Escape Extinction Research Articles

SPOON DISTANCE FADING WITH AND WITHOUT ESCAPE EXTINCTION AS TREATMENT FOR FOOD REFUSAL

Little is known about the characteristics of meals that serve as motivating operations (MOs) for escape behavior. In the current investigation, we showed that the distance at which a therapist held a spoon from a child's lips served as an MO for escape behavior. Based on these results, we implemented spoon distance fading, compared fading with and without escape extinction (EE), and compared fading plus EE to EE alone. Initially, inappropriate mealtime behavior decreased during fading, but this effect was not maintained as fading progressed. Inappropriate mealtime behavior was lower initially when we combined fading and EE relative to EE alone, but acceptance increased more rapidly with EE than with fading plus EE. These results suggest that a number of mealtime characteristics might function as MOs for escape behavior and that analyses of MOs may be useful for developing treatments for food refusal.

A comparison of simultaneous versus sequential presentation of novel foods in the treatment of food selectivity

AbstractThe present study extended the literature on feeding disorders by conducting a comparison of sequential and simultaneous food presentation in the treatment of food selectivity. In the simultaneous condition, a highly preferred food was presented in the same bite with a non‐preferred food (NPF), and during the sequential condition, a highly preferred food was delivered as a consequence for acceptance and consumption of NPFs. Generalization and maintenance of food consumption was assessed. Although results for two participants indicated that both presentation methods produced an increase in acceptance and consumption of NPFs when combined with an escape extinction procedure, anecdotal observations suggested that participants may have had a preference for eating foods in a sequential fashion. Copyright © 2010 John Wiley & Sons, Ltd.

Additive, Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder

This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components—including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading—were introduced sequentially as the focus of treatment shifted to address refusal topographies along the chain of behaviors associated with consumption. The assessment process, treatment planning and sequencing, and generalization of treatment gains to caregivers are presented in detail. In doing so, the study illustrates the core features involved in applying a flexible, evidenced-based approach to treat severe feeding difficulties.

Training children with autism spectrum disorders to be compliant with an oral assessment

Little research has been conducted on teaching children with autism spectrum disorders to be compliant with dental procedures. This study evaluated a behavioral package to train children with autism spectrum disorders to be compliant with an 8 component oral assessment. After a dental hygienist performed an assessment pretest, noncompliance on steps of the assessment was targeted for training. A package of training procedures was implemented, including a preference assessment, priming DVD, various prompts, stimulus fading (i.e., fading in aversive stimuli), distracting stimuli, escape extinction, and differential reinforcement. Results showed the efficacy of the intervention procedures, maintenance of responding, and stimulus generalization of responses across examiners and from analog to in vivo settings. The study extends the generality of a model for the assessment and intervention of noncompliance to health care procedures by children with autism spectrum disorders.

Parent-Implemented Procedural Modification of Escape Extinction in the Treatment of Food Selectivity in a Young Child with Autism

Fool selectivity is characterized by the consumption of an inadequate variety of foods. The effectiveness of behavioral treatment procedures, particularly nonremoval of the spoon, is well validated by research. The role of parents in the treatment of feeding disorders and the feasibility of behavioral procedures for parent implementation in the home has not been investigated extensively. In this study, a procedural variation of escape extinction was used to treat the food selectivity of a young child with autism. Treatment occurred in the child’s home and all procedures were implemented by his mother. At the conclusion of treatment, the child independently consumed all foods presented in regular family meals within an appropriate time period. DESCRIPTORS autism, food selectivity, parent training, pediatric feeding disorders

A Retrospective Chart Review of Dietary Diversity and Feeding Behavior of Children With Autism Spectrum Disorder Before and After Admission to a Day-Treatment Program

The nutritional status and mealtime performance among a group of children with autism spectrum disorders (ASD) were examined before and after admission to an intensive feeding day-treatment program. Treatment involved escape extinction, reinforcement, and stimulus fading procedures. Outcomes focused on dietary diversity and mealtime performance, including acceptance, swallowing, and disruptive mealtime behaviors. Upon admission, participants exhibited severely restricted diets, low rates of acceptance and swallowing, and high rates of disruptive mealtime behavior. Following treatment, significant improvements regarding food variety, consumption, and appropriate mealtime behavior were demonstrated. Gains were maintained after caregiver training was conducted and caregivers were introduced as the primary feeders.

Training children with autism spectrum disorders to be compliant with a physical exam

The purpose of this study was to train children with autism spectrum disorders to be compliant with a 10-component physical examination. After a physician assistant administered an exam pretest, noncompliance on steps of the exam were considered with respect to a skill deficit and escape from aversive stimuli. A package of training procedures was implemented, including preference assessment, priming DVD, various prompts, contact desensitization (i.e., fading in aversive stimuli), shaping, escape extinction, and differential reinforcement of other behavior. Results showed the efficacy of the intervention procedures, maintenance of responding, and stimulus generalization of responses. The study provides a model for the assessment and intervention of noncompliance to health care procedures by children with autism spectrum disorders.

FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.

Behavioral Approaches to Training Developmentally Disabled Children for an Overnight EEG Procedure

Smith-Lemli-Opitz syndrome (SLOS) is a genetic syndrome associated with multiple congenital malformations, mental retardation, and autism spectrum behaviors. This clinical protocol was part of a larger study investigating the effects of a cholesterol-lowering medication for SLOS patients. Behavioral therapists were consulted to facilitate participants' cooperation with an overnight electroencephalogram (EEG). Seventeen children participated in one 1-hour training session of a mock EEG. Behavioral methods included task analysis, differential reinforcement, and escape extinction. Descriptive data reveal low cognitive and adaptive functioning. Fifty three percent of children tolerated all steps of the training procedure and 88% of participants tolerated all of the actual EEG procedure. Behavioral methods of training children may be an effective preparation for EEG procedures for children with SLOS. This study indicates that sedation, anesthesia, or restraints are not necessary to accomplish EEG testing of children with SLOS. Results may generalize to children with a range of disabilities.

Treatment of Selective and Inadequate Food Intake in Children: A Review and Practical Guide

Treatment of highly selective or low overall eating by children may prevent the development of more complicated feeding difficulties, which can result in compromised health status and developmental concerns as well as the need for more intensive interventions. Caregiver-friendly intervention strategies that can be implemented with children in their community environments (e.g., in the child's home or school) may reduce the need for tertiary care. A small but growing number of studies have found that certain behavioral procedures can be effective in the absence of escape extinction with children who have established eating patterns (i.e., inadequate intake, selectivity by food type). This article reviews these procedural variations within the behavioral pediatric feeding literature and provides a practical guide for individuals who develop behavioral interventions for children in community settings.

Treatment of Escape-Maintained Behavior with Positive Reinforcement: The Role of Reinforcement Contingency and Density

Functional analyses suggested that the disruptive behavior of three preschool children was maintained by escape from demands. While keeping the escape contingency intact, we conducted (a) a density analysis in which the children earned preferred items for task completion according to two schedules that varied in reinforcement density, and (b) a contingency analysis in which preferred items were delivered either contingent on task completion or provided noncontingently. Edible delivery (regardless of density or contingency) without escape extinction resulted in clinically significant decreases in the disruptive behavior of one child, and consistent but nonclinically significant reductions for a second child. An increase in compliance was observed for all three children. No effects of reinforcement density were detected at the parameters manipulated in this study, and no differences were observed between contingent and noncontingent reinforcement conditions. Escape extinction was eventually implemented with two children, and was effective with one of them. Additional interventions (instructional fading and embedding) were required to reduce the remaining child’s rate of disruptive behavior. Our results suggest that noncontingent delivery of preferred items may be effective in decreasing escape-maintained behavior and promoting compliance for some children.

Training vision screening behavior to children with developmental disabilities

The American Academy of Pediatrics recommends vision screening of all children between 3 and 5 years of age, and states have mandated vision screening for all school children. Participants were three 4–6-year old school children with either a developmental delay or autism who scored “could not test” on the state required vision screening. Participants’ screening performance indicated both a visual discrimination skill deficit and escape/avoidance behavior. Discrimination training procedures included preference assessment, match-to-sample discrimination discrete trials training, transfer of stimulus control procedures, differential reinforcement, and choice making. Escape/avoidance was treated by fading-in the aversive sensory stimulus (i.e., duration of wearing glasses), escape extinction, and reinforcement of alternative behavior. Following training, two children passed their vision screening and compliance generalized to their hearing screening. The third child met the performance criterion for the two vision screening behaviors trained.

SOME EFFECTS OF NONCONTINGENT POSITIVE REINFORCEMENT ON MULTIPLY CONTROLLED PROBLEM BEHAVIOR AND COMPLIANCE IN A DEMAND CONTEXT

Functional analysis suggested that the problem behavior of an 8-year-old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.

Behavioral intervention to increase compliance with electroencephalographic procedures in children with developmental disabilities

The EEG, or electroencephalogram, is a neurophysiological technique used to detect and record electrical activity in the brain. It is critical to the diagnosis and management of seizure disorders, such as epilepsy, as well as other neurological conditions. The EEG procedure is often not well tolerated by children with developmental disabilities because of anxiety about unfamiliar equipment, difficulty inhibiting motion, and tactile defensiveness. The inability of children with developmental disabilities to tolerate an EEG procedure is especially problematic because the incidence of epilepsy is considerably higher in children with disabilities. This clinical outcome study sought to determine the efficacy of using behavioral intervention to teach children with developmental disorders to cooperate with an EEG procedure. The behavioral training employed modeling, counterconditioning, escape extinction, and differential reinforcement-based shaping procedures. Results indicated that behavioral training is successful in promoting EEG compliance without restraint, anesthesia, or sedation.

