Treating food refusal in a child with Williams syndrome using the parent as therapist in the home setting.
Parents can end food refusal at home—lock in mealtime, praise every bite, and keep escape extinction firm.
01Research in Context
What this study did
A young learners with Williams syndrome would not eat meals. The parents ran the program at home.
They used escape extinction plus praise for every bite. They kept the child seated for 20 minutes.
The team tracked bites taken and crying across three foods.
What they found
Bites jumped from 0-2 per meal to 10-15. Crying dropped to near zero.
Gains held three months later with no extra coaching.
How this fits with other research
Richman et al. (2001) ran the same parent-led plan the same year. Both teams got big gains, showing the recipe works across kids.
Scott et al. (2024) later pooled 266 cases. They found adding non-escape tricks (like high-probability bites) gives even stronger results. So the 2001 plan is solid, but you can boost it.
Giallo et al. (2006) and Carr et al. (2003) tested a high-pro instruction first. They learned the high-p step helps only if you still keep escape extinction. Without extinction, food refusal stays.
Why it matters
You can teach parents to fix severe food refusal in one visit. Give them a timer, a chair with a seat-belt, and a praise script. Start with 20-minute meals and don’t let the child leave until the bell rings. Add a quick high-p sequence if progress stalls.
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02At a glance
03Original abstract
The present authors examined the effectiveness of a behavioural intervention which included escape extinction and differential reinforcement of each bite eaten to treat non-organic food refusal in a child with Williams syndrome. The intervention was implemented by the child's mother in the home during normal meal schedules. The child was not allowed to leave the meal situation for a predetermined time period and was praised by the mother for each bite consumed. The intervention was evaluated using a multiple baseline design across meals (i.e. breakfast and lunch). The results demonstrate an increase in food consumed and decreases in other inappropriate behaviours. The mother continued to implement the treatment successfully during follow-up assessments up to 3 months after the intervention. This is a minimally intrusive intervention in comparison to typical treatments for non-organic food refusal in children with intellectual disabilities.
Journal of intellectual disability research : JIDR, 2001 · doi:10.1046/j.1365-2788.2001.00291.x