The authors wish to acknowledge the support of Florida International University and the Center for Children and Families.

This protocol follows Florida International University&#8217;s guidelines for research with human subjects and consent is always obtained from parents/caregivers before any treatment is started. In addition, obtain clearance from a physician before the start of treatment. &#160;
NOTE: Although specific age ranges and individual variables have not been empirically validated, this protocol has been used clinically for children ages 2-7 with autism and developmental delays. Participants should be referred for behavioral intervention by their caregiver and a medical professional. Clear participants of any medical or physical underlying issues related to feeding as part of the screening for eligibility for behavioral intervention protocols to address food selectivity.
1. Session Structure and Clinical Environment
<ol>
	<li>Conduct treatment sessions in an outpatient treatment setting, between two and four times per week, for approximately 1 hr per session. Conduct sessions in treatment rooms equipped with a table, chairs, and items that are used during mealtimes (i.e., plates, napkins and utensils). Additionally, bring toys and other tangible items into the room to serve as reinforcers throughout out the intervention procedure.</li>
</ol>
2. Pre-treatment Assessments
<ol>
	<li>Preference Assessment.</li>
	<li>Conduct a brief, informal preference assessment at the start of each session, to determine tangible items that may function as reinforcers for compliance during that session. Present an array of toys on the table and the give the child the opportunity to choose the toys he/she wants to work for that day.</li>
	<li>Food Assessment
	<ol>
		<li>Ask parents or caregivers to indicate foods that the child is likely to eat 100% of the time when they are offered, 80% of the time, 60% of the time, and so on down to those foods the child would not accept (0%) in twenty percent increments.</li>
		<li>Begin the intervention with those foods the child is likely to eat (100% of the time when offered) and proceeded to more difficult foods that the child has never tried. &#160; 
		NOTE: The purpose of including a preferred (100%) food in the first intervention condition is to initially foster compliance with the demand fading steps.</li>
	</ol>
	</li>
</ol>
3. Sessions and Procedures
<ol>
	<li>During baseline present a bite of each of the target foods that have not yet been exposed to the intervention on a white plate in front of the child and say, &#8220;Eat this.&#8221; Do not provide any consequences contingent on any response emitted during baseline.</li>
	<li>If the child eats the food, then allow them time to consume it and then present the next bite. If the child does not eat the food after 10 sec the trials ends and then present the next food. &#160; 
	NOTE: Present each food should 5 times during baseline in an alternating order. Conduct at least 2 baseline sessions prior to beginning intervention for any target food. Continue to probe the remaining foods in baseline at least one time per week.</li>
	<li>Confirm parent report of the child&#8217;s food preferences by placing one food from each category (i.e., 100%, 80%, etc.) on a white plate in front of the child and say, &#8220;Eat this.&#8221; Present each of the foods five times in an alternating order. If the child eats the food, move on to the next trial. If the child does not eat the food after 10 sec, remove it from the plate and present the next food item. If the child throws the food or says they do not want it move on to the next food item without addressing the problem behavior. &#160; 
	NOTE: Only use those foods that are consistent with parent report for intervention. If there are foods that do not match the parent report, for example the parent reports that the child eats an item 20% of the time and they eat it 100% of the time during this phase, do not include this food as a target for intervention.</li>
	<li>Intervention Sessions.</li>
	<li>Conduct all treatment sessions as trials (rather than time based) and a session includes five trials. A trial begins when the target food is placed on the placemat and the instruction is delivered. A trial ends contingent on compliance or after 10s of noncompliance. Vary the number of sessions completed during each 1 hr visit depending on child variables and characteristics, including compliance with instructions. &#160; 
	NOTE: The mastery criterion for each step in the intervention is 80% or higher of compliance across two consecutive sessions. Compliance is defined as completing the presented task within 10 sec from the time the instruction is delivered.</li>
</ol>
4. Treatment Package
NOTE: The treatment package consists of shaping and sequential and simultaneous presentation procedures.
<ol>
	<li>Shaping
	<ol>
		<li>Implement a shaping procedure for each target food, where successive approximations to eating are reinforced. The shaping procedure is composed of seven steps; a) put the food in therapist&#8217;s hand, b) touch the food to the child&#8217;s cheek, c) touch food to nose; d) touch food to lips; e) touch food to tongue; f) bite down on food; g) eat food (i.e., mouth clean [swallowing the food so that none of it remains in the child&#8217;s mouth]). &#160; 
		NOTE: During each step the child has to complete the target behavior independently (e.g., the child has to put the food in the therapist&#8217;s hand).</li>
	</ol>
	</li>
	<li>Sequential Presentation
	<ol>
		<li>Use a placemat containing two different colored circles to serve as a visual representation of the sequential presentation procedure. Always place target foods on the left and less preferred foods on the right side of the placemat. &#160; 
