Unit2 SPPHS5006 Due 10.18.2022ReadingsUse your .docx

Unit2 SPPHS5006 Due 10.18.2022
Readings
Use your
Social Policy and Social Programs text to complete the
following:
· Read Chapter 2, "An Overview of Social Policy Analysis: A
Critical Value Approach," pages 29–39.
Use the Capella Library to complete the following:
· Contandriopoulos, D., & Brousselle, A. (2012).
Evaluation models and evaluation use [PDF].
Evaluation, 18(1), 61–77.
Multimedia
Listen to this audio presentation:
·
Ethics, Values, and Policy Analysis.
UNIT2ASSIGN: Assignment Description
This assignment involves the application of Chambers and
Bonk's (2013) contention that all social programs and policies
are created to meet three criteria: adequacy, equity, and
efficiency (p. 2). As a social worker, you will spend a great deal
of time working within the social program or policy context. In
other words, you will work in the agencies created by policies,
implement the programs offered by the agencies, and have
direct contact with those who are served by the programs and
policies. Social workers must be concerned about these policies
and programs, both their weaknesses and strengths, if social
workers are to uphold our professional ethical
standards.Assignment Instructions
For the first assignment for this course, compose a written

document that contains the following:
· A description and assessment of your past experiences with
policy and program planning, either your experience making
policy or experience with a policy that someone else made.
· Reflect on your past professional involvement with policy or
program planning and evaluation either in the human services
field or elsewhere. If you do have some knowledge and
experience in this regard, please describe it. What kind of
policy or program were you concerned with? What was the
degree of your involvement and the level of knowledge you had
at that time regarding social policy and program planning?
· The selection and explanation of a program or policy that
oppresses, alienates, or discriminates, informed by personal
experience or information found via the Internet or the Capella
Library.
· Strategies for policy or program changes that aim to empower
or create privilege.Reference
Chambers, D. E., & Bonk, J. F. (2013).
Social policy and social programs: A method for the
practical public policy analyst (6th ed.). Pearson.
Submission Requirements
The assignment you submit is expected to meet the following
requirements:
· Written communication: Written communication is free of
errors that detract from the overall message.
· APA formatting: Resources and citations are formatted
according to current APA style and formatting standards.
· Length of paper: 2–3 double-spaced pages.
· Font and font size: Times New Roman, 12 point.
View the scoring guide for this assignment to ensure you fulfill
all grading criteria. SEE BELOW

Unit2Disc1: Diverse Policy Analysis Methods (1 page, site
resources in APA)
What differentiates the value critical analysis from the analytic
descriptive method evaluation? Note at least three differences.
Identify the commitments inherent in the value critical
approach. Which process would be best for analyzing the social
issue you identified in the first discussion of Unit 1?
image1.png
211
Functional Assessment and Treatment
of Mealtime Behavior Problems
Tami L. Galensky
St. Louis County Special School District
Raymond G. Miltenberger
North Dakota State Univesity
Jason M. Stricker
Arlington Development Center
Matthew A. Garlinghouse
Southeast Human Service Center
Abstract: This study utilized descriptive assessment methods to
develop hypotheses regarding
the function of mealtime behavior problems for three typically
developing children. Functional
treatment was evaluated in the natural setting with caregivers as

change agents. Overall, results
of the descriptive assessment suggested that each child’s
problem behavior was maintained by
escape and, to a lesser extent, attention. In addition, this study
suggested that direct observa-
tion was more reliable than a behavioral interview or
questionnaire in acquiring the informa-
tion necessary to develop hypotheses on factors maintaining a
child’s mealtime behavior
problems. Finally, a functional treatment package consisting of
extinction, stimulus fading, and
reinforcement of appropriate eating behaviors implemented by
the caregivers was effective in
decreasing the mealtime behavior problems for two of the
children who continued in the study,
thus providing support for the hypotheses developed from the
assessment.
Feeding problems, such as food refusal and food selectiv-
ity, are reported to occur frequently in children with men-
tal developmental disabilities and/or physical limitations
and less frequently in children of typical development
(Linscheid, 1983). Jones (1982) reported that 19% to 61%
of individuals with mental developmental disabilities dis-
played behavioral feeding problems. Although there is lit-
tle rigorous experimentation on feeding problems in the
general child population (Linscheid, 1983), Sisson and Van
Hasselt (1989) reported that feeding problems &dquo;occur in
approximately one out of four children&dquo; (p. 45). Babbitt
et al. (1994) also indicated that some reviews estimate that
feeding disorders may affect 25% of infants and children.
The bulk of scientific research has focused on populations
composed of children with intellectual, neurological, or
physical limitations. Due to the clinical significance of
feeding disorders, the research on feeding disorders usually
takes place in the inpatient setting and focuses on having

the therapist as the change agent.
The literature on food refusal has expanded since the
late 1970s and early 1980s. Numerous treatment studies
support the use of behavioral interventions, especially posi-
tive reinforcement procedures (Ahern, Kerwin, Eicher,
Shantz, & Swearingin, 1996; Cooper et al., 1995), stimulus
fading procedures (Freeman & Piazza, 1998; Luiselli, 1994;
Shore, Babbitt, Williams, Coe, & Snyder, 1998), and escape
extinction procedures (Johnson & Babbitt, 1993; Kern &
Marder, 1996) as effective procedures in the treatment of
food refusal. Some researchers have used other procedures,
such as peer modeling (Greer, Dorow, Williams, McCorkle,
& Asnes, 1991 ), caregiver training in behavioral treatments
(Werle, Murphy, & Budd, 1993), and relaxation tech-
niques, to assist in managing feeding problems (Weinman,
Haydan, & Sapan, 1990). However, identifying the vari-
ables maintaining food refusal prior to implementing
treatment procedures has been rarely reported. In fact,
very few experiments have mentioned or included func-
tional assessment procedures for food refusal. For exam-
ple, although many studies use extinction of refusal to
accept food, refusal to swallow food, and inappropriate
mealtime behaviors, very few of these studies address or
demonstrate the maintaining reinforcers for the behavior
prior to treatment implementation.
During the past two decades more emphasis has been
placed on the assessment of controlling environmental
variables to ascertain the function of problem behavior(s).
Functional assessment uses a variety of techniques to iden-
tify antecedent and consequent events, including indirect/

