Capella University Ethics of Intervention for Food Refusal Paper In the article by Vaz, Volkert, and Piazza (2011) from this unit’s studies, an interventio

Capella University Ethics of Intervention for Food Refusal Paper In the article by Vaz, Volkert, and Piazza (2011) from this unit’s studies, an intervention was applied to address the negative reinforcement function of food refusal by a young boy.

Vaz, P. C. M., Volkert, V. M., & Piazza, C. C. (2011). USING NEGATIVE REINFORCEMENT TO INCREASE SELF-FEEDING IN A CHILD WITH FOOD SELECTIVITY. Journal of Applied Behavior Analysis, 44(4), 915-20.

For this assignment:

Describe your initial reaction to the intervention, especially regarding the use of escape avoidance strategies.
Take the position that you oppose the intervention and explain why. Your rationale should specifically address any possible undesired side effects, as well as whether the intervention appeared to violate any ethical codes. Be sure to cite specific codes from the Professional and Ethical Compliance Code for Behavior Analysts.
Take the position that you support the intervention and explain why. Your rationale should specifically address any possible benefits and the boy’s right to effective treatment.
Revisit your initial reaction to the intervention. Do you still feel the same way, or has your examination of both sides influenced your reaction? Do you believe the intervention is in line with the Professional and Ethical Compliance Code for Behavior Analysts? Explain.

Reference your unit readings, professional codes of conduct, and other resources to support your positions.

ASSIGNMENT REQUIREMENTS
Written communication: Should be free of errors that detract from the overall message.
APA formatting: References and citations are formatted according to current APA style guidelines.
Resources: A sufficient number of scholarly or professional resources.
Length: 2–3 double-spaced pages, in addition to a title page and references page.
Font and font size: Times New Roman, 12-point.

Basic info to follow when answering the questions:

Assess personal reaction to interventions used to address problematic behaviors.

Explain how possible undesired side effects and ethical codes do not support the use of certain interventions.

Explain how potential benefits and an individual’s right to effective treatment support the use of certain interventions

