Use of a multicomponent treatment for food refusal.

Lejuez et al. (2001) tested a two-part feeding package on a five-year-old who refused almost all food. The team removed a favorite toy each time the child turned away or screamed. At the same moment they praised and gave a tiny toy for every bite accepted.

Parents watched the sessions and later ran the same plan at home. The study tracked bites accepted and any crying, hitting, or spitting during meals.

Bite acceptance jumped to 100% and stayed there. Problem behavior dropped to almost zero. When parents took over, the good results continued.

Alaimo et al. (2018) asked a new question: is removing a toy really needed? They compared the same DRA plus toy-removal against DRA plus escape extinction (no escape from the spoon). Escape extinction won on every measure—more bites, fewer screams, bigger meals. The 2001 toy-removal still worked, but escape extinction works even better.

Ulloa et al. (2020) later showed the escape-extinction version keeps working even when staff slip up. Effects held when the protocol was followed only 40% of the time. This tells us the newer package is both stronger and tougher.

Chawner et al. (2019) reviewed 36 feeding studies and found most use the same building blocks: reinforcement plus some form of extinction. The 2001 paper is one of the early proofs that adding a consequence for refusal (toy loss) can tip the scale toward acceptance.

If you still run toy-removal protocols, try switching to escape extinction plus DRA. The evidence stack shows you will get faster acceptance and fewer tantrums. Train parents the same way: keep the spoon at the lips until the bite is taken, then shower praise and a small toy. The data say this single change beats the older package head-to-head.