Behavior modification of food aversion in a profoundly retarded female: a case study.

Abstract

Operant conditioning techniques have been successfully applied to anorexia ne~osa in individuals of normal intelligence (Bachrach, Erwin, & Mohr, 1956), but with severely or profoundly retarded individuals special problems arise. Since food is aversive, it cannot be used as a reward for eating, ar least during initial stages of conditioning. The choice of secondary reinforcers is restricted because of the retardate's limited responsiveness to sensory and social stimuli. This report summarizes a treatment approach which successfully used a secondary reinforcer to re-establish a primary reinforcer and restore eating in a profoundly retarded girl. S was a profoundly retarded 17-yr.-old female with ~henylketonuria. Over several months she &owed an-increasing aversion to food. when accepted as an inpatient for treatment, S was ingesting no food, either liquid or solid. Physical examination revealed her to be malnourished, anemic, and mildly dehydrated with a weight loss from 130 Ib. to 80 Ib. A complete medical evaluation which included a urinalysis, an upper GI series, a neurological evaluation, and an EEG revealed no organic cause for her aversion. Initially, S was consistently agitated and negativistic when presented with food, turning her head vigorously, throwing and push~ng away any food presented to her. After typical social reinforcers, i.e., praise, encouragement, and social attention, were ineffective in reinforcing approach toward food, it was noted S would respond positively to the ringing of a bell. Several simple motor acts, e.g., touching nose with finger, were shaped and reinforced by E's ringing the bell or by allowing S to play briefly with it. An attempt was then made to shape approach behavior toward a bottle of Coca-Cola. At first S reacted negatively to the Coca-Gla, pushing it away from her. Through pairing the presentation of the Coca-Cola with ringing of the bell, E was able to get S to hold the bottle in her hand. Successive approximations to raising the bottle to her mouth (with E modeling the desired behavior) were then reinforced with ringing of the bell. After several hours of such shaping, S began to imitate the desired behavior and drink the Coca-Cola. Once this behavior stabilized, a more nutritive liquid (Instant Breakfast) was substituted for the Coca-Cola. Several more hours of shaping were required, using the bell and sips of Coca-Cola as a reinforcer to get S to consume the Instant Breakfast. From this point, improvements in S's eating behavior proceeded more ra idly, and she began to gain weight. Both Coca-Cola and Instant Breakfast became rein6rcers for eating. Sernisolid and soft foods such as ice cream, scrambled eggs, and soup were gradually intre duced. Initially, bites of these foods were reinforced with sips of Coca-Cola and Instant Breakfast. Frequency of reinforcement was gradually reduced until the alternation of liquids and solids during a meal approximated normal behavior. Then foods from a regular menu were introduced with little difficulty. Finally, S's parents were trained in behavior management and participated in mealtime sessions. Since discharge and return home over one year ago S has regained and maintained normal body weight and presented no significant feeding problems.