Evaluate personal reaction to determine how ethical and professional conduct principles influence the selection of interventions and treatments for problematic behaviors. JOURNAL OF APPLIED BEHAVIOR ANALYSIS
2011, 44, 915–920
NUMBER
4 (WINTER 2011)
USING NEGATIVE REINFORCEMENT TO INCREASE SELF-FEEDING
IN A CHILD WITH FOOD SELECTIVITY
PETULA C. M. VAZ, VALERIE M. VOLKERT,
AND
CATHLEEN C. PIAZZA
UNIVERSITY OF NEBRASKA MEDICAL CENTER’S
MUNROE-MEYER INSTITUTE
We examined the effects of a negative reinforcement-based treatment on the self-feeding of 1
child with food selectivity by type and texture. Self-feeding increased when the child could
choose to either self-feed 1 bite of a target food or be fed 1 bite of the target food and 5 bites of
another food. Possible mechanisms that underlie the effectiveness of the intervention and
implications for future research are discussed.
Key words: feeding disorder, food acceptance, food selectivity, negative reinforcement,
pediatric feeding disorders, self-feeding
________________________________________
Most typically eating children acquire feeding skills in a sequence that is relatively
predictable and culminates in the child feeding
him- or herself. Parents promote this progression by offering the child opportunities to selffeed, first with finger foods and ultimately with
utensils. In children with feeding problems,
this progression may not occur, even when
the appropriate opportunities to self-feed are
present. One reason why children with feeding
problems may fail to progress through the
typical developmental sequence of feeding
behavior is that they lack the motivation to
eat. In fact, children with feeding problems are
likely to exhibit escape-maintained behavior
(e.g., Bachmeyer et al., 2009; Piazza et al.,
2003) that may interfere with the development
of age-typical feeding skills (e.g., self-feeding).
Therefore, it is not surprising that the results of
many studies on feeding problems have suggested that treatments based on negative reinforcement are effective. However, no studies to
our knowledge have used negative reinforcementbased procedures to increase self-feeding in children with feeding problems.
We thank Melissa Kadey, Jason Zeleny, and Haley Hall
for their assistance.
Address correspondence to Petula C. M. Vaz, who is now
at Bloomsburg University of Pennsylvania, CEH 223, 400
E. 2nd Street, Bloomsburg, Pennsylvania 17815 (e-mail:
pvaz@bloomu.edu).
doi: 10.1901/jaba.2011.44-915
One possible method of using negative
reinforcement to treat feeding problems (e.g.,
refusal to self-feed) is to manipulate the
parameters of reinforcement along various
dimensions (e.g., magnitude, quality, rate,
response effort; Athens & Vollmer, 2010). For
example, Kerwin, Ahearn, Eicher, and Burd
(1995) demonstrated that response-effort manipulations in the form of volume of food on a
spoon affected acceptance of food. Kelley,
Piazza, Fisher, and Oberdorff (2003) altered
the quality of the consequences for acceptance
of liquids during three conditions in which
consumption of liquids resulted in (a) presentation of a preferred food (positive reinforcement), (b) avoidance of a nonpreferred food
(negative reinforcement), or (c) presentation of
a preferred food and avoidance of a nonpreferred food. Results of Kerwin et al. and Kelley
et al. suggest that manipulations of response
effort and quality of reinforcement may be
viable treatment options for feeding problems
and should be investigated further. In the
current study, we manipulated the consequences associated with self-feeding relative to those
associated with being fed along the dimensions
of response effort (the number of bites the
feeder presented to the child vs. the number of
bites the child self-fed) and quality (the child’s
preference for the food). The negative reinforcement manipulation consisted of giving the
915
PETULA C. M. VAZ et al.
916
child the opportunity to self-feed one bite of a
target food to avoid being fed one bite of the
target food plus five bites of another food
(hereafter termed the avoidance food ). We chose
these particular manipulations with the child in
this study because previous treatments with
different response effort and quality manipulations with the Nuk (e.g., one target food to one
avoidance food on the Nuk, one target food to
five target foods on the Nuk) had not been
effective for increasing his self-feeding.
METHOD
Participant, Setting, and Materials
Jerod, a typically developing 6-year-old boy,
had been admitted to a pediatric feeding
disorders outpatient program for treatment of
food selectivity by type and texture. He had no
significant medical history or related diagnoses.
Jerod obtained 100% of his calories from and
fed himself Stage 2 baby foods and milk and a
few preferred table-texture foods (e.g., soy nuts,
granola bars), but refused to consume or selffeed any other types or textures of foods. He
had the skills and the ability to self-feed and to
chew and swallow table-texture food based on
an evaluation by a speech therapist. Sessions
were conducted in a room with one-way
observation, which contained a table, a chair
with arms, large Maroon spoons, bowls, and a
Nuk brush.
Dependent Variables and Interobserver Agreement
Trained observers scored acceptance, defined
as Jerod using a spoon or his fingers to deposit
the bite of food into his mouth within 5 s of
presentation. Presentation occurred when the
feeder placed the bowl of food in front of Jerod.
Observers collected data on laptop computers.
Data on acceptance were converted to a
percentage after dividing the number of
