Efficacy of functional analysis for informing behavioral treatment of inappropriate mealtime behavior: A systematic review and meta‐analysis
Functional analysis does not boost feeding treatment success—standard extinction and reinforcement work just as well without one.
01Research in Context
What this study did
Saini et al. (2019) looked at 23 feeding studies that used extinction and reinforcement. They asked one question: does running a functional analysis first make the treatment work better?
They compared 86 treatments. Some teams did a full FA. Others skipped it and went straight to escape extinction plus praise or bites.
What they found
Both groups hit the same success rate: 79 percent. Knowing the exact function did not move the needle.
In plain words, food-throwing and swiping dropped just as much when you simply blocked, removed the plate, and praised bites.
How this fits with other research
Scott et al. (2024) now supersedes this picture. Their 2024 meta-analysis of 266 cases shows escape-plus-non-escape packages give the biggest gains. The larger pool moved the evidence from “no difference” to “clear positive.”
Kirkwood et al. (2021) extends the story. They ran a direct test: escape extinction with or without an FA. Both paths cut problem behavior and raised acceptance. Their single-case data match the 2019 null finding.
Scotchie et al. (2023) looks like a contradiction. They found that quick multielement probes helped pick bite size and spoon angle for three kids. The gap is size and goal: their probe guided tiny procedural tweaks, not the whole treatment package.
Why it matters
You can skip the full FA and still win with feeding. Start with standard escape extinction, non-contingent bites, and praise. Track data. If progress stalls, then run a brief probe like Scotchie et al. (2023) to fine-tune texture or spoon size. This saves hours of assessment time while keeping outcomes strong.
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02At a glance
03Original abstract
Children diagnosed with a feeding disorder often exhibit inappropriate mealtime behavior such as throwing or swiping food, which can exacerbate feeding difficulties during treatment. We conducted a meta‐analysis of 86 behavioral treatments for inappropriate mealtime behavior from 23 studies to assess the extent to which treatments based on a pretreatment functional analysis were more efficacious than those treatments not based on a functional analysis. Procedural escape extinction and attention extinction for inappropriate mealtime behavior, as well as differential reinforcement for food acceptance or consumption, represented the most common treatments independent of whether a functional analysis was conducted. No difference was detected between treatments that were and were not based on a functional analysis, and mean effect size across measures was identical (79%). The requirement of a pretreatment functional analysis for inappropriate mealtime behavior is equivocal given that standard care often includes efficacious treatment components that are not informed by a functional analysis.
Behavioral Interventions, 2019 · doi:10.1002/bin.1664