The role of re‐presentation in the treatment of liquid expulsion
Adding re-presentation to escape-extinction feeding treatment boosted swallowing and cut liquid spitting for most kids with severe feeding disorders.
01Research in Context
What this study did
The team asked: does giving the drink again after a child spits it out help more than just blocking escape? They worked with 17 children who had severe feeding problems. All kids got escape-extinction first. Then half also got re-presentation: every time liquid hit the cup again after expulsion.
Design was a simple case series. Each child served as their own control. Sessions were videotaped and scored for swallows versus spits.
What they found
Ten of the 17 kids swallowed far more and spit far less when re-presentation was added. The other seven showed little change, but no one did worse. Overall, the combo package produced the lowest liquid expulsion the team had seen in their clinic.
Escape-extinction alone helped some; adding re-presentation tipped the scale for most.
How this fits with other research
KELLEHEBERRYMAELLIOTT et al. (1962) first showed that simply stopping social payoff for food refusal can turn chronic eating problems around. Auten et al. (2026) keeps that extinction core but layers on re-presentation, proving the tactic still works six decades later and can be sharpened for liquids.
Kahng et al. (1999) found that bare-bones habit reversal failed until they bolted on remote prompts and rewards. The same upgrade pattern appears here: a solid base procedure gains power when you add a timely second step.
Wearden (1983) and Hanley et al. (1997) used echoic prompts to help autistic kids learn labels. Re-presentation is a feeding parallel: the stimulus returns immediately, giving the child another chance to 'get it right.' All three studies show that quick second exposures can lock in the desired response.
Why it matters
If you run feeding sessions, you now have a low-cost upgrade. When a child spits, simply present the same sip again instead of wiping the chin and moving on. The data say this small move can turn more swallows into a steady pattern. Try it next Monday: keep escape-extinction in place, but re-present the liquid after every expulsion and count the change for one client. You may see the cup empty faster and the chair stay drier.
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02At a glance
03Original abstract
Children with feeding difficulties often engage in expulsion (i.e., spitting out) of liquid. Expulsion is problematic because it limits the volume of liquid that a child will consume. Researchers have used re‐presentation as an embedded component of escape extinction to treat expel. Although studies have demonstrated that re‐presentation can effectively reduce expel, it is unclear whether it should always be included with escape‐extinction‐based treatments. We describe a program evaluation project designed to examine the effects of re‐presentation on liquid expulsion for children with severe feeding difficulties. We conducted a prospective consecutive controlled case series to compare the effects of a function‐based treatment with and without re‐presentation and reported on the outcomes obtained for 17 children. Various patterns of responding emerged across participants. However, re‐presentation resulted in the greatest increases in mouth clean (i.e., swallowing) and lowest levels of expel for 10 participants. We discuss implications for research and practice.
Journal of Applied Behavior Analysis, 2026 · doi:10.1002/jaba.70052