinforce the target behavior (Hoch et al, 1994). behavioral eating problems often have multiple functions and require multiple contingencies to be addressed by treatments with multiple components (Hoch et al, 2001). Present literature on the subject suggests that a combination of escape extinction and differential reinforcement is the best practice for treating food refusal.