autism · food refusal · mealtime · picky eaters

Picky Eaters

For many parents, finding the right foods their children will eat comes with a set of challenges. These challenges can most often be attributed to behaviors that we call picky eating behaviors, leading to picky eaters. Picky eaters only eat certain foods, while refusing to eat any new foods that parents want to introduce as part of maintaining a balanced diet. Many parents become faced with challenging behaviors such as intensive crying, and spitting food out, which makes it difficult to incorporate a variety of food at mealtime.

When researching this topic I found an article that describes two effective procedures in reducing picky eating behavior. One procedure decreases challenging behaviors, and the second effectively increases children’s consumption of different types of foods, eliminating picky eating behavior.

Before I go into these particular procedures, I would like to talk about why people behave. The field of applied behavior analysis has identified 4 reasons1 why people behave (Cooper, Heron, & Heward, 2007).

People may behave to

1. Get somebody’s attention (ex. the child cries, so his mother can come to hold him)

2. Get something such as money, favorite toys, food, and so forth

3. Get out of the task (ex. the child cries and throws the tantrum, so she does not have clean up the toys)

4. Get the feelings they like (ex. scratching your arm makes the arm no longer itchy.)

* Notice a #1 next to the word reasons bolded in the above paragraph. You will find a glossary below with each word that has a number next to it. I have provided the technical term used in applied behavior analysis for those reading who would like to know more about these principles, procedures and terms.

What’s in review?

There are two procedures found to be effective in increasing different types of food consumption in children and stopping them from refusing food (being picky eaters).

Who participated?

The participant was Cam, a 3-year-old boy who was diagnosed with autism spectrum disorder. He likes to eat applesauce and Stage 3 baby food. The sessions took place in a room at The Autism Treatment Center. An analysis was conducted at this treatment center to identify why Cam refused to eat many foods.

What 2 procedures were used to decrease picky eating and increase food consumption?

Procedure 12: In the first procedure, the researchers identified the behavior they wanted the child to do which was to eat food. When the child ate food they rewarded him by providing lots of attention, and giving him his favorite toys. At the same time, they did not let him avoid the food by spitting it out, throwing it or doing any behavior that would result in him refusing food. They simply continued the procedure until he ate all the food.

Procedure 23: In the second procedure, the child received lots of attention regardless of whether he ate the food or not at that moment. This procedure continued until the child ate all the food. This may sound counter intuitive, but it is very similar to procedure 1 in that he gets all the attention, it just wasn’t contingent upon eating the food. In this procedure the emphasis is on providing attention for eating food or not, but continuing until Cam finished the food. Furthermore, Cam would still have to finish the food but the attention was provided even in the moments that he was not eating, or if he refused food.

What is the behavior chosen to be rewarded4 and the identified bad behavior5?

The rewarded behavior4 was the acceptance of the bite of food, which means Cam clearing the mouth by chewing and swallowing the whole bite of food. Next, the bad behavior5 to be reduced was defined as Cam turning his head away from the spoon, hitting or blocking the feeding hand, arm or spoon of the person feeding him.

What methods were are used to increase eating?

  1. Finding What Cam likes6
  2. Finding the Reason for Cam’s Bad Behavior7
  3. Procedure 1
  4. Procedure 2

1) Finding What Cam likes

Cam’s five favorite toys were identified through a rewards assessment, by showing two toys at a time to see which item he picked. First, the researcher selected multiple toys before conducting the assessment. Next, the researcher showed two items at a time and asked Cam to pick one. The researcher repeatedly did this. The item that Cam selected the most became the favorite toy for Cam at that moment, and the one used during the procedures.

2) Finding the Reason for Cam’s Bad Behavior

The reason for Cam’s bad behavior was to get out of eating the bite of food. If you remember from above when I described the four reasons why people behave, this would be number 3. Therefore, Cam exhibited his behavior to get out of something, eating the food. When Cam had his favorite toys and the therapist’s consistent attention while his bite of food was in front of him, he did not have the bad behavior, and he did not eat it. Next, his bite of food was placed in front of him. Unless he had the bad behavior, he could not have a break from eating it. In other words, his bad behavior prevented him from eating the bite of food. In the latter situation, he had more bad behaviors. Therefore, he had a bad behavior in order to get out of eating the bite of food.

