Effects of the High-Probability Instructional Sequence in Children With Feeding Disorders: A Synthesis.
High-p requests help kids with feeding issues take more bites, yet the evidence is still too thin for evidence-based status.
01Research in Context
What this study did
The team looked at every study that used the high-probability sequence with kids who refuse food. They wanted to know if the trick works well enough to be called an evidence-based practice.
They followed CEC rules. These rules ask for big samples and clear data before giving the thumbs-up.
What they found
Kids took more bites or stayed at the table longer after three-to-five easy requests. Still, the studies were small and short, so the trick is not yet evidence-based.
The review says the method is promising, but we need bigger studies.
How this fits with other research
Waldron et al. (2023) got the same boost in autistic preschoolers during classwork. Their data add weight to the feeding review because both show quick compliance gains.
Boudreau et al. (2015) looks like a clash at first. They found high-p only works when each easy request earns real food. The feeding review did not test this rule, so the papers differ in detail, not in spirit.
Lipschultz et al. (2017) came first. They told clinicians to tweak pace and number of easy requests. The 2020 review backs that tip with stricter standards.
Why it matters
You can still use the high-p sequence at lunch today. Give three bites the child already eats, then present the new food. Track data and keep reinforcement strong. Until larger studies pass CEC gates, treat the method as a pilot tool, not a guarantee.
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02At a glance
03Original abstract
The high-probability (high-p) instructional sequence is an intervention commonly used to increase compliance in a variety of skill domains, including compliance with low-probability (low-p) mealtime demands in children with pediatric feeding disorders. However, the effects of the high-p sequence on feeding have varied across studies, a systematic synthesis of the literature to guide practice and further research is lacking, and whether the high-p sequence, as an intervention for feeding problems, meets current evidence-based practice standards in special education is unknown. First, we conducted a systematic multistep search, identified seven studies that met inclusion criteria, and synthesized participant and study characteristics. Then we compared the evidence with the 2014 Council for Exceptional Children (CEC): Standards for Evidence-Based Practices in Special Education. The results suggest that (a) the high-p sequence can improve compliance with low-p mealtime demands in young children with feeding disorders but that more research is needed to clarify relevant contexts and for whom the intervention is likely to be effective, (b) additional research should examine the effects of the high-p sequence on feeding in older children or adults with disabilities as more intrusive procedures based on escape extinction become inappropriate, and (c) the evidence falls short of meeting the CEC standards for an evidence-based practice. We conclude with preliminary practice guidelines.
Behavior modification, 2020 · doi:10.1177/0145445519858273