Functional Assessment and Treatment of Migraine Reports and School Absences in an Adolescent with Asperger's Disorder

Psychological interventions for migraines typically include biofeedback training, stress-management training, or relaxation training and are implemented without consideration of environmental variables that might maintain migraines or complaints of migraines. An adolescent with daily reports of migraines that negatively impacted school attendance participated in therapy with his parents. A functional assessment of migraine complaints was conducted with the participant and his mother. After developing a hypothesis that the function of migraine complaints was escape from tasks and school, differential reinforcement and escape extinction were implemented. Results indicate that migraine reports can be successfully treated using a function-based intervention even when standard psychological interventions were ineffective, illustrating the importance of considering the function of a problem rather than treating based upon the topography.

Use of a high‐probability instructional sequence to increase compliance to feeding demands in the absence of escape extinction

AbstractWe evaluated the effects of a high‐probability (high‐p) instructional sequence on the feeding‐related compliance (food acceptance) of a young boy diagnosed with a feeding disorder. The high‐p sequence consisted of three presentations of an empty spoon; the low‐probability (low‐p) instruction was the presentation of a spoon with food. Results showed that acceptance of food increased in the presence and not the absence of the high‐p sequence. Data are discussed in terms of the role of high‐p instructional sequences in the treatment of feeding problems. Copyright © 2007 John Wiley & Sons, Ltd.

An Empirical Investigation of Time-Out With and Without Escape Extinction to Treat Escape-Maintained Noncompliance

The present study evaluates the effectiveness of two time-out (TO) procedures in reducing escape-maintained noncompliance of 4 children. Noncompliant behavioral function was established via a functional assessment (FA), including indirect and direct descriptive procedures and brief confirmatory experimental analyses. Following FA, parents were taught to consequate noncompliance with two different TO procedures, one without and one with escape extinction following TO release. Although results indicate TO without escape extinction is effective in increasing compliance above baseline levels, more optimal levels of compliance were obtained for all 4 children when escape extinction was added to the TO procedures already in place. Results indicate efficacy of TO with escape extinction when applied to escape-maintained noncompliance and are discussed as an initial example of the successful application of TO to behaviors maintained by negative reinforcement.

Behavioral Training for Increasing Preschool Children's Adherence With Positive Airway Pressure: A Preliminary Study

Behavioral training was implemented to increase adherence with positive airway pressure (PAP) in 4 preschool children. The training employed distraction, counterconditioning, graduated exposure, differential reinforcement, and escape extinction. A non-concurrent multiple baseline experimental design was used to demonstrate program effects. Initially, the children displayed distress and escape–avoidance behavior when PAP was attempted. With training, all 4 children tolerated PAP while sleeping for age appropriate durations. For the 3 children with home follow-up data, the parents maintained benefits. The results are discussed in relation to behavior principles, child health, and common barriers to PAP adherence.

The Use of Descriptive Analysis to Identify and Manipulate Schedules of Reinforcement in the Treatment of Food Refusal

The feeding behaviors of a child diagnosed with failure to thrive were assessed using descriptive analysis methodology to identify the schedules of reinforcement provided by the child's parents. This analysis revealed that the child's appropriate feeding behaviors (i.e., bite acceptance, self-feeding) were on a lean schedule of positive reinforcement and that the child's refusal behaviors (e.g., non-acceptance, expulsion) were on a rich schedule of negative reinforcement. A treatment package consisting of differential positive reinforcement for bite acceptance with and without escape extinction was evaluated by manipulating the schedules of reinforcement that were identified to be used by the child's parents. The results showed a reduction of the child's inappropriate mealtime behaviors and increases in the child's acceptance of offered food items. The results also suggested that the differential reinforcement component appeared to be most responsible for ongoing effectiveness of the treatment. These results are discussed in terms of treating the food refusal behavior of children diagnosed with failure to thrive as a preventive measure for later development of developmental disabilities.

An evaluation of a high-probability instructional sequence to increase acceptance of food and decrease inappropriate behavior in children with pediatric feeding disorders

We evaluated the effects of escape extinction with and without a high-probability (high-p) instructional sequence on food acceptance and inappropriate behavior for children diagnosed with feeding problems. The high-p sequence consisted of three presentations of a response that was similar topographically (i.e., presentations of an empty nuk ®, liquid on a spoon, and a preferred liquid on a spoon) to the low-p response (i.e., presentation of a nuk with food, liquid from a cup, and presentation of a nonpreferred food). Acceptance of food increased in the presence and not the absence of the high-p sequence during initial withdrawals for two of the three children. In addition, the high-p sequence plus escape extinction was associated with reduced levels of inappropriate behavior relative to escape extinction alone for two children. Data are discussed in relation to behavioral momentum, motivating operations, and the relative contributions of the high-p instructional sequence and escape extinction in the treatment of feeding problems.