212
informant methods, such as interviews, rating scales, and
questionnaires, and direct/naturalistic methods, which in-
volve direct observation. Functional analysis, the third class
of functional assessment techniques, involves the actual
manipulation of environmental variables to establish a
functional relationship between the controlling variables
and the behavior (Lennox & Miltenberger, 1989).
In the literature on food refusal and food selectivity, it
appears as though most assessments begin with a clinical
interview; however, few of the studies report what sort of
interview was used to acquire the reported information.
Interestingly, the studies concerned with implementing be-
havioral interventions rarely mention the use of a behav-
ioral interview and rarely identify the antecedents and
consequences related to the problem behavior. It appears
as though most researchers informally consider possible
hypotheses regarding the function of eating-related prob-
lems and very rarely document these hypotheses.
A few studies mentioned the use of behavioral or
functional assessment but did not discuss the techniques
used or report the results (Hagopian, Farrell, & Amari,
1996; Luiselli, 1989; Riordan, Iwata, Finney, Wohl, & Stan-
ley, 1984). A few other researchers have reported descrip-
tive functional assessment results prior to treatment for
food refusal. Linscheid, Tarnowski, Rasnake, and Brams
(1987) noted that a 6-year-old boy with short gut syn-
drome needed considerable persuasion from care pro-
viders to consume nutritional supplements and that the
child engaged in escape behavior. Handen, Mandell, and

Russo (1986) used an interview to determine caregiver
consequences for food refusal and direct observation to as-
sess both antecedents, specifically the use of prompting
and consequences. Werle et al. (1993) employed a home-
based functional assessment evaluating caregiver feeding
behaviors, antecedents such as provision of prompts and
food properties, and consequences such as provision of at-
tention and rewards. Luiselli (1994) used a behavioral
feeding assessment but did not report hypotheses resulting
from this assessment. Although the author mentioned
(post hoc) that vomiting might have occurred in order to
escape the meal, this hypothesis was not assessed. Cooper
et al. (1995) used a behavioral interview that looked at an-
tecedents and consequences. From this assessment, hy-
potheses were developed about the problem behaviors and
were utilized in the selection of treatment components. Fi-
nally, Hoch, Babbitt, Coe, Duncan, and Trusty (1995) re-
ported a history of escape following food refusal for a
3-year 6-month-old girl but did not mention if this infor-
mation was acquired through a prior assessment or by ob-
servation during treatment.
To date, a functional analysis of the maintaining vari-
ables for food refusal has not been reported in the feeding
disorder literature. However, Munk and Repp (1994) eval-
uated a behavioral assessment that investigated the effect
of food characteristics, such as food type and texture, on
food acceptance in five individuals with disabilities and
limited food intake. The experimenters used 10 to 12 dif-
ferent food types and 4 types of food texture. The assess-
ment consisted of presenting several foods at the same
texture level, then using these same foods while progress-
ing to coarser textures to determine whether the individual

rejected food of a certain type and/or texture or displayed
total food refusal. Munk and Repp proposed more research
regarding the effects of treatment based on assessment re-
sults and suggested functional analysis of consequences.
Although the use of functional assessment and analy-
sis procedures is common practice in research that ad-
dresses behavior problems in children and persons with
developmental disabilities, functional assessment is rarely
used as the basis for treatment selection for feeding disor-
ders. The purposes of this study were to evaluate indirect
versus direct functional assessment methods for develop-
ing hypotheses about the function of food refusal and then
to evaluate the effects of brief functional treatment con-
ducted by the caregivers in the natural setting on the oc-
currence of food refusal.
Method
PARTICIPANTS AND SETTING
Participants were three typically developing children who
exhibited frequent mealtime behavior problems. Brenda,
age 2 years 10 months, engaged in food refusal, elopement,
play, and occasional expulsion of nonpreferred food. The
caregivers indicated that they had tried various techniques
such as verbal prompting, removing Brenda’s plate contin-
gent on inappropriate behavior, and providing reinforce-
ment with treats and games to get Brenda to eat and
behave appropriately during meals.
Roxy, age 6 years 11 months, engaged in food refusal,
expulsion of nonpreferred foods, play, and elopement. The
caregivers’ attempted techniques included the inconsistent
use of punishment, moderate verbal prompting, assisted
feeding, and rewards with treats and activities, none of

which increased her food intake.
David was a 4-year and 11-month-old boy who dis-
played very restricted food preferences and engaged in
tantrum behavior if a nonpreferred food was on his plate.
During the beginning of this study, David ate only six
foods, and his caregivers reported that certain foods that
David used to eat were no longer accepted. The caregivers
indicated that they occasionally tried to prompt consump-
tion of new foods, but to no avail. Therefore, they discon-
tinued the use of verbal prompting and began to solely
provide preferred foods for meals without requiring David
to eat. David’s caregivers reported that the pediatrician in-
dicated no physiological abnormalities that would account
for his refusal behaviors. All assessments and meals were
213
conducted in the dining areas of the participants’ homes,
with the entire family present.
DATA COLLECTION AND DEPENDENT MEASURES
Data were collected for all children on the percentage oc-
currence of target behaviors during 10-second intervals,
the number of bites per minute, and the estimated per-
centage of total food intake, as well as the estimated per-
centage of total preferred and nonpreferred food intake.
Each session was videotaped and scored according to a
10-second partial interval recording method. A high-
resolution VCR that digitally displayed seconds and min-
utes was used to view each session. The observer marked
each interval in which a target behavior occurred or con-
tinued to occur. This procedure allowed for reliable real-

