Treating total liquid refusal with backward chaining and fading.

A 12-year-old boy with autism and total liquid refusal drank nothing all day. Doctors ruled out medical causes.

The team used backward chaining plus fading. They started with the last sip, then slowly added more liquid. Sessions happened at school and at home.

The boy moved from zero intake to full cup drinking. He kept the skill without gagging or spilling.

Parents and teachers only needed simple prompts by the end.

Hamm et al. (1978) used the same chaining plus prompt fading to teach janitorial steps to teens with ID. The package works across tasks.

Price et al. (2018) and Schaal et al. (1990) also used total-task chaining for adolescents. Their skills were bus riding and phone use. The feeding study shows the method still works when the target is inside the body.

Pellegrino et al. (2020) moved chaining to telehealth with adults. The 1996 case did not use video calls, but the prompt logic is identical.

If a child drinks nothing, you can start with one sip and build up. Use backward chaining and fade the amount. No special cups or meds were needed. Try it in both home and school so the skill travels. Record intake each session; the jump from zero will show fast.