Antecedent manipulation in the treatment of primary solid food refusal.

A 4-year-old with primary solid food refusal was treated with systematic fading of utensil type and food texture, using a multiple probe design across food groups. The subject was a multi-handicapped boy hospitalized for feeding problems, self-injurious behaviors, and sleep cycle reversal. At admission, the subject received all nutrition in the form of a liquid nutritional supplement through regular bottle feedings every half hour. Craniofacial anomalies and past multiple facial surgeries precluded the use of a physical prompting procedure. During the first treatment phase, pureed foods were presented with a preexisting stimulus (a regular baby bottle). Accepted presentations were reinforced with music delivered through headphones. All other behaviors received neutral consequences. In the second treatment phase, undiluted pureed foods were presented in bottles, which allowed experimenter control of the size of the bolus entering the mouth. Consequences were identical to those in Treatment 1. Next, spoon-feedings were introduced with the same consequences in place. Reinforcement with a newly acquired preferred food was initiated and faded to a variable ratio three (VR3) schedule. This fading procedure was effective in teaching this young multihandicapped child to consume a nutritionally balanced diet of pureed foods with an average acceptance of 94% and a concomitant decrease in inappropriate mealtime behaviors.