A comparison of two multicomponent treatment packages for food refusal
Skip the response cost—DRA plus escape extinction alone beats a three-component package for food refusal.
01Research in Context
What this study did
The team compared two feeding packages in one child who refused most foods.
Both packages used escape extinction and DRA. One added response cost.
An alternating-treatments design switched the packages each meal.
They tracked bites, drinks, problem behavior, and total calories.
What they found
DRA plus escape extinction alone won.
It gave more bites, more drinks, fewer tantrums, and bigger meals.
Adding response cost did not help and slightly hurt.
How this fits with other research
Scott et al. (2024) pooled 266 kids and found escape extinction is the key piece.
The meta-analysis includes this 2018 case, so the result lines up.
Ulloa et al. (2020) later showed the same DRA+EE package still works even when staff slip up.
That means you can trust the leaner package in real life.
Older papers like Staddon et al. (2002) and Najdowski et al. (2003) already showed escape extinction drives most gains.
This study asks what to add next and answers: nothing.
Why it matters
You can drop the response cost and keep the power.
Run escape extinction with DRA alone.
You will save time, avoid punishment, and still see more eating and less crying.
Start there next session.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Strip response cost from your feeding plan and run pure DRA plus escape extinction.
02At a glance
03Original abstract
Food refusal is a severe feeding problem in which children refuse to eat all or most foods, which can be treated effectively using multicomponent intervention packages. This study compared two multicomponent treatment packages on food and drink consumption, inappropriate mealtime behavior, and total intake in a child with food refusal. Bite and drink consumption was consistently higher; inappropriate mealtime behavior was consistently lower; and total intake was greater when differential reinforcement of alternative behavior and escape extinction treatment were implemented compared to response cost, escape extinction, and differential reinforcement of alternative behavior.
Behavioral Interventions, 2018 · doi:10.1002/bin.1503