time recording of the percentage of intervals the problem
behavior occurred and the number of bites of food per
minute while eliminating the need for the observer’s pres-
ence. Percentages were calculated by dividing the number
of intervals the child engaged in the target behavior by the
total number of intervals during the meal and multiplying
by 100. The number of bites per minute was calculated by
dividing the total number of bites by the number of min-
utes the meal lasted.
A bite was recorded if the child opened his or her
mouth and bit down on the food within 5 seconds after the
utensil presentation. Refusal behavior included negative
statements indicating that the child did not like the food,
did not want to eat, was not hungry, or was feeling sick,
and/or physical refusals such as pushing the plate or spoon
away or shaking his or her head &dquo;no.&dquo; Refusals
were
counted as one episode if they occurred together within 5
seconds. Elopement was scored anytime the child’s but-
tocks were out of the chair except when he or she was try-
ing to reach for something pertaining to the meal (e.g., if a
child was reaching for a condiment). An expulsion was
scored anytime food, which was previously in the child’s
mouth, was spit out beyond the lip or chin area or was
taken out of the mouth with his or her fingers. Food play
included any manipulation of food with the child’s fingers
and any use of a utensil, other than for the goal of picking
up the food and directing it to the mouth for ingestion.
In addition to these behavioral measures, the percent-
age of each child’s meal consumption and the consump-
tion of preferred and nonpreferred foods were recorded by
the caregiver. The caregiver completed a rating form every
meal. First, the caregiver circled the rating that estimated
the child’s total meal intake. Next, the caregiver used the

same rating scale to estimate the approximate percentage
of preferred and nonpreferred foods consumed. The care-
giver used the following rating scale: 1 = 0% of the meal,
2 = 1 % to 24% of the meal, 3 = 25% of the meal, 4 = 26%
to 49% of the meal, 5 = 50% of the meal, 6 = 51 % to 74% of
the meal, 7 = 75% of the meal, 8 = 76% to 99% of the mea4
and 9 = 100% of the meal.
Phase 1: Descriptive Assessment
Descriptive assessment involved the completion of a func-
tional assessment questionnaire, entitled the Functional
Assessment Questionnaire of Mealtime Behavior Problems
(FAQ); a functional assessment interview (FAI); and direct
observation of the antecedents and consequences pertain-
ing to the problem behavior via completion of an A-B-C
checklist (Miltenberger, 2001).
FAO .
Questions pertained to the antecedents and consequences
of both feeding behavior and mealtime disruptive behav-
ior in order to assist in developing hypotheses regarding
the function of problem behavior. The questionnaire in-
cluded sections on present and past feeding behavior and
took approximately 30 to 60 minutes to complete. Interob-
server agreement on the hypothesized function of the
behavior was assessed by having two behavior analysts in-
dependently review the completed questionnaire and
record their hypotheses. They also rated their confidence
in the hypotheses on a 7-point scale ( 1 = not at all confident,
and 7 = completely confident).
FAI

The first author conducted a behavioral interview using
the questions from the FAQ. The interview lasted about 60
to 90 minutes, and the caregivers were encouraged to an-
swer with as much detail as possible and to provide exam-
ples. Following the completion of the interview, the first
author used the information to determine the function of
the food refusal and then rated the confidence in this hy-
pothesis on a 7-point scale. Interobserver agreement on
the function of the behavior was gathered by having a
practicing master’s-level behavior analyst listen to an
audiotape of the interview, record his or her hypotheses re-
garding the function of the behavior, and provide a confi-
dence rating of the hypotheses.
A-B-C OBSERVATIONS
The A-B-C checklist (Miltenberger, 2001), a form that doc-
uments the time the problem behavior occurred and the
antecedents and consequences of the behavior, was com-
pleted while observing four videotaped meals. Observers
were provided operational definitions of the target behav-
ior(s) and the possible antecedent and consequent events
to record, all of which were acquired from the interview
and preliminary mealtime observations. From the A-B-C
assessment, the average percentage of times the occurrence
214
of the mealtime problem behavior was followed by the
consequences listed on the checklist was determined by di-
viding the number of occurrences of each consequence by
the frequency of the behavior. A hypothesis about the
function of the behavior was identified from the A-B-C

recording by the first and second authors after they inde-
pendently evaluated the completed A-B-C data sheets.
Both raters also indicated the confidence of their hypothe-
ses on a 7-point scale. &dquo;
INTEROBSERVER AGREEMENT OF
A-B-C OBSERVATIONS
Interobserver agreement on the scoring of the A-B-C data
from videotape was obtained for 50% of the videotaped
observations. The observers used the digital second
counter on the VCR in order to facilitate reliable recording
of the antecedents, consequences, and behavior. The ob-
servers recorded the exact time the target behavior occurred
and then identified the antecedents and consequences for
that behavior. Percentage of agreement was calculated by
comparing agreement on the occurrence of the target be-
havior at the specific time. Agreements were defined as the
two observers identifying the same behavior as occurring
within 3 seconds of each other. Percentage agreement on
the occurrence of behavior was determined by dividing the
number of agreements by the number of agreements plus
disagreements and then multiplying by 100. For each in-
stance of behavior that was previously agreed on, percent-
age of agreement was calculated for both the antecedents
and the consequences for the target behavior. Percentage
agreement on the antecedent events was determined by di-
viding the number of agreements on antecedents by the
number of agreements plus disagreements on antecedents
and then multiplying by 100. This same procedure was
used to determine percentage of agreement on consequent
events.
Agreement between observers on the occurrence of

