Contingency contacting. Combining positive reinforcement and escape extinction procedures to treat persistent food refusal.
Escape extinction is the powerhouse; pairing it with a bite-contingent toy finishes the job faster.
01Research in Context
What this study did
Hoch et al. (1994) worked with two kids who had refused food for years.
The team mixed two tactics: give a fun toy right after a bite and do not let the child leave the table.
They flipped the conditions on and off four times to be sure any change came from the treatment.
What they found
When both tactics were used together the kids ate almost every bite and stopped crying or hitting.
Reinforcement alone had helped a little, but adding the no-escape rule made the big jump.
How this fits with other research
Najdowski et al. (2003) later tested the same mix part-by-part with more kids. They found the no-escape rule did the heavy lifting; the extra toy only trimmed yelling.
That larger study therefore sharpens the 1994 claim: escape extinction is the engine, reinforcement is the polish.
Staddon et al. (2002) kept the no-escape core but tried two ways to deliver the toy—after the bite or after the swallow. Both worked the same, showing the exact moment of reward is flexible.
Richman et al. (2001) moved the whole package into family homes. Parents ran the plan with video coaching and still saw big gains, proving the idea travels beyond clinic walls.
Why it matters
If a client spits out every bite, start with escape extinction first—block head turns and keep the spoon present. Add a quick reinforcer if problem behavior stays high, but know the toy alone will not do the job. You can train parents to run this at dinner tonight; the procedure is tough but forgiving and keeps working even if you slip a few times.
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02At a glance
03Original abstract
Chronic food refusal has traditionally been treated with forced feeding and other physical prompting-based procedures when positive reinforcement procedures prove inadequate. Potential problems with such procedures, however, include exacerbation of feeding difficulties and health risks, as well as low parental approval and probability of implementation. Contingency contacting maximizes contact between oral acceptance and positive reinforcement, prevents escape functions of inappropriate behaviors, and requires minimal physical contact between feeder and child. Performances of two children exhibiting chronic food refusal were observed under baseline, positive reinforcement, and contingency contacting conditions. Positive reinforcement increased acceptance only slightly and did not change negative vocalization or interruption for one child. Contingency contacting rapidly increased acceptance and grams of food consumed, and decreased negative vocalization and interruption for both children. Withdrawal to positive reinforcement decreased acceptance for both children and grams consumed for one. Reinstituting contingency contacting rapidly increased acceptance and recovery of grams consumed for one child. Parental approval ratings and treatment and research implications are discussed.
Behavior modification, 1994 · doi:10.1177/01454455940181007