Operant control of pathological tongue thrust in spastic cerebral palsy.

One girl with cerebral palsy kept pushing her tongue out while eating. Food fell out and drooling soaked her shirt. The team used an ABAB reversal design to test two things at once. When her tongue stayed inside for five seconds she got a spoon of applesauce. If it poked out the feeder gently pushed the spoon against her lips to guide it back in.

Tongue thrust dropped from 80 % of intervals to almost zero the moment the program started. Food expulsion and drooling fell too. Chewing time doubled. Each time the rules were removed the problems returned, proving the package worked.

Amore et al. (2011) later used escape extinction instead of punishment and still got big feeding gains in another child with CP. Their method let the child leave the table right after taking the required bites. Scotchie et al. (2023) went further by running a quick multielement test first to find the exact bite size and texture that cut expulsion before any treatment began. Together the three studies show you can start simple with DR plus a mild response block, or you can pre-assess and use negative reinforcement, and still see fast mealtime improvements.

If you work with kids who drool or lose food because their tongue pushes forward, pair a bite of preferred food with a gentle physical prompt. Run a quick reversal to be sure the change is real. The whole package took only a few meals and parents can copy it at home.