Brenda’s target behaviors ranged from 75% to 100%, with
a mean of 87.5%. Interobserver agreement on the occur-
rence of antecedents ranged from 97% to 99.3%, with a
mean of 98.2%; agreement on the occurrence of conse-
quences ranged from 90.5% to 100%, with a mean of
95.3%. For Roxy, interobserver agreement on the occur-
rence of target behaviors ranged from 72% to 81%, with a
mean of 76.5%. Agreement between observers on the oc-
currence of antecedents and consequences resulted in
means of 98.5% (range 98% to 99%) and 98%, respec-
tively. For David, agreement between observers on the oc-
currence of target behaviors ranged from 81 % to 100%,
with a mean of 90.5%. Interobserver agreement on the oc-
currence of antecedents and consequences ranged from
89% to 97% and 95% to 98%, respectively, with means of
93% and 96.5%, respectively.
Phase 1: Results and Discussion
PROCEDURE
’
For each participant, the results were examined for the
FAI, FAQ, and the A-B-C Checklist. Table 1 reports the hy-
Table 1. Phase 1 Descriptive Assessment Results for Each
Child: Hypothesized Functions, Percentage of
Interobserver Agreement, and Confidence Ratings
Note. FAI-I = functional assessment interview hypotheses from
the primary rater; FAI-2 = functional assessment interview
hypotheses from the secondary rater;
FAQ-1 = functional assessment questionnaire hypotheses from
the primary rater; FAQ-2 = functional assessment questionnaire

hypotheses from the secondary rater
A-B-C- I= direct observation hypotheses from the primary rater;
A-B-C-2 = direct observation hypotheses from the secondary
rater. Each rater’s confidence ratings are
in parentheses.
aoverall mean confidence rating per method. boverall % of
agreement on the behavior function between raters.
215
pothesized functions of the mealtime problem behavior
for each child, the corresponding confidence ratings from
the independent raters, the overall percentage of interob-
server agreement between behavior analysts on the func-
tion of mealtime problem behavior per assessment method,
and the overall mean confidence rating per assessment
method.
FUNCTIONAL HYPOTHESES FROM THE FAI
For Brenda, the primary and secondary raters agreed that
food refusal behaviors functioned to acquire escape (mean
confidence rating of 6.0: moderately certain). The primary
rater also hypothesized access to tangibles (confidence rat-
ing of 7.0: strongly certain). Attention was also hypothe-
sized by the secondary rater (confidence rating of 7.0). For
Roxy, both raters supported the escape function (mean
confidence rating of 6.5: moderately certain). The primary
rater also included attention and access to tangibles as
maintaining factors (confidence rating of 4.0 for each
function). For David, both the primary and secondary
raters determined escape to be a maintaining factor (mean
confidence rating of 6.5). In addition, the primary rater
hypothesized access to tangibles as a maintaining factor

(confidence rating of 7.0).
Overall, across children, the primary and secondary
raters’ reviews of the information from the interview re-
sulted in a mean confidence rating of 6.1 (moderately cer-
tain). In addition, the primary and secondary raters agreed
100% of the time in identifying an escape function and
agreed 0% of the time in identifying an attention or tangi-
ble function.
FUNCTIONAL HYPOTHESES FROM THE FAO
For Brenda, both the primary and secondary raters agreed
that the food refusal behavior functioned to acquire escape
(mean confidence rating of 4.5: fairly certain) and atten-
tion (mean confidence rating of 4.0). In addition, the
primary rater hypothesized that access to tangibles also
contributed to maintaining the refusal behavior (mean
confidence rating of 3.0: fairly uncertain). For Ro~, the
primary and secondary raters indicated that both escape
and attention maintained the behavior (mean confidence
ratings of 4.7: fairly certain and 2.7: mildly uncertain, re-
spectively). In addition, the secondary rater hypothesized
that access to tangibles also was a maintaining factor (con-
fidence rating of 2.0), thus indicating moderate uncer-
tainty. For David, both the primary and secondary raters
agreed that the food refusal behaviors functioned to ac-
quire escape (mean confidence rating of 4.7: fairly certain).
The primary rater also indicated that access to tangibles
was a maintaining factor (confidence rating of 4.5), and
the secondary rater indicated that attention was a main-
taining factor (confidence rating of 4.5).
Overall, across primary and secondary raters, the
questionnaire resulted in a mean confidence rating of 4.0

( fairly uncertain). Across children, the primary and sec-
ondary raters agreed 100% of the time in identifying an es-
cape function, agreed 67% of the time in identifying an
attention function, and agreed 0% of the time in identify-
ing a tangible function.
FUNCTIONAL HYPOTHESES FROM A-B-C OBSERVATION
For Brenda, direct observation revealed that her refusal be-
haviors acquired escape from eating 70% of the time, ac-
quired attention from the caregivers 58% of the time, and
gained access to preferred foods 15% of the time. The pri-
mary and secondary raters agreed that both escape and at-
tention were maintaining factors (mean confidence ratings
of 6.3 and 6.5, respectively). For Roxy, the A-B-C assess-
ment indicated that mealtime behaviors occurred to es-
cape eating 26% of the time and acquire attention from
caregivers 67% of the time. The primary and secondary
raters determined that escape and attention were main-
taining factors (mean confidence ratings of 6.8 and 5.5,
respectively). For David, refusal behaviors resulted in at-
tention 64% of the time, escape 57% of the time, and ac-
cess to tangibles 14% of the time. The primary and
secondary raters agreed that both escape and attention
maintained refusal behaviors (mean confidence ratings of
6.8 and 6.5, respectively).
Overall, the primary and secondary raters’ reviews of
the information from direct observation resulted in a
mean confidence rating of 6.4 (moderately certain). The
primary and secondary raters agreed 100% of the time on
the functions of escape and attention and the absence of a

