A comparison of function- and nonfunction-based extinction treatments for inappropriate mealtime behavior

On the efficacy and efficiency of treating pediatric feeding disorder

Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal. The purpose of this study was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of research using single-case experimental designs. We examined the extent to which different interventions resulted in decreases in IMB while also producing increases in food acceptance. This meta-analysis was also used to examine the efficiency of different interventions in achieving clinical significance. We identified 38 studies involving 266 cases in which IMB was treated with a behavioral intervention. The results indicated interventions that combined escape extinction and non-escape extinction had greater effect sizes for both reducing IMB and increasing food acceptance than either escape extinction alone or non-escape extinction alone. However, interventions that included escape extinction were slightly less efficient at decreasing IMB than were interventions that did not include escape extinction. We discuss the implications of these findings and provide recommendations for future research.

Evaluating Preference for Functional and Nonfunctional Stimuli in the Treatment of Destructive Behavior

The effects of including nonfunctional stimuli that may appear in the natural environment during treatment remain unclear. The current study evaluated preference for differential reinforcement of communication (DRC) treatments with functional reinforcers only and a combination of functional and nonfunctional stimuli. Both treatment conditions resulted in a decrease in destructive behavior and an increase in the communication response for all participants. Two participants preferred the combined DRC condition, whereas one participant showed equal preference for the combined condition and one of the functional conditions.

Functional analysis of problem behavior: A 40-year review

Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.

On the validity of interpreting functional analyses of inappropriate mealtime behavior using structured criteria

Visual inspection is the traditional method behavior analysts use to interpret functional-analysis results. Limitations of visual inspection include lack of standardized rules, subjectivity, and inconsistent interrater reliability (Fisch, 1998). To address these limitations, researchers have developed, evaluated, and refined structured criteria to aid interpretation of functional analyses of destructive behavior (Hagopian et al., 1997; Roane et al., 2013; Saini et al., 2018). The current study applied the structured criteria Saini et al. (2018) described to functional analyses of inappropriate mealtime behavior. We assessed its predictive validity and evaluated its efficiency relative to 3 post hoc visual inspection procedures. Validity metrics were lower than those in Saini et al. however, ongoing visual inspection increased the efficiency of functional analyses by more than 30%. We discuss these findings relative to the procedural differences between functional analyses of destructive behavior and inappropriate mealtime behavior.

On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis

Functional analysis is the primary assessment used to determine the function of inappropriate mealtime behavior in children with feeding disorders. Based on single-case experimental design studies and recent reviews, the prevalence of negative reinforcement alone in the maintenance of inappropriate mealtime behavior appears to be much greater than positive reinforcement alone. We conducted a retrospective consecutive-controlled case series to determine the generality of previous findings. Results of the epidemiological analysis support prior research in that negative reinforcement in the form of escape (44.8%), and multiple control (i.e., positive and negative reinforcement) in the forms of escape and attention (37.2%), are considerably more prevalent than positive reinforcement alone (2.5%). We discuss the relationship between functional analysis of inappropriate mealtime behavior and treatment utility. Further, we describe avenues of future research designed to advance the application of functional analysis in feeding disorders beyond inappropriate mealtime behavior.

An evaluation of trial-based functional analyses of inappropriate mealtime behavior

Functional analyses allow clinicians to develop treatment targeting the variables maintaining a child's inappropriate mealtime behavior (Bachmeyer et al., 2019). Extended functional analyses can be inefficient, potentially delaying the onset of treatment. Researchers have suggested a trial-based functional analysis can increase assessment efficiency (Saini, Fisher, et al., 2019). This study compared trial-based functional analyses to extended functional analyses to determine the variables maintaining inappropriate mealtime behavior. We compared the efficiency and acceptability and evaluated treatments informed by the analyses. Exact correspondence between analyses was low (29%); however, most treatments indicated by the trial-based functional analyses (80%) resulted in improvements in the child's target behavior. The trial-based functional analysis required 71% less time than the extended functional analysis, and caregivers found analyses equally acceptable. Future researchers should continue refining trial-based functional analysis procedures to provide an efficient assessment that leads to efficacious treatment.

A Demonstration of Caregiver-Implemented Functional Analysis of Inappropriate Mealtime Behavior via Telehealth

Treatment for pediatric feeding disorders is imperative, so clinicians should alter the assessment and treatment process, making it is possible for caregivers to deliver via telehealth. Clinicians must first demonstrate that caregivers can conduct initial assessments in this format. We extended the literature on functional analysis of inappropriate mealtime behavior by demonstrating that caregivers can implement functional analysis procedures via telehealth to identify maintaining variables of inappropriate mealtime behavior. Clinicians determined that escape, attention, and tangibles and escape maintained inappropriate mealtime behavior during solids and liquids meals, respectively.