An evaluation of a high-probability instructional sequence to increase acceptance of food and decrease inappropriate behavior in children with pediatric feeding disorders.
A three-step high-p sequence right before the bite can make escape-extinction meals smoother for many kids with feeding refusal.
01Research in Context
What this study did
Three kids with feeding disorders sat at a small table. Each child had refused many foods for months.
The team used a reversal design: ABAB. In B phases they gave three easy instructions the child always followed (high-p). Then they quickly presented a bite of refused food. If the child accepted, praise flew. If not, the spoon stayed put until the bite went in (escape extinction).
What they found
Two of the three children doubled or tripled food acceptance when the high-p sequence came first. Problem behavior like crying or head-turns dropped by half.
The third child showed little change, so the high-p boost is not magic for every learner.
How this fits with other research
Carr et al. (2003) ran a similar single case and found the high-p sequence alone did nothing; escape extinction did all the work. Giallo et al. (2006) now shows that, for some kids, the high-p step still helps once extinction is already in place.
Scott et al. (2024) pooled 266 cases and agreed: combining escape extinction with other tactics (like high-p or non-escape prompts) gives the biggest gains. Their meta-analysis includes the 2006 data, so the two papers line up, not clash.
Rubio et al. (2020) later added a finger prompt instead of high-p and also raised bite acceptance. Both studies extend escape extinction, just with different low-effort add-ons.
Why it matters
If you already use escape extinction but still see lots of refusal or crying, try slipping in three quick high-p instructions right before the bite. It costs five extra seconds and may cut problem behavior in half for many kids. Track each child separately; if acceptance does not jump after two meals, drop the add-on and stay with pure extinction or switch to another prompt like the finger guide.
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Join Free →Before the next bite, give three easy instructions your client always follows (e.g., “clap hands, touch nose, give five”), then immediately present the refused food and hold the spoon until acceptance.
02At a glance
03Original abstract
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.
Research in developmental disabilities, 2006 · doi:10.1016/j.ridd.2005.05.005