tangible function for all of the children.
The results of Phase 1 indicate that direct observation,
via the A-B-C checklist, resulted in hypotheses that yielded
the highest confidence ratings, with a mean rating of 6.4,
and the highest interobserver agreement, with a mean per-
centage agreement of 100%. Therefore, the hypotheses
from direct observation were used in the development of
functional treatment.
The FAQ resulted in hypotheses of attention and es-
cape that were similar to the hypotheses developed from
direct observation; however, it also resulted in the lowest
confidence ratings from independent raters, with a mean
rating of 4.0, and low interobserver agreement, with a
mean percentage agreement of 56%. Although the ques-
tionnaire results led to the hypotheses of escape and atten-
tion, the information acquired from the caregivers was
sparse and lacking detail, thus resulting in the lower confi-
dence ratings.
On the other hand, the interview yielded higher confi-
dence ratings from independent raters, with a mean rating
of 6.1, but the lowest interobserver agreement, with a mean
percentage of 44%. Although the interview took much
216
time to conduct, it provided more detailed information
and practical examples of feeding behaviors and the events
surrounding feeding situations than did the questionnaire.
In light of these results, some issues need to be con-
sidered. First, no decision rules are in place to assist indi-

viduals in determining the function of a behavior. This
issue is especially true with interpreting A-B-C assessment
results and may have influenced the results from this
study’s A-B-C assessment. For example, the A-B-C assess-
ment indicated that David’s food refusal behaviors resulted
in escape 57% of the time, attention 64% of the time, and
access to preferred food 14% of the time. Therefore, rele-
vant questions may have included, (a) Was the primary
hypothesis an attention or escape function? (b) How
significant was the function of gaining access to preferred
foods or other tangibles? (c) Should intervention have
addressed all of the demonstrated hypotheses? and
(d) What percentage of time should a consequence follow
a behavior before it is considered a significant function of
the behavior?
Another factor requiring consideration involves the
influence of differing levels of experience of the indepen-
dent observers on the determination of hypotheses from
the functional assessment methods. For example, a behav-
ior analyst with a doctorate and more experience and fa-
miliarity with the procedures may be more efficient and
accurate in determining hypotheses as compared to a less
experienced, master’s-level behavior analyst. A third issue
involves the factors influencing the independent raters’ in-
terpretation of the interview and questionnaire results. For
example, the first author conducted all of the interviews
and viewed and recorded all of the A-B-C data, whereas the
independent raters reviewed the permanent products (e.g.,
the completed questionnaire, the audiotaped interview,
and the scored A-B-C checklist). Therefore, the personal
interaction with the family or the procedures may have re-
sulted in differing hypotheses than the hypotheses devel-
oped from those individuals viewing the raw data alone.

Overall, this study found that neither the results from
the questionnaire nor the behavioral interview were as
consistent as the results from direct observation in de-
termining functional hypotheses. Until further research
provides more support for the utility of interview or ques-
tionnaire methods, these results suggest that researchers/
practitioners should use direct rather than indirect func-
tional assessment methods when attempting to develop
hypotheses about the function of mealtime problem be-
haviors. Although the current feeding literature briefly dis-
cusses the use of interviews and direct observation, it is
important that future studies systematically evaluate func-
tional assessment and functional analysis procedures with
feeding behaviors to ascertain variables that influence and
maintain these behaviors. In addition, one direction for fu-
ture research may be to compare the results of functional
assessment procedures carried out by caregivers versus re-
searchers.
The direct observation results from this phase of the
study, as well as results from the preference assessment in
Phase 2, were used to develop functional interventions to
address mealtime problem behaviors (Phase 3).
Phase 2: Stimulus Preference and
Avoidance Assessment
PROCEDURE
Twelve foods, determined via caregiver report, were evalu-
ated in a paired-choice format (Fisher et al., 1992) to de-
termine relative stimulus preference and avoidance (Fisher
et al., 1994). First, the caregivers of each child developed a

list of six preferred foods and six nonpreferred foods that
the caregivers wanted the child to be eating by the termi-
nation of treatment. During the assessment, each food
item was placed in a clear plastic cup with a plastic spoon
to facilitate consumption. Two cups were then placed on
the table approximately 5 inches from the child and ap-
proximately 4 inches apart. The child was instructed to
choose only one food item from the pair. Preference
was determined by measuring the number of times a child
chose an item out of the total number of times that item
was presented.
PREFERRED VERSUS NONPREFERRED FOODS
We briefly compared preferred versus nonpreferred foods
to assess the validity of the caregiver’s verbal report re-
garding preferred and nonpreferred food items. Each of
the six preferred foods was randomly paired with one of
the six nonpreferred foods and presented to the child in six
trials. Validity of the caregiver’s verbal report was evaluated
by comparing the assessment results (the actual food items
that the child chose) with the caregiver’s predictions. To
assess predictions, the caregiver reviewed the list of the
preferred/nonpreferred food pairs and circled the food
item he or she thought the child would choose.
STIMULUS PREFERENCE ASSESSMENT
The stimulus preference assessment compared preferred
food items in order to determine potential edible rein-
forcers for use during treatment. Each of the six preferred
food items was randomly presented once with every other
preferred food item. In this forced-choice assessment, each
food item was presented 5 times, for an overall total of 15
trials. Relative preference was reported as the number of
times each food item was chosen across the 5 trials that in-

cluded that food.
217
STIMULUS AVOIDANCE ASSESSMENT
The stimulus avoidance assessment compared each of the
six nonpreferred food items in order to develop a hierarchy
of the most-acceptable to least-acceptable nonpreferred
food items. Each nonpreferred food was randomly pre-
sented once with every other nonpreferred food. Each
nonpreferred food was presented 5 times, for a total of 15
trials. Relative preference of nonpreferred foods was re-
ported as the number of times each food item was chosen
across the 5 trials that included that food.
PREFERRED VERSUS NONPREFERRED FOOD
All three children chose the preferred foods over the non-
preferred foods.
STIMULUS PREFERENCE ASSESSMENT
Brenda’s preference assessment indicated that macaroni
was the most preferred food because it was chosen five out
of five stimulus presentations. The remaining order of pre-
ferred foods consisted of cheese (4/5), cereal (3/5), cooked
carrots (2/5), and french fries (1/5). Roxy’s preference as-
sessment indicated that ice cream was the most preferred
item because it was chosen five out of five presentations,
followed by cereal (3/5), grapes (3/5), bread (2/5), waffles
(1/5), and noodles (1/5). David’s preference assessment in-

