Simultaneous Presentation to Decrease Packing in a Child With a Feeding Disorder

The team worked with one 4-year-old who had autism and packed food in his cheeks for minutes at a time. They put a tiny bite of applesauce on the same spoon as a bite of non-preferred food. After the child swallowed, they slowly gave less applesauce until the non-preferred food sat alone on the spoon.

They tracked how long food stayed in the mouth across meals. The fade-out plan moved from full applesauce to none in clear steps.

Packing dropped as soon as simultaneous presentation started. When applesauce was fully faded, the child still swallowed bites quickly. The skill moved to new foods and new settings without extra teaching.

Davis et al. (2023) found sequential presentation worked better than simultaneous for increasing how much kids ate. Their study looked at consumption, not packing, and used no escape extinction. The two papers seem to clash, but they target different problems: Davis wanted more bites taken; Whipple wanted faster swallows.

Earlier work used chasers, re-distribution, or flipped spoons to stop packing (M et al. 2012; S et al. 2014). Whipple adds a fade-out step so the helper does not stay glued to the applesauce forever.

Ahearn (2003) first showed that pairing a liked condiment with a disliked vegetable helps kids with autism accept bites. Whipple extends that idea by showing the condiment can later be removed.

You can start simultaneous presentation today for kids who hold food in their cheeks. Plan a quick fade so the preferred item disappears within a week or two. This keeps meals natural and avoids long-term dependence on extra applesauce or condiments.