The effects of sleep disruption on the treatment of a feeding disorder.

The team watched one child with developmental delay during meals. Some days the child slept badly. Other days the child slept normally.

They tested bite acceptance with and without escape extinction. Escape extinction means the child could not leave the table after spitting out food.

After a bad night, bite acceptance dropped only when escape extinction was off. When escape extinction was on, sleep loss did not hurt feeding.

Escape extinction acted like a shield. It kept gains safe even when the child was tired.

O'Reilly et al. (2000) saw the same shield break in a different way. In their study, bad sleep raised self-injury that was kept going by escape. The target paper shows the shield can be put back if you add escape extinction.

Scott et al. (2024) looked at 266 kids and found mixing escape and non-escape extinction gives the best results. The 2005 single case hints why: escape extinction alone can block sudden drops after rough nights.

Haney et al. (2022) warn that relapse hits about half of extinction cases later. The sleep shield finding matters because tired days can look like relapse but are really just a short-term dip.

You can stop blaming yourself when a client eats less after a stormy night. Keep escape extinction in place instead of adding new tricks. One rough night does not mean your whole plan is broken.