An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal.

Staddon et al. (2002) worked with three children who refused most foods. The team tested two ways to reinforce eating while using escape extinction. One way reinforced the moment the child put food in their mouth. The other way reinforced only after the child swallowed and the mouth was clean.

Both ways paired praise or toys with escape extinction. That means the kids could not leave the table until they ate. The study used single-case design to track each child's bites across meals.

All three children started eating much more once escape extinction began. The choice of which eating step to reinforce did not matter. Mouth-clean reinforcement worked as well as acceptance reinforcement.

Two children kept eating well even after escape extinction stopped. The third child needed the extinction step to stay in place.

Najdowski et al. (2003) ran a similar test one year later. They also found escape extinction drove the gains. Adding extra positive reinforcement only cut problem behavior, not bites. Together the two papers show the same core rule: blocking escape is the key.

Scott et al. (2024) pooled 266 cases in a meta-analysis. The large review agrees that escape extinction is essential. It adds that mixing escape and non-escape extinction gives the best overall results. The 2002 finding sits inside that bigger picture.

Ulloa et al. (2020) later showed the same DR-plus-extinction package still works when staff follow the plan only 20–40% of the time. This extends the 2002 study into real-world messy kitchens where perfect fidelity is rare.

If a child refuses food, start escape extinction first. You can reinforce any clear eating step you can see easily. Do not worry about picking the perfect moment; just block escape and praise bites. The procedure is sturdy even if your timing slips.