		NOTE: This presentation is designed to foster predictability in the procedure and to acquire stimulus control for compliance with foods presented on the left side.</li>
		<li>Additionally, place preferred tangible items on the right side of the placemat. Use the prompt, &#8220;First [shaping step] then [name of preferred food and tangible]&#8221; to introduce the instruction for the sequential presentation procedure. For example, &#8220;first touch the pea to your nose and then you can have your cookie and crayons.&#8221;</li>
	</ol>
	</li>
	<li>Simultaneous Presentation
	<ol>
		<li>Present both the preferred and non-preferred foods together during the simultaneous procedure. Specifically, place the non-preferred food on top of the preferred food (e.g., a grain of rice is placed on top of a chip) and place this combination on the left side of the placemat.</li>
		<li>Place preferred tangible and edible items on the right side of the placemat, as is done in the sequential procedure. Slowly increase the amount of non-preferred food placed on top of the preferred food until equal amounts of non-preferred and preferred foods are presented.</li>
		<li>Present all foods in bite size pieces. Use pieces that are small enough that the child can consume it with one bite, but large enough so that the child will need to chew it several times before swallowing. Present foods with or without a utensil depending on individual needs. Require that participants feed themselves during all sessions.</li>
	</ol>
	</li>
</ol>
5. Intervention
<ol>
	<li>Training Phase (Preferred Food) 
	NOTE: Use the most preferred food (i.e., the food identified as most likely to be eaten 100% of the time in the food assessment) during the training phase, aimed at facilitating familiarity with and compliance with the steps in the shaping sequence.
	<ol>
		<li>Begin the training phase with the initial step of placing the food in the examiner&#8217;s hand and continue until the child reaches the mastery criterion (i.e., at least 80% compliance across two consecutive sessions) for the final step (i.e., eating).</li>
	</ol>
	</li>
	<li>Shaping and Sequential Presentation
	<ol>
		<li>Use the next food identified in the food assessment (child is likely to eat 80% of the time when offered) for this phase of the intervention. During each session, the participant and therapist sit side by side at the table.</li>
		<li>Place the placemat in front of the child and all food and tangible items are placed on the table next to the therapist.</li>
		<li>Begin each trial by placing the target food on the left side of the placemat and the potential reinforcers on the right side. The therapist then provides the first-then prompt.</li>
		<li>Contingent on compliance, allow the child to have access to the reinforcers (consumption of preferred food and access to tangible item for approximately 30 sec). Contingent on noncompliance (not completing the target behavior within 10 sec or throwing the target food), represent the first-then prompt.</li>
		<li>Begin this phase with step 1 of the shaping procedure (put the food in therapist&#8217;s hand) and tell the participant &#8220;first put ___in my hand and then you can have (reinforcer).&#8221; Continue until the mastery criteriais met (80% or higher compliance across two consecutive sessions).</li>
		<li>Move to step 2 of the shaping procedure (touch the food to the child&#8217;s cheek) when mastery criteria are met. Continue sessions in this manner until the last step of eating the food is mastered. Introduce the next food identified at this point starting with step 1 of the shaping procedure and repeating the shaping steps as described.</li>
	</ol>
	</li>
	<li>Shaping, Sequential, and Simultaneous Presentation 
	NOTE: Introduce a simultaneous presentation phase in instances when shaping and sequential presentation are not effective in increasing compliance for the last step in the shaping sequence (i.e., mouth clean).
	<ol>
		<li>Begin this phase by first combining the two foods so that the non-preferred food is not visible to the child. For example, place the non-preferred food inside of the preferred and placed on the placemat so that the child cannot see the non-preferred food.</li>
		<li>Systematically increase the size of the non-preferred food and decrease the preferred food until the non-preferred food is presented alone. The ratio of the two foods (i.e., preferred and non-preferred) is systematically changed when compliance reaches 80% or better across two consecutive sessions. Continue to use the placemat and first-then prompt in this phase.</li>
	</ol>
	</li>
</ol>
6. Data
<ol>
	<li>Record yes or no data on compliance for each trial. A trial begins when the if-then prompt is delivered and compliance is defined as initiating the behavior within 10 sec from the time the prompt is presented.</li>
	<li>Make separate graphs for each target food with the independent variable being the session (i.e., 5 trials) and the dependent variable the percent compliance for the session. Enter the percent compliance in spreadsheet in order to create a graphical display of the session data in a spreadsheet. Enter the data into columns.</li>
	<li>Then select the data, click Insert then Chart. When the chart choices are presented select the marked line chart choice. Draw vertical lines between the phases of the procedure. Insert a text box with the label &#8220;baseline&#8221; above the data for the baseline sessions.</li>
	<li>Insert a text box with a number corresponding to the step of the procedure at the top of the figure for each step of the procedure. Place a label at the top of the chart denoting which food is being displayed (e.g., &#8220;100% food&#8221;, &#8220;80% food). Copy and paste the first chart at the top of a blank page and copy and paste the subsequent charts below in order.</li>
</ol>

