An ABAC comparison of two intensive interventions for food refusal.

The team compared two escape-extinction ways to end food refusal. One way was physical guidance: the adult gently opens the child’s mouth and puts the bite in. The other way was nonremoval of the spoon: the spoon stays at the lips until the bite is taken.

They used an ABAC single-case design. Each child got one method, then both methods stopped, then the other method started. The order flipped across kids so no method had the advantage of going first.

Both methods pushed food acceptance up to at least 75 percent of bites. The big surprise came in the second round. Whichever method a child saw first made the next method work faster, even after a break. Starting with either procedure taught the child that escape was no longer possible, so the second procedure met almost no fight.

Dougherty et al. (1996) ran almost the same comparison five years earlier. That study used an alternating-treatments design and found physical guidance beat nonremoval on shorter meals and fewer screams. The 2001 paper flips the design and still sees both methods win, showing the choice may matter less than simply starting escape extinction.

Rubio et al. (2021) later reviewed every physical-guidance paper and finger prompts came out on top. Their finding lines up with the 2001 data: gentle mouth prompts work, and the exact prompt style is less important than sticking with it.

Laugeson et al. (2014) and Kozlowski et al. (2024) extend the idea. When a child clamps shut, start with a syringe or your finger, then fade to the spoon. These fade-in steps borrow the same nonremoval rule but soften the first contact, giving clinicians more roads to the same 75 percent goal.

You no longer have to pick the “best” escape-extinction tactic before starting. Choose either physical guidance or nonremoval of the spoon, run it until acceptance climbs, then switch if needed. The first round does the heavy lifting; the second round moves faster and feels easier for everyone at the table.