Accumulated‐ and distributed‐reinforcer arrangements in the treatment of challenging mealtime behavior

Chen and team worked with three kids who had feeding disorders. Each child tried three ways of earning reinforcement during lunch.

One way gave a tiny toy or praise right after every bite. Another way saved the prize until the child ate five bites. A third way used tokens that traded for a bigger toy after five bites.

All sessions used non-removal of the spoon. The child could leave the table only after finishing the set number of bites.

Every schedule cut problem behavior and helped kids accept bites. No schedule failed.

Yet each child liked a different setup. One wanted the toy after every bite. Another liked saving up for the big prize. The third did best with tokens.

The take-home: match the schedule to the child, not to the textbook.

Fulton et al. (2020) first tested the same save-up versus bite-by-bite question with kids who hit or ran to escape work. They saw less problem behavior when the break came only after 15 tasks. The feeding study flips that result: here, bite-by-bite worked just as well and was often preferred. The difference is the response type. Chewing and swallowing are quick; academic tasks are not.

Kirkwood et al. (2021) showed that when food refusal is driven by both escape and attention, you must add extinction for each function. Chen’s study kept extinction constant (non-removal of spoon) and only changed when praise or toys arrived. Together, the papers say: first block all escape and attention, then fine-tune when you deliver the reinforcer.

Van Arsdale et al. (2024) reviewed 15 recent feeding studies and found non-contingent reinforcement is common but poorly defined. Chen’s work gives a clear, testable way to make reinforcement contingent and still flexible across kids.

You no longer need to guess between bite-by-bite praise or a big end-meal reward. Run a quick alternating-treatments probe across two lunches. Let the child’s data pick the schedule. You will likely see the same drop in gagging, crying, or head-turning no matter which you choose, but the child will finish faster and happier when the schedule matches his or her preference. Start Monday by offering both options during one meal and graph which one produces the most bites with the least fuss.