Combining stimulus fading, reinforcement, and extinction to treat food refusal.

The team worked with a 6-year-old girl who refused most foods.

They mixed three tactics at once: stimulus fading, reinforcement, and escape extinction.

Fading means the spoon started far away and moved closer only after calm bites.

Reinforcement gave her favorite toy for swallowing.

Extinction blocked head turns and spit-outs so escape no longer worked.

The combo quickly raised the number of bites she swallowed each meal.

Problem behavior like crying dropped at the same time.

Gains stayed high when the spoon distance rule was later relaxed.

Waller et al. (2010) later asked if fading was even needed.

They ran the same fading-plus-extinction package, then tried extinction alone.

Extinction by itself grew acceptance faster, so they mark the 1998 combo as superseded.

Najdowski et al. (2003) took the package apart piece by piece.

They showed escape extinction is the main engine for consumption; reinforcement just softens negative vocalizations.

Scott et al. (2024) pooled 266 kids and agreed: add non-escape extinction on top of escape extinction for the biggest payoff.

Tereshko et al. (2021) reviewed 21 studies that skipped extinction and still saw gains, giving you a gentler first option before you pull out the escape-blocking gloves.

You now know extinction is the must-have piece.

Start with antecedent and reinforcement tricks from Tereshko et al. (2021).

If acceptance stays flat, add escape extinction right away; you can skip the extra fading step the 1998 team used.

Track mouth-clean, not just first bite, because Staddon et al. (2002) showed the contingency spot rarely matters once extinction is in place.