The Combined Effects of Immediate and Delayed Positive Reinforcement to Increase Consumption of Solid Food: A Brief Report

Background: While positive reinforcement is perhaps the most common component in interventions for feeding problems, the literature suggests it is not sufficient to address more severe problems. Method: An ABACDB reversal design was used to evaluate the effectiveness of praise, in-session reinforcement, and a visual cue + post-session reinforcement to increase solid food consumption in a nine-year-old boy with an intellectual disability who was completely dependent upon gastrostomy tube feeds. Results and Discussion: A combination of praise, in-session reinforcement, and the visual cue + post-session reinforcement was more effective at increasing bites consumed than praise combined with either one of the other two components. The results suggested a multiplicative effect. Multiple reinforcement components may be considered in the treatment of persons with feeding problems as either an alternative to escape extinction or a method of minimizing escape extinction.