Functional analysis and food refusal: A brief review.

Abstract

In their article, Iwata et al. (1982/1994) developed a functional analysis methodology that underscored the need for behavior analysts to conduct functional analyses in order to identify maintaining conditions and develop effective function-based treatments for problematic behavior. Since the Iwata et al. (1982/1994) article, behavior analysts have stressed the importance of conducting functional analyses when developing treatments for food refusal. The primary purpose of this paper was to review the use of functional analysis (e.g., Iwata et al., 1982) in interventions aimed at treating food refusal in children as seen in the Journal of Applied Behavior Analysis (JABA) (1982-2005). The search found 22 articles. Those articles were reviewed to first, identify studies that reported using a functional analysis prior to the development of a treatment and second, examine the treatments implemented in each study. Keywords: Functional analysis, food refusal, feeding problems. ********** Childhood mealtime problem behavior occurs in many healthy infants and children but it is more common in children with disabilities (e.g., Luiselli, 1989), including but not limited to children with physical disabilities, mental retardation, and prolonged illness (e.g., Palmer, Thompson, & Linscheid, 1975; Reilly, Skuse, & Poblete, 1996). A feeding problem is identified when a child is unable or refuses to eat or drink sufficient quantities to maintain nutritional status (e.g., Babbitt, Hoch, & Coe, 1994; Budd et al., 1992). Feeding problems can encompass a variety of behaviors including, but not limited to, lack of independent self-feeding skills, disruptive behavior (e.g., tantrums, aggression) during mealtimes, eating too much or too little, and limited intake due to selectivity by type or texture of food, resulting in dietary inadequacies. (e.g., Cooper et al., 1995; Luiselli, 1989; O'Brien, Repp, Williams, & Christophersen, 1991; Sisson & Van Hasselt, 1989). Food refusal is a type of feeding problem. Food refusal can be conceptualized as a form of noncompliance in which the child refuses to eat a sufficient volume or variety of food (Kerwin, Ahearn, Eicher, & Burd, 1995). Persistent and chronic eating problems, especially food refusal behaviors, have significant negative impact on a child's health and growth (e.g., Luiselli & Gleason, 1987). Children who consume insufficient amounts of food are at a higher risk for excessive weight loss, lethargy, malnutrition, diminished physical and cognitive function, and growth retardation (Budd et al., 1992; Oates, Peacock, & Forrest, 1985; Howard & Cronk, 1983; Riordan, Iwata, Finney, Wohl, & Stanley, 1984). Despite the potential seriousness of food refusal, little is known about possible variables maintaining food refusal and similar feeding problems (e.g., Piazza et al., 2003). Understanding the functional characteristics of food refusal may be helpful in developing treatments that more precisely match the sources of reinforcement that maintain the problems. A second rationale for applying functional analysis to the assessment of food refusal is that selecting a function-based treatment may increase the chances of the new behavior maintaining after the departure of the researcher. Functional analysis methodologies, initially applied to self-injurious behavior (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994), was adapted to analyze environment-behavior interactions that maintained a wide variety of behavior, such as aggression (e.g., Wacker et al., 1990), destructive behaviors (e.g., Slifer, Ivancic, Parrish, Page, & Burgio, 1986), stereotopy (e.g., Wacker et al., 1990), and tantrums (e.g., Carr & Newson, 1985). In their article on behavior analytic research, Iwata et al. (1982/1994) formulated a comprehensive and standardized functional analysis methodology that underscored the need for behavior analysts to conduct functional analyses in order to identify conditions maintaining problematic behavior (e. …