Using backward chaining and a physical guidance delay to teach self‐feeding

Rubio et al. (2018) tested backward chaining plus a short wait before help. The child first learned the last bite step. The therapist then added earlier steps one at a time. A tiny pause came before any hand-over-hand help.

The study used a single-case design. The team worked with one child who had a feeding disorder. No group numbers or stats were reported.

The paper only says the plan was “feasible.” No bite counts, meal length, or other data are given. We know the child could already swallow; the goal was to move the spoon alone.

Hansen et al. (2023) asked, “What if chaining is not needed?” They dropped physical prompts and used extra-yummy rewards instead. Both kids in their study ate more bites. The 2023 paper extends Rubio by showing a different, reward-heavy path to the same goal.

Patel et al. (2023) and Bloomfield et al. (2021) moved feeding work into telehealth. Parents ran the sessions at home and still saw big gains. These studies extend Rubio by proving you do not need a clinic table to win at mealtimes.

Williams et al. (2023) zoom out. Their 2023 review lumps Rubio’s chaining study with dozens of others. The review calls for longer follow-ups and caregiver-led models. In short, the field has already marched past the 2018 pilot.

If you still use prompt-heavy backward chaining, try adding a brief pause before you help. That tiny wait may nudge the child to move the spoon alone. Then look ahead: pair the chain with strong reinforcers or shift the whole program to parent coaching via telehealth. The newer papers show those tweaks save time and travel while keeping gains strong.