Relapse during the treatment of pediatric feeding disorders
Plan for relapse in half of extinction-based feeding cases and act fast when bite rates jump or caregivers take over.
01Research in Context
What this study did
Haney et al. (2022) looked back at many extinction-based feeding cases. They asked how often kids relapsed after treatment stopped or moved rooms.
They counted two kinds of relapse: resurgence (old refusal comes back) and renewal (refusal spikes in a new place).
What they found
Resurgence hit 4 of every 10 kids. Renewal hit 5 of every 10.
Bite-rate jumps and caregiver hand-offs were the main triggers.
How this fits with other research
Ibañez et al. (2019) first showed renewal when kids went from clinic to home. Haney’s 2022 numbers back that up with a bigger count.
Muething et al. (2020) saw 42% renewal across all behavior cases. Haney’s 52% for feeding sits just above that range, pointing to food refusal as extra fragile.
Greer et al. (2023) found longer extinction does not cut resurgence. Haney agrees: plan for relapse no matter how long you treat.
Scott et al. (2024) meta-analysis says combine escape plus non-escape extinction for best gains. Haney warns even the best combo still risks relapse, so add their 2021 mitigation step when you switch rooms or feeders.
Why it matters
Expect relapse in half of your feeding cases. Watch bite rate and who is holding the spoon. When either changes, run a brief renewal-mitigation plan: keep extinction going and reinforce acceptance heavily for the first few meals in the new spot.
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Join Free →Track bite rate per minute; if it jumps up for two bites, add a brief renewal-mitigation phase—continue extinction and give a bite of preferred food after each accepted bite—for the rest of that meal.
02At a glance
03Original abstract
Resurgence and renewal are treatment-relapse phenomena in which previously extinguished behavior returns after the conditions for an alternative response worsen or the context changes, respectively. Recently, researchers have evaluated the prevalence of resurgence and renewal when treating destructive behavior with functional communication training. However, resurgence of inappropriate mealtime behavior has yet to be evaluated; perhaps because treatments involve qualitatively different resurgence opportunities (e.g., increased bite-presentation rate). We evaluated the prevalence of resurgence and renewal of inappropriate mealtime behavior across 22 and 25 applications of extinction-based treatments, respectively. Resurgence occurred in 41% (9/22) of applications, most often following presentation-rate increases. Renewal occurred in 52% (13/25) of applications, most often following feeder changes from therapist to caregiver. We discuss these findings in terms of their ability to inform relapse-mitigation strategies for resurgence and renewal of inappropriate mealtime behavior.
Journal of Applied Behavior Analysis, 2022 · doi:10.1002/jaba.913