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The authors declare that they have no competing financial interests.

This paper presents a treatment package composed of antecedent manipulations that have demonstrated success in increasing food acceptance for children who exhibit food selectivity. Notably, this paper presents a set of procedures that may be effective without the use of escape extinction. These methods are consistent with previous literature (Penrod et al., 2012) that suggests that a shaping procedure can be used to increase food acceptance with children who engage in active food refusal (e.g., throwing...

食品の選択、食品のいくつかの寸法に基づいて、新しい食品を試して不本意のように定義された（ 例えば 、質感、色、またはプレゼンテーション）は、多くの場合、自閉症スペクトラム障害（ASD）と幼児の摂食行動を特徴付け、他の発達の遅れ2、 4,7,10。 食品の選択性を示す子どもたちは、多くの場合、いくつかの食品を食べるが、これらの食品は、しばしば様々な限定されている（ 例えば 、スナック、炭水化物）と十分な栄養を提供することはできません。食品の選択は、（ 例えば 、成長障害や胃栄養チューブの挿入の診断が）しかし、食品の選択を持つ子どもの限定された食品のレパートリーは、栄養不備につながる可能性があり医師の手当てを必要とする総食物拒否につながることはありませんがあります。 急性食物選択性を有する小児における食品の受け入れを高めるための効果的な介入は、非除去の形で、絶滅を逃れるありますスプーンおよび/ ​​または物理的なガイダンス1,6,11。 重度の不適応な摂食行動に従事する子どもたちは、多くの場合、制限された体重増加と成長をもたらし、胃管栄養の使用が必要な場合があり、全食品の拒否に従事します。子供の摂食行動は、その開発に影響を与えるされている場合、絶滅を逃れる迅速食品の受け入れを高めるために不可欠であってもよいです。例えば、クーパーと同僚5は、エスケープ絶滅はすべてが悪いの成長を示し、食品が提示されたとき、かんしゃくの動作（ 例えば 、吐き気、吐きと叫び）に従事して3〜4の参加者の治療パッケージで必要なコンポーネントがわかりました。 エスケープ絶滅を繰り返ししかし、慢性摂食障害を持つ子どものための治療パッケージで貴重なコンポーネントとして実証されています。これらの手順は、重症度の低い摂食行動に従事する子ども（ すなわち 、食品selectivのために必要ではないかもしれません性）。重度の摂食行動に従事する子どもは、範囲と栄養価に制限されているが、食品の選択と子供たちは、いくつかの食品を消費する可能性があるとして、ここで総食物拒絶に関与し得るという深刻な摂食行動に、食品の選択に従事する子どもたちと異なる場合があります。 食品のさえ限られた数の一貫した消費は、エスケープ絶滅の添加を必要としない強化ベースの介入に応答する子どもたちにつながる可能性があります。自閉症児のために、正の強化手順は、ベストプラクティス9と見ていると、子供の行動は、エスケープ絶滅の使用を保証するものではありませ可能性がある場合、食品の選択の治療で実施されるべきです。