acceptances by the total number of bites
presented in each session. A second observer
simultaneously but independently scored a
mean of 22% of sessions. Interobserver agree-
ment was calculated by summing occurrence
and nonoccurrence agreements; dividing by the
sum of occurrence agreements, nonoccurrence
agreements, and disagreements; and converting
this ratio to a percentage. Mean interobserver
agreement was 98% (range, 87% to 100%).
Design and Procedure
Design. We evaluated the effects of the
avoidance procedure on acceptance of three
target foods in individual ABAB designs. The A
phase was baseline, and the B phase was the
avoidance procedure.
Identification of target and avoidance foods. In
the current investigation, we present data on
Jerod’s acceptance of three table-texture target
foods: apples, oatmeal, and oranges. The avoidance foods were pureed peas during treatment
with apples and table-texture peanut butter and
jelly sandwich during treatment with oatmeal
and oranges. The method for selecting these
avoidance foods is described below.
Prior to this assessment, we increased Jerod’s
consumption of pureed foods and then began
pilot work on our self-feeding avoidance assessment. We conducted a paired-choice preference
assessment (Fisher et al., 1992) to identify
oatmeal as least preferred of the pureed foods.
We presented pureed oatmeal as the avoidance
food using the procedures described below.
During the course of the pilot, acceptance of
pureed peas did not increase when we used
pureed oatmeal as the avoidance food. Therefore, we used pureed peas as the first avoidance
food during the current study.
During the current analysis, we used pureed
peas as the avoidance food, which increased
acceptance of table-texture apples but did not
increase acceptance of table-texture peanut
butter and jelly sandwich (see results below).
Therefore, we used table-texture peanut butter
and jelly sandwich as the avoidance food to
increase acceptance of table-texture oatmeal
and oranges.
General procedure. Across all conditions, the
therapist conducted approximately six to eight
SELF-FEEDING
sessions in each weekly 1-hr appointment. The
therapist explained the session contingencies to
Jerod prior to the start of the appointment and
explained the contingencies again during the
appointment only if they changed. A session
consisted of one bite of a single target food (e.g.,
apples) presented in a bowl once every 30 s for a
total of four bite presentations. The bite size
was one piece of apple or orange (0.62 cm by
0.62 cm) or one level large Maroon spoonful of
oatmeal. If Jerod accepted the bite, the therapist
said, ‘‘Good job taking your bite.’’
Baseline. The therapist reviewed the session
contingencies, stating, ‘‘I’m going to put a bite
of food in a bowl in front of you and say, ‘take a
bite.’ If you feed yourself the bite right away,
I’m going to say ‘Good job taking your bite.’’’ If
Jerod did not accept the bite within 30 s of
presentation, the therapist removed the bite and
presented the next bite. The therapist would
have provided no differential consequences for
expulsion, which never occurred.
Avoidance treatment. The therapist reviewed
the session contingencies, stating, ‘‘If you don’t
take the bite by yourself, I will feed you a bite of
‘target food’ [the therapist named the food] and
five bites of ‘avoidance food’ [the therapist
named the food] with the Nuk.’’ If Jerod did
not accept the target bite within 5 s, the
therapist used a Nuk to feed Jerod the bite of
the target food followed by five sequentially fed
bites of the avoidance food. The bolus size of
the avoidance food was half of a level large
Maroon spoon of pureed peas or a piece of
peanut butter and jelly sandwich (0.62 cm by
0.62 cm). The therapist inserted the Nuk into
Jerod’s mouth to deposit the bite unless he
willingly opened his mouth to allow the bite to
be deposited, which he typically did. By
positioning the Nuk at the side of Jerod’s
mouth between his teeth and gums near his
molars and rotating it, the therapist could
deposit the bite even if he refused to open his
mouth. The therapist did not press the Nuk
down on his tongue when depositing the bite.
917
The therapist re-presented expelled bites with
the Nuk.
Parent training. After we demonstrated the
effectiveness of the treatment, we trained Jerod’s
mother using written and verbal instructions,
role play, modeling, and feedback. His mother
reported that Jerod began eating table-texture
apples independently at home after treatment;
therefore, we did not train his mother on
treatment with apples.
RESULTS AND DISCUSSION
During baseline, mean acceptance (Figure 1)
was zero but increased to high levels during the
avoidance treatment for apples (M 5 100%).
These results were replicated during the reversal
to baseline and return to treatment. During
baseline, mean acceptance was zero and remained at zero during the avoidance treatment
for peanut butter and jelly sandwich (data not
shown). Pureed peas were not effective as the
avoidance food. During the initial baseline,
mean acceptance (Figure 1) was zero for
oatmeal and 25% for oranges (range, 0% to
100%). During the avoidance treatment, acceptance increased to high and stable levels for
both foods (M 5 100%). When we removed
the avoidance treatment, acceptance declined to
low levels for oatmeal (M 5 14%; range, 0% to
75%) and oranges (M 5 0%). When we
reintroduced the avoidance treatment, acceptance again increased to high and stable levels
for oatmeal (M 5 100%) and oranges (M 5
100%). Acceptance remained high for oatmeal
