Overview of Escape Extinction (EE) When Used for Food Refusal

Food Refusal

Food refusal pertains to behaviors such as head turns, torso turns, batting at the spoon, covering the mouth, and crying.

Sometimes it pertains to expelling, gagging, packing, and vomiting. These particular behaviors can also be attributed to skill deficits or medical conditions.

Function of Food Refusal

Typically the function of food refusal (in children who have feeding disorders) is escape. This in itself does not necessarily explain the genesis of a feeding disorder, but rather only signifies that previous displays of refusal have led to the termination of meals (escape).

What is an Extinction?

Extinction is a procedure in which a behavior or stimulus is no longer followed by a reinforcer after previously being reinforced. As a result, the behavior no longer occurs or a stimulus no longer elicits a particular behavior.

Extinction Burst

When a behavior is put on extinction, initially that particular behavior occurs at a higher rate than previous to initiating the extinction procedure.

For example: a target behavior of head turns has previously led to the withdrawal of a spoon containing food. The feeding therapist has determined that head turns are interfering with intake, thus deciding to put head turns on extinction.

The therapist in turn does not withdraw the spoon at each instance of a head turn. This initially leads to a high rate of head turns. After a few sessions the rate quickly dissipates until the behavior no longer occurs.

Spontaneous Recovery

This refers to a previously extinguished behavior occurring again without any reinforcement. The time period between these occurrences become greater on average with the passage of time as long as reinforcement continues to no longer occur.

Escape Extinction and Feeding

Many children exhibit food refusal behaviors which can include head/torso rotation, hitting the spoon, kicking, mouth coverings, and crying. If these behaviors are not addressed (reduced), they will interfere with intake. Many therapists find it difficult to implement extinction procedures with mealtime behaviors. This can lead to reinforcement of refusal because either the refusal is not being addressed (allowing escape) or the therapist may react in such a way that reinforces the refusal.

Beyond Escape Extinction

Escape extinction by itself seldom solves issues with intake. It does not necessarily address packing, expelling, or in some cases mouth openings and bouts of emesis. It is estimated that somewhere between 10–15 percent of feeding disorder cases can be resolved by only implementing EE. Most of the time other treatment regimes are necessary in conjunction with EE.