Further examination of the treatment of multiply controlled inappropriate mealtime behavior

Four kids with feeding disorders sat at a table. Each child refused food for two reasons. Some wanted to escape the demand “take a bite.” Others wanted Mom’s attention when they spat.

The team first watched each child during meals. They saw which refusal got escape and which got attention. Then they wrote one plan that blocked both pay-offs. Kids earned a toy bite-by-bite. At the same time, spitting no longer removed the spoon and crying no longer brought Mom close.

Three of the four children soon took 80-100 % of bites. Spitting, head-turning, and crying dropped to almost zero. The fourth child improved only after the team added stricter escape blocking.

When the plan missed one function—say, only blocking escape but still giving attention—problem behavior bounced back. Matching every function mattered.

Chen et al. (2022) asked a different question: should we give the toy right after each bite or save it up? They still found big gains, showing the toy itself works. Kirkwood shows the toy must be paired with blocking every function, not just one.

ALee et al. (2022) got kids with autism to eat using praise alone. That looks like a contradiction—why add extinction here? Their kids only had food selectivity, not escape-plus-attention refusal. Mild pickiness may yield to praise; multiply controlled refusal needs the heavier package.

Van Arsdale et al. (2024) reviewed 15 recent feeding studies. Many named noncontingent reinforcement, but few defined it the same way. Kirkwood gives a clear recipe: deliver the reinforcer for eating while you withhold it for refusal, and do this for every identified function.

If you run a feeding protocol and see quick gains that later slip, check your functional assessment. One missed function can keep the whole top spinning. Write separate extinction rules for escape and for attention, then reinforce each bite on the spot. Start Monday by re-probing refusal—one trial with escape blocked, one with attention blocked—and adjust your plan before the spoon hits the tray.