Noncontingent and differential reinforcement in the treatment of pediatric feeding problems
Pairing escape extinction with either NCR or DR lifts food acceptance and drops mealtime problem behavior.
01Research in Context
What this study did
Berth et al. (2019) worked with four children who refused food or drink.
The team tested two simple plans: noncontingent reinforcement (NCR) and differential reinforcement (DR).
They also used escape extinction when needed and watched how acceptance and problem behavior changed.
What they found
Both NCR and DR helped the kids accept more bites or sips.
DR alone ended liquid refusal for one child.
When escape extinction was added, the other three children showed steadier acceptance and fewer screams or refusals.
How this fits with other research
Luis et al. (2021) ran a near-copy study and saw the same gain: NCR cut problem behavior, but DR was still needed to keep food intake high when the reinforcer came less often.
O’Brien et al. (2023) flipped the order: they tried DR first for task disengagement, and when it failed they rescued the session with NCR.
Together these papers show NCR and DR can back each other up, not compete.
Lancioni et al. (2009) already ruled NCR plus extinction as “well-established” for developmental disabilities, so the new feeding data simply extend that badge to mealtimes.
Why it matters
If a child keeps spitting, screaming, or turning away from the spoon, you now have two levers.
Start with DR if the learner can already earn bites.
If refusal stays high, add NCR or move to escape extinction while keeping one of the reinforcement plans in place.
The mix keeps acceptance climbing and your session calmer.
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02At a glance
03Original abstract
We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.
Journal of Applied Behavior Analysis, 2019 · doi:10.1002/jaba.562