dicated that chicken nuggets, chosen four out of five pre-
sentations, was the most preferred stimulus, followed by
hash browns (3/5), slightly toasted bread (3/5), waffles
(3/5), hamburgers (2/5), and apples (0/5).
STIMULUS AVOIDANCE ASSESSMENT
The results of the stimulus avoidance assessment (see Fig-
ure 1) indicated that, for Brenda, raw carrots, chosen five
out of five presentations, was the most acceptable nonpre-
ferred food item, followed by mashed potatoes (4/5),
boiled potatoes (3/5), rice (1/5), chunked beef (1/5), and
crumbled beef (1/5). For Roxy, the most acceptable non-
preferred food was watermelon (5/5), followed by can-
taloupe (4/5), mashed potatoes (3/5), green beans (2/5),
peas (1/5), and corn (0/5). David’s results indicated that
bread with peanut butter (5/5) would be the most accept-
able nonpreferred food, followed by mashed potatoes
(4/5), grapes (3/5), corn (2/5), cheese pizza (1/5), and mac-
aroni (0/5). In this assessment, David refused to take a bite
of any nonpreferred foods; therefore, the most-acceptable
to least-acceptable nonpreferred food range was assessed
by having him indicate which food item was more accept-
able. In addition, five random stimulus pairs of food items
Figure 1. The number of nonpreferred food presen-
tations accepted for each child during the stimulus
avoidance assessment.
were represented to assess the reliability of his verbal re-
port. Results indicated that the reliability of his verbal re-
port was 100%.
INTEROBSERVER AGREEMENT AND CAREGIVER’S
VERBAL REPORT

An independent data collector scored the videotaped pref-
erence assessment and stimulus avoidance assessment for
each participant. Interobserver agreement was calculated
by dividing the number of times there was agreement on
the child’s food choice by the number of agreements plus
disagreements and then multiplying by 100. The mean in-
terobserver agreement for each child’s food choice was
100%.
For all of the children, each caregiver was 100% cor-
rect in identifying preferred over nonpreferred foods. For
Brenda, the caregiver was 93.3% accurate in predicting the
child’s preferred food choice and 26.7% accurate in pre-
dicting the child’s nonpreferred food choice, with a total
accuracy of 60%. For Roxy, the caregiver was 53.3% accu-
rate in predicting the child’s preferred food choice and
218
60% accurate in predicting the child’s nonpreferred food
choice, with a total accuracy of 56.7%. For David, the care-
giver was 73% accurate in predicting the child’s preferred
food choice and 83% accurate in predicting the child’s
nonpreferred food choice, with total accuracy of 78%.
Phase 2 results suggested that the caregiver’s verbal re-
port was valid in that each caregiver correctly reported the
child’s preferred and nonpreferred foods and correctly pre-
dicted the child’s consumption of the preferred food over
the nonpreferred food. Altogether, the caregivers were not
much more accurate than chance in predicting the child’s
food choice in both the stimulus preference and avoidance
evaluations.

Overall, the stimulus preference and avoidance assess-
ments were useful in systematically answering important
questions relevant to developing functional treatment.
First, the stimulus preference results assisted in the deter-
mination of the most preferred food to use as a potential
reinforcer for each child. Second, the stimulus avoidance
assessment results assisted in the determination of the least
nonpreferred food to use as the initial target stimulus in
order to increase the child’s success with a stimulus fading
procedure.
The literature currently supports the use of preference
assessments in identifying reinforcers (Bowman, Piazza,
Fisher, Hagopian, & Kogan, 1997) for use during treat-
ment. One important issue to consider is that an individ-
ual’s relative preference for a stimulus may change from
day to day (Bowman et al., 1997). Unfortunately, we were
not able to determine the degree to which this phenome-
non may have influenced the results of this assessment. Be-
cause an individual’s preference may change periodically, it
seems relevant to suggest that a preference assessment may
need to be conducted more than once, especially when re-
lying on a stimulus to act as a reinforcer for appropriate
behavior. Therefore, further research needs to be done to
determine if more frequent preference assessments are es-
sential, and if so, can we determine more efficient ways to
conduct these assessments on a frequent basis? Due to the
small sample size, replication of this phase is encouraged
to determine if the results of caregiver verbal report occur
across individuals and to provide further evidence for or
against determining relative nonpreference.
Phase 3: Treatment Evaluation

PROCEDURE
Phase 3 involved using the information acquired from
Phase 1 for determining the components of a functional
treatment package and using the information from Phase
2 for determining potential positive reinforcers as well as a
hierarchy of target foods to be used in treatment. A multi-
ple baseline across participants’ research design was used
to evaluate brief functional treatment implemented by the
caregivers in the natural setting.
Baseline Measures
Meals were videotaped in the dining area of the partici-
pants’ homes with the experimenter present but not inter-
acting with the child or caregiver. For Brenda, Roxy, and
David, baseline consisted of 6, 9, and 11 videotaped din-
ners, respectively. For each participant, the caregiver pre-
sented at least one nonpreferred food with the meal and
proceeded to conduct the mealtime as usual. In addition,
the caregiver occasionally verbally prompted the child to
try the nonpreferred food item.
Functional Treatment .
For each child, functional treatment consisted of rein-
forcement and extinction procedures that specifically ad-
dressed the function of each child’s mealtime behavior.
Functional treatment was implemented by the caregivers
in the natural setting with the assistance of the therapist,
who provided the caregivers with guidance and corrective
feedback. The treatment components were the same across
children because the direct observation assessment indi-
cated escape and attention functions for all three children.

