Use of the high-probability instructional sequence and escape extinction in a child with food refusal.

One preschooler refused almost every bite at lunch.

The team tried two plans. First they gave three easy instructions the child already liked. Then they offered food. This is called a high-probability (high-p) sequence.

When that failed they added escape extinction: the spoon stayed at the lips until one bite was taken. They counted bites accepted and time to finish.

High-p sequence alone did nothing. The child still cried and turned away.

Once escape extinction began acceptance jumped from 0 % to 90 % and meals shortened from 30 min to 10 min.

Refusal dropped to near zero and stayed there for the whole three-week follow-up.

Giallo et al. (2006) later repeated the package with three kids and saw the same pattern: high-p plus escape extinction beat escape extinction alone for two of them.

Richman et al. (2001) and Swaim et al. (2001) had already shown parents can run escape extinction at home. E et al. simply bolted the high-p sequence onto that core.

Rubio et al. (2020) extends the idea again: when escape extinction still fails, a quick finger prompt can finish the job.

If you only use high-p instructions you will waste sessions. Add escape extinction from day one. Start with three easy tasks the child always completes, then present the bite and hold the spoon until acceptance. Track bites and meal length; you should see change within five meals.