Using a Novel Variant of Stimulus Fading in the Treatment of Food Refusal and Co-Morbid Challenging Behaviour in a Child with Autism

Interventions drawn from operant psychology have proven effective in the treatment of food refusal displayed by children with ASD. Multi-component behavioural intervention is typically implemented in such cases and involves escape extinction, stimulus fading and differential reinforcement. However, escape extinction may result in an initial increase in challenging behaviour and may be problematic in cases where such behaviour is severe. The current study implemented a variant of stimulus fading alone in a four year old boy with ASD and a history of food refusal. Parental report indicated that the boy ate a small number of hard textured foods and pureed baby food. Functional assessment indicated that the child was able to chew hard food and shallow pureed food but was unable to eat foods with a combination of hard and soft textures. Stimulus fading was implemented by gradually reducing the latency period between chewing of hard texture and swallowing pureed food. The intervention was implemented without a single occurrence of gagging, vomiting, rejection of food and challenging behaviour. At the end of intervention, the child was eating a variety of age appropriate foods. Clinicians are urged to consider interventions in the treatment of food refusal that may be less aversive for the child to experience prior to the use of escape extinction.