Functional treatment consisted of the following:
1. tangible reinforcement, in which preferred foods
were given contingent on bites of nonpreferred
food;
2. stimulus fading, in which the portion size of
nonpreferred food was increased across meals;
treatment sessions progressed from the least
.
, nonpreferred to the most nonpreferred foods
(as determined in the stimulus avoidance assess-
ment). Components 1 and 2 were designed to
’
. address the escape function of the problem
behaviors;
3. differential reinforcement of alternative/other
behavior, in which attention was contingent on
the appropriate use of utensils, sitting in the
chair, eating, and abstaining from play behaviors
every 30 seconds during a meal in order to
address the attention function of the problem
behaviors;
4. extinction, which involved ignoring attention-
maintained problem behaviors (to address the
attention function), and escape extinction, in
which the child was not allowed to leave the
table until the nonpreferred food was eaten
(to address the escape function);

5. physical redirection, involving gentle redirection
of any occurrence of elopement behavior and
the second occurrence of play behavior (to
address the escape function).
219
Interobserver Agreement
For each participant, two independent data collectors
scored 25% of the videotaped sessions from both baseline
and functional treatment phases. Interobserver agreement
was calculated by dividing the number of intervals of
agreement on the occurrence and nonoccurrence of the
target behavior by the total number of intervals in the
sample and then multiplying by 100. An agreement was
scored when the observers marked the exact same behav-
ior in the exact same interval. The mean interobserver
agreement for Brenda’s refusals was 95.1% (range =
89%-98.6%), play was 86.5% (range = 76.4%-100%),
elopement was 97.7% (range = 95.7%-100%), and expul-
sions was 98.5% (range = 96.9%-100%). The mean agree-
ment for the occurrence and nonoccurrence of bites was
94.6% (range = 91.7%-97%). For Roxy, mean interob-
server agreement was 98.4% for refusals (range = 95.8%-
100%), 98% for elopement (range = 93%-100%), 99.2%
for expulsions (range = 98%-100%), 93.5% for play
(range = 84%-98.9%), and 94.3% for the occurrence and
nonoccurrence of bites (range = 90%-99%). The mean in-
terobserver agreement for David was 93.6% for refusals
(range = 85.3%-100%), 99.9% for expulsions (range =
99.5%-100%), and 89.7% for the occurrence and nonoc-

currence of bites (range = 70%-100%).
Treatment Integrity
Twenty-five percent of each participant’s baseline and treat-
ment sessions were scored for the occurrence of the fol-
lowing treatment components:
(a) contingent attention and preferred food for con-
sumption of the targeted nonpreferred food;
(b) ignoring of refusal and play behaviors;
(c) physical redirection for elopement and play
behaviors; and
(d) differential reinforcement, an average of every
30 seconds, for appropriate eating behavior,
sitting in the chair, and the absence of play.
Contingent reinforcement of the acceptance of the tar-
geted nonpreferred food item was determined if praise and
a bite of preferred food were delivered following the con-
sumption of the target food. Ignoring of refusal and play
behaviors was determined by recording whether attention
followed either behavior, thus indicating an incorrect in-
tervention response on the caregiver’s behalf. The correct
use of physical redirection was determined if assistance
was applied following the occurrence of elopement and/or
play behaviors. Differential reinforcement (DRA-30s) was
calculated by dividing the number of 10 second intervals
in which behavior-specific praise occurred by the total
number of intervals.
Social Validation

Treatment acceptability was assessed via the Treatment
Evaluation Inventory-Short Form (TEI-SF; Kelly, Heffer,
Gresham, & Elliott, 1989), a questionnaire with nine items
rated on a Likert-type scale from 1 to 5. A score of 27 or
greater, out of a total possible score of 45, on the TEI-SF
indicated that the child’s caregiver perceived the treatment
package to be acceptable for treating the child’s mealtime
problem behaviors.
FUNCTIONAL TREATMENT
Figure 2 displays the percentage of occurrence of play and
elopement behaviors for Brenda and Roxy, and Figure 3
displays the percentage of refusal and expulsions for each
meal across baseline and treatment. For Brenda, treatment
resulted in a mean decrease in refusal, elopement, and play
behaviors. Expulsions were low across baseline and treat-
ment. For Roxy, treatment resulted in a decrease of elope-
ment and play behavior, whereas expulsions and refusals
remained low across baseline and treatment phases. For
David, treatment resulted in a &dquo;burst&dquo; of refusal
behavior,
Figure 2. The percentage of play and elopement be-
haviors for Brenda and Roxy across baseline and
treatment sessions.
220
Figure 3. The percentage of refusal behavior and ex-
pulsions for Brenda and Roxy across baseline and

treatment sessions.
which was followed by his parents’ decision to terminate
treatment. Bites per minute increased for both Brenda and
Roxy (see Figure 4). Figure 5 shows an increase in the per-
centage of nonpreferred foods consumed by Brenda and
Roxy.
Brenda
For Brenda, food refusal decreased from a baseline mean of
16.4% to a treatment mean of 7.9% of intervals. Play be-
haviors decreased from 25.6% to 10.6% of intervals. For
expulsions, baseline and treatment means were low (1.3%
and 1.8%, respectively). Elopement remained stable, with a
baseline mean of 10.7% and a treatment mean of 10.1 % of
intervals, respectively. The number of bites per minute
slightly increased from a baseline mean of 2.2 to a treat-
ment mean of 2.6. The percentage of preferred foods con-
sumed slightly increased from baseline to treatment, with
mean rankings of 5.5 (50%-75% of food consumed) and
6.8 (75% of food consumed), respectively. The percentage
of nonpreferred foods consumed increased greatly from
baseline, with a mean ranking of 1.5 (0%-25% consump-
tion), to treatment, with a mean ranking of 9.0 (100% con-
sumption).
ROXV
For Roxy, play behaviors decreased from a baseline mean
of 17.9% to a treatment mean of 6.4% of intervals. Elope-
ment decreased from 14.7% to 1.2% of intervals. Expul-
sions decreased slightly, from 2.4% to 0.8% of intervals.