先行操作およびエスケープ絶滅の使用に可能な選択肢として、正の強化方法論の利用に関する最近の研究では、これらの方法は、食品の選択3,11,12を示すいくつかの子供たちのために有効であり得ることを示唆しています</s&gt;アップ。 食品の選択性を治療するための先行操作の使用を評価する研究は、高Pシーケンス6,11,12、および順次同時食品プレゼンテーション1,8,13を含む種々の手順が組み込まれています。これらの手順を評価する研究の結果は、先行操作が食品選択12,14に従事する子どもたちのための食品の受け入れを増加させるのに有効であることが示されています。例えば、Penrodや同僚12を効果的に高P配列からなる処理パッケージを使用して、アクティブな食品拒否（ 例えば 、唾吐き、吐き気および嘔吐）に従事してASDと診断された二人の子供の食物消費量が増加し、手順をフェージング求めています。 優先および非優先の食品が提示される方法（ 例えば 、同時提示対シーケンシャル）も従事する子どもたちのための治療パッケージの有効性に寄与することができます食品の選択。 （すなわち、好適な食品に続いて非優先の食品を提示する）と同時（すなわち、一緒に非優先であり、好ましい食品を組み合わせた）の提示方法は、食品の受け入れ13,14の増加にある程度の成功を実証している。シーケンシャル両方例えば、広場ら 13は 、エスケープ絶滅せずに同時提示手順は、3〜4の参加者が増加し、食品の受け入れに有効で、そのシーケンシャルプレゼンテーションは2参加者には無効であることがわかりました。これとは対照的に、ピッツォ、同僚14が正常にASDと16歳の少年で、食品の受け入れを高めるために、順次発表して食欲操作からなる処理パッケージを使用していました。これらのプレゼンテーション手順はエスケープ絶滅を添加せずに成功している度合いは不明であるが、いくつかの研究は、これらの手順は、いくつかの子供のための効果的な先行操作であることを示唆しています。もっとresearCHは、エスケープ消光成分を含まない治療パッケージでシーケンシャルと同時プロシージャの両方の有用性を決定するために必要です。 食品の選択に従事する子どもたちのための治療パッケージを設計するには、食品の限られた数を食べる子供や介入に対する応答性に影響を与える可能性がある。このような総食物拒否に従事する人たちとの違いを考慮することが重要です。食品の選択に従事する子どもたちのために、親と臨床家は、彼らがこれらの介入を正当化するのに十分なような重篤な子供の行動が表示されない可能性があるため侵入エスケープ絶滅手順を実施に消極であってもよいです。 Tarbox、シッフとNajdowski 15は、事例報告がエスケープ絶滅手順は両親が受け入れることは困難であり得ることを示すことを示唆しています。著者らは、ケースにはあまり侵入し得る他の行動療法処置の有効性を評価するのに有用であり得ることを提案しますここで、エスケープ絶滅は両親によって受け入れられないことがあります。 レビュー研究の結果からは、先行操作は、食品の選択のための治療パッケージへの重要かつ強力なコンポーネントであるという証拠を提供します。先行操作は、多くの形態（ 例えば 、高Pシーケンスと逐次同時食品プレゼンテーション）をとることができ、それは研究を効果的に逃がし消滅を添加することなく、食品の受け入れを高めるために処理パッケージに組み合わせることができる構成要素に焦点を当てていることが重要です。エスケープ消光手順が必要でない場合、これらの介入は、より少ない侵入選択肢を提供することができます。この原稿は、シェーピング、シーケンシャルと同時提示の手順を組み合わせた治療パッケージを説明します。これらの手順は、他の先行操作と組み合わせた場合に増加する食品の受け入れで有効であったが、以前に治療パッケージに組み合わされていません。現在プロトcolがより集中的な治療を求める前に、親、教師、および限られた訓練と臨床医によって実現することができ、治療の最初の行としての役割を果たすことができる成形手順で処理するパッケージに含めることにより、順次および同時提示手続きに関する文献を拡張します。

