Utensil Fading to Increase Appropriate Utensil Acceptance
Fade the utensil, not the food, when a child with autism clamps shut to escape the spoon or cup.
01Research in Context
What this study did
The team worked with two oral-feeding children with autism. Both kids clamped their mouths when a spoon or cup arrived.
Instead of holding the utensil in place, the therapists faded the tool. They moved from finger-feeds to a spoon, or from a syringe to a cup, in tiny steps.
Each step stayed in place until the child took the food without turning away.
What they found
Both children began to accept the spoon and the cup. Acceptance rose and stayed high.
No force-feeding was needed. The kids opened on their own as the tool changed shape.
How this fits with other research
Laugeson et al. (2014) first showed syringe-to-cup fading beats tooth-clenching escape. Kozlowski et al. (2024) now repeats that win in children with autism.
Hattier et al. (2011) taped a spoon inside a cup rim and slid it out 1 cm each meal. The new study uses the same spoon-to-cup path, proving the move works outside intestinal-failure cases.
LeFrancois et al. (1993) mixed utensil and texture fading for a multi-handicapped preschooler. The 2024 paper keeps the utensil part and drops texture changes, showing the tool fade alone is enough.
Why it matters
If escape extinction stalls because the child locks their jaw, try utensil fading first. You can start with what the child already accepts—finger, syringe, or loaded spoon—and shift to the target tool in small, visible steps. No extra equipment, no tears, and you keep the session moving.
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02At a glance
03Original abstract
Escape extinction is an empirically supported treatment to increase food and drink acceptance in children with feeding difficulties. However, nonremoval of the spoon or cup may not be effective in isolation when children press their lips closed or clench their teeth. Physical guidance procedures may circumvent this concern, though this is not always the case and may require the bite or drink be deposited with an alternate utensil. Previous research has demonstrated the effectiveness of spoon-to-cup, syringe-to-cup, and syringe-to-spoon fading in typically developing children with gastrostomy tube dependence. The current study extends the existing research literature by replicating spoon-to-cup fading with a child with autism spectrum disorder who was an oral feeder, and by demonstrating the effectiveness of finger-to-spoon fading. We also provide an additional clinical example for syringe-to-cup fading for a child with autism spectrum disorder who was an oral feeder. The online version contains supplementary material available at 10.1007/s40617-024-00911-7.
Behavior Analysis in Practice, 2024 · doi:10.1007/s40617-024-00911-7