The percentage intervals of food refusal remained stable,
with a mean of 3.4% in baseline and 3.6% in treatment.
The number of bites consumed per minute increased from
2.0 in baseline to 3.0 in treatment. The percentage of pre-
ferred foods consumed remained stable during baseline
and treatment sessions, with mean rankings of 7.9 and 7.5
(consumption of 75%-100% of food), respectively. The
percentage of nonpreferred foods consumed increased
from baseline, with a mean ranking of 2.6 (0%-75% of
foods consumed per meal), to treatment, with a mean
ranking of 9.0 ( 100% consumption).
Figure 4. The number of bites per minute for
Brenda and Roxy across baseline and treatment
sessions.
221
Figure 5. The caregivers’ rating of the percentage of
preferred and nonpreferred food consumption per
meal for Brenda and Proxy across baseline and
treatment sessions.
David
For David, food refusal increased from a baseline mean of
22.9% to a treatment mean of 79.8% of intervals before
functional treatment was terminated by his parents. Expul-
sions were very low across baseline and treatment ( 1.1% &
0.6% of intervals, respectively). The percentage of preferred
foods that was consumed slightly increased from baseline
to treatment, with mean rankings of 6.7 (consumption of
50%-75%), and 8.5 (consumption of 75%-100%), respec-
tively. The percentage of nonpreferred foods that was con-

sumed increased from baseline, with a mean ranking of
1.4 (consumption of 0%-25% of food), to treatment, with
a mean ranking of 9.0 ( 100% consumption).
. TREATMENT INTEGRITY
For Brenda, data from the baseline videotapes showed that
the caregiver provided behavior-specific praise in 1.8% of
the 10-second intervals. During treatment, differential re-
inforcement for appropriate mealtime behavior was pro-
vided 26% of the 10-second intervals; physical redirection
for elopement was provided 100% of the time it was
needed; and contingent preferred food and praise for eat-
ing the nonpreferred target food was provided 100% of the
time, thus indicating the correct use of these treatment
procedures. On the other hand, physical redirection for
play behaviors was provided approximately 50% of the
time; planned ignoring of play behavior occurred approx-
imately 50% of the time; and attention was provided for
refusals 27% of the time; thus suggesting lower integrity
with these treatment components.
For Roxy, praise was provided in 0% of the 10-second
intervals during baseline. During treatment, contingent
preferred food and praise for the consumption of the non-
preferred target food was provided 100% of the time;
physical redirection for elopement was provided 100% of
the time; and differential reinforcement for appropriate
eating behavior was provided in 24% of the 10-second in-
tervals, thus indicating the correct use of these treatment
components. On the other hand, physical redirection for
play behaviors was provided approximately 50% of the
time; planned ignoring of play behaviors occurred approx-
imately 50% of the time; and attention was provided for

refusal behaviors 33% of the time, thus suggesting lower
integrity for these treatment components.
David’s baseline data indicated that praise was pro-
vided in 1.4% of the 10-second intervals. During treat-
ment, ignoring food refusal occurred 82% of the time. The
use of behavior-specific praise and contingent preferred
food following consumption of the target food was used
correctly. In addition, the escape extinction procedure and
physical assistance was used 100% correctly.
SOCIAL VALIDATION
The caregivers’ total TEI-SF ratings of treatment for Brenda
and Roxy were 41 and 32, respectively, thus suggesting that
the caregivers found treatment to be acceptable for their
children’s behavior problems. Because David did not con-
tinue the study, treatment acceptability ratings were not
available.
Phase 3 evaluated functional treatment packages de-
signed to address each child’s mealtime behaviors, which
were hypothesized from the descriptive assessment to be
maintained by escape and attention. The findings from
222
Phase 3 suggested that a functional treatment package com-
posed of stimulus fading, reinforcement, and extinction
decreased the occurrence of food refusal, elopement, and
play behaviors for Brenda and decreased elopement and
play for Roxy. Treatment also increased the number of
bites per minute and increased the percentage of nonpre-
ferred food consumed for these two participants. In addi-

tion, the extinction burst from David suggested that we
were correct in identifying the maintaining variables for
his behaviors. However, treatment could not be evaluated
fully for David because the parents terminated their par-
ticipation in the study.
Most of the food refusal literature focuses on dealing
with feeding problems on the inpatient unit with the ther-
apist as the change agent. Research has indicated that treat-
ment in a setting other than the natural setting may lead to
difficulties in generalizing the results (Bakken, Milten-
berger, & Schauss, 1993). A few studies in the food refusal
literature have attempted to programfor generalization of
treatment results from inpatient therapists to parents as
therapists and/or from an inpatient setting to the natural
setting (Bernal, 1972; Greer et al., 1991; Handen et al., 1986;
Hatcher, 1979; Ives, Harris, & Wolchik, 1978; Thompson,
Palmer, & Linscheid, 1977), with only one study to date
formally evaluating assessment and treatment in the nat-
ural setting (Werle et al., 1993). Similar to Werle et al., we
assessed the child in the home and had the caregivers im-
plement the treatment package in the home with the fam-
ily present; however, certain problems were evident.
First, although functional treatment was effective in
improving mealtime behavior, treatment effects were some-
what variable. The problem behaviors that occurred at a
low level during baseline (expel for Brenda; expel and re-
fusal for Roxy) did not decrease during treatment, perhaps
because of a floor effect. On the other hand, behaviors that
occurred at a moderate to high level in baseline all de-
creased at least to some extent during treatment. Moderate
treatment integrity may help explain the variable treat-
ment results. During baseline for all participants, little

praise was provided for eating behavior and attention, and
escape usually followed inappropriate behaviors. However,
following intervention, the caregivers maintained above
80% treatment integrity with the provision of praise, approxi-