3) Procedure 1

Only when Cam accepted the bite of food, he had a 30 second “break” from eating, got lots of praise, and played with his favorite toys as a reward for exhibiting the good behavior. Before the researcher showed the first bite of the food, they gave Cam his five favorite toys from the earlier toy assessment and selected the first two toys that Cam picked for using them as rewards. On the other hand, when Cam had his bad behavior, the researcher continued to have the bite on his lips until he accepted. The next bite was presented 30 seconds after. This process was repeated for 20 minutes. In this procedure the therapist did not let Cam avoid taking a bite.

4) Procedure 2

This process is similar to Procedure 1, except Cam played with his favorite toys, got the praise from the researcher, and interacted with the therapist during the whole time as compared to taking a bite of food first. In other words, Cam played with the toys, and the researcher provided attention regardless of him having a bad behavior or accepting the bite.

Results of Study

Both procedures were effective in increasing the acceptance of bites of food and decreasing the bad behaviors. However, Cam’s mother prefers Procedure 2 compared to Procedure 1 according to the questionnaire she filled out. The mother stated she prefers Procedure 2 because it is easier to implement and fits better to Cam’s needs. Furthermore, she feels more comfortable implementing this procedure at home and in public settings. His mother reported that she and her husband implemented Procedure 2 at home successfully after this study. She felt that letting Cam play with his favorite toys was comforting to him than providing these toys only when he accepted the bite.

Discussion

Procedure 1 and 2 had the same component, which was not letting Cam get away from eating the bite of food8. Not letting Cam get away from eating may be the reason why both of the procedures were successful. This component alone was not evaluated because one of the focuses of this study was to evaluate Procedure 1 and 2, and also his mother did not approve the implementation of only this component during the intake of the study.

This procedure may be helpful in assisting parents with picky eating behaviors. Parents can identify rewards such as fun toys to earn for eating food provided at mealtime. A rewards assessment can assist in this process. When a reward has ben identified, earning those rewards can be contingent on eating food at mealtime.

Example: Rewards Assessment

Parents can either ask their kids to rate what they like or compare items 2 at a time. For example; car vs train. In the below example TV time is the most preferred.

Rewards Most to least rating scale 1-5
Car 3
Train 4
Game 2
TV time 1
Color 5

Reference

Allison, J., Wilder D., Chong, I., Lugo, A., Pike, J., & Rudy, N. (2012). A comparision of

differential reinforcement and noncontingent reinforcement to treat food selectivity in a

child with autism. Journal of Applied Behavior Analysis, 45(3), 613-617.

Cooper, J. O., Heron, T. E., and Heward, N. L. (2007). Applied behavior analysis (2nd ed.).

Upper Saddle River, NJ: Pearson Education.

*Please see the glossary below if you are interested in the technical terms that are used in applied behavior analysis for intervention implementation. You can refer to the second reference sighted above in the Applied Behavior Analysis 2nd edition book.

Feeding behaviors are a great concern not only for parents, but also for behavior analysts in the field who work directly with children that refuse foods. Although Behavior Buzz strives for research reviews that are free of technical language, the glossary is included in this review to assist those directly in the field who want to further research these specific procedures.

*The principles and procedures for the above example do not ensure treatment effectiveness as no direct observation, assessment, or implementation by a board certified behavior analyst (BCBA) has taken place, nor do they enter BCBA Behavior Buzz Blogger and public into a binding contract. The procedures are strategies used in the field of applied behavior analysis, and are only offered as strategies and examples for analysis, articulation and an understanding of evidence based practices and procedures. Please reference article citation for further analysis.

Glossary

1. Functions of behavior

2. Differential Reinforcement Alternative Behaviors Plus Escape Extinction

3. Noncontingent Reinforcement Plus Escape Extinction

4. Alternative behavior

5. Problem behavior

6. Paired-stimulus preference assessment

7. Functional analysis

8. Escape extinction

Sarah Kagawa, MS, BCBA

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