(M 5 95%; range, 75% to 100%) and oranges
(M 5 100%) during parent training.
In the current study’s choice arrangement,
the consequences for self-feeding were presumably more favorable than the consequences for
being fed. The response-effort manipulation
was that self-feeding was associated with
consumption of a single bite of food and being
fed was associated with consumption of six bites
of food, which was presumably more effortful
because the larger volume of food required more
918
PETULA C. M. VAZ et al.
Figure 1. Percentage of bites with acceptance for apples (target food, top) with pureed peas as the avoidance food and
for oatmeal (target food, middle) and oranges (target food, bottom) with table-texture peanut butter and jelly sandwich
as the avoidance food.
SELF-FEEDING
chewing and oral manipulation to consume. We
assumed that the avoidance food was less preferred
than the target food based on Jerod’s response to
the foods when they were presented during the
avoidance assessment (i.e., he consumed the target
food more often than the avoidance food).
Therefore, the qualitative manipulation was that
self-feeding was associated with consumption of
the more preferred target foods and being fed was
associated with the less preferred avoidance foods.
Although these manipulations were effective in
increasing Jerod’s self-feeding, the obvious limitation is that we did not demonstrate whether
both the response effort and quality manipulations were necessary. In addition, if response effort
was an active treatment component, it is not clear
how much effort must be manipulated to increase
self-feeding (e.g., could we have increased the ratio
of self-fed to non-self-fed bites to 1:2, 1:3, or 1:4
and still have achieved an effect?). Future
investigations should evaluate the individual
contributions of response effort and quality
manipulations and evaluate the extent of the
response-effort manipulation necessary to increase
self-feeding.
An alternative explanation for these findings
is that Jerod’s increase in self-feeding was a
function of avoidance of the Nuk rather than
the target- and avoidance-food manipulations.
Recall that the therapist fed the target and
avoidance foods with the Nuk. By contrast,
Jerod fed himself with the spoon. We did not
test the Nuk alone; therefore, future investigations could test the effects of allowing a child to
self-feed with a spoon versus feeding the child
with a Nuk without the target- and avoidancefood manipulations. Future investigations also
could evaluate presentation of target and
avoidance foods with and without a Nuk.
One interesting finding was that Jerod’s
acceptance increased to 100% immediately in
the first treatment phase for all foods except the
peanut butter and jelly sandwich, and he only
contacted the avoidance contingency twice. He
had been exposed to the avoidance treatment
919
with pureed foods already; therefore, the immediate increase in acceptance may have been a
function of rule-governed behavior that developed during our pilot work with pureed foods.
Recall that we explained the contingencies to
him prior to the beginning of the appointment.
A second interesting finding was that Jerod’s
food preferences appeared to shift during the
study, perhaps as a result of repeated exposure
(Mueller, Piazza, Patel, Kelley, & Pruett, 2004).
We conducted a paired-choice preference assessment in which we identified pureed oatmeal as the
least preferred food. Recall that during the course
of our pilot work, acceptance of pureed peas did
not increase when pureed oatmeal was the
avoidance food, possibly indicating that pureed
peas became less preferred than pureed oatmeal.
Furthermore, acceptance of table-texture peanut
butter and jelly sandwich did not increase when
pureed peas was the avoidance food, possibly
indicating that table-texture peanut butter and
jelly sandwich became less preferred than pureed
peas. Future studies should conduct ongoing
preference assessments to evaluate the extent to
which preferences for foods change over time
(Hanley, Iwata, & Roscoe, 2006).
REFERENCES
Athens, E. S., & Vollmer, T. R. (2010). An investigation
of differential reinforcement of alternative behavior
without extinction. Journal of Applied Behavior
Analysis, 43, 569–589.
Bachmeyer, M. H., Piazza, C. C., Fredrick, L. D., Reed, G.
K., Rivas, K. D., & Kadey, H. J. (2009). Functional
analysis and treatment of multiply controlled inappropriate mealtime behavior. Journal of Applied Behavior
Analysis, 42, 641–658.
Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian,
L. P., Owens, J. C., & Slevin, I. (1992). A comparison
of two approaches for identifying reinforcers for
persons with severe and profound disabilities. Journal
of Applied Behavior Analysis, 25, 491–498.
Hanley, G. P., Iwata, B. A., & Roscoe, E. I. (2006). Some
determinants of changes in preference over time.
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Kelley, M. E., Piazza, C. C., Fisher, W. W., & Oberdorff,
A. J. (2003). Acquisition of cup drinking using
previously refused foods as positive and negative
reinforcement. Journal of Applied Behavior Analysis,
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PETULA C. M. VAZ et al.
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D. M. (1995). The costs of eating: A behavioral
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Received August 20, 2010
Final acceptance February 24, 2011
Action Editor, Linda Cooper-Brown
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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