Motivating children with feeding disorders to self-feed: An evaluation of using differential reinforcement and manipulation of establishing operations to increase self-feeding

Self-feeding is a behavioral cusp vital to independence, growth, and development. Previous studies demonstrate that interventions like escape extinction in the form of physical guidance are effective at increasing self-feeding in children with feeding disorders. However, these interventions may not be effective for all children. In the present study, we evaluated the effects of a treatment package that involved increasing the quality of feeder attention and access to tangibles to decrease the comparative value of escape from the self-feeding demand for two children with feeding disorders using a nonconcurrent multiple baseline design. Despite demonstrating the skills to self-feed preferred foods and consume target foods, neither child self-fed target foods independently. Following differential reinforcement with the manipulation of establishing operations, both children demonstrated improvement in self-feeding bites of target foods. In addition, caregivers were trained to implement the protocol with high procedural integrity.