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Small table</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
		</tr>
		<tr>
			<td>small chairs</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
		</tr>
		<tr>
			<td>paper plates</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
		</tr>
		<tr>
			<td>plastic silverware</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
		</tr>
		<tr>
			<td>toys</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
		</tr>
		<tr>
			<td>placemat</td>
			<td></td>
			<td></td>
			<td>We have these at our site</td>
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a treatment package without escape extinction to address food selectivity

困難を供給し、供給障害は幼児、自閉症などの発達の遅れと、特に子供のための一般的に生じる問題です。摂食困難の治療のための行動分析的な介入は、しばしば治療の主要な構成要素として絶滅を逃れるあります。それはまた、問題行動（ 例えば 、消光バースト）の出現と関連しているようなエスケープ絶滅の使用は、有効ではあるが、問題となる可能性があります。このような挑戦的な動作は、給紙の問題（ 例えば 、障害が繁栄する）重度慢性であり、治療の場合に許容可能な副作用であってもよいです。しかし、より深刻な場合（ 例えば 、選択的摂食）に、負の副作用は、不当な、不要とすることができます。食品の選択の行動療法のより最近の研究は、エスケープ絶滅を含まない困難を供給するための治療法を評価するために始めている（ 例えば 、需要フェージング、行動momentuいくつかの成功を収めてM）、。しかし、これまでの研究では、このような治療に対する反応の個人差を明らかにし、明確な好ましい治療が出現していません。この原稿は、発達の遅れを持つ4つの幼児の食品選択の治療のための整形、シーケンシャルプレゼンテーションと同時提示を含む多成分治療パッケージを説明します。この処理パッケージは、食品の選択のための行動療法に関する文献を拡張し、治療のシナリオおよび設定の範囲にわたって臨床的に適用することができる多成分治療プロトコルを提供しています。

The procedure of shaping and sequential presentation described can result in initial compliance with behaviors related to eating (e.g., touching the food) that can be strengthened through the use of reinforcement and shaping. By reinforcing successive approximations (shaping steps) behavior can be shaped slowly until reaching the target behavior of eating. The results depicted in Figure 1 show that the technique of shaping is capable of increasing compliance with food acceptance and the steps in...

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A Treatment Package without Escape Extinction to Address Food Selectivity

Feeding difficulties are a common problem for children with developmental disorders, including autism, and behavioral interventions often include escape extinction. Recent research has begun to evaluate treatments that do not include escape extinction. This manuscript describes a multicomponent treatment package that does not use escape extinction to treat feeding difficulties.

食品選択性に対処するためのエスケープ絶滅せずに治療パッケージ

Feeding difficulties and feeding disorders are a commonly occurring problem for young children, particularly children with developmental delays including ...

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Behavior

11.4K ビュー.  Florida International University. Feeding difficulties are a common problem for children with developmental disorders, including autism, and behavioral interventions often include escape extinction. Recent research has begun to evaluate treatments that do not include escape extinction. This manuscript describes a multicomponent treatment package that does not use escape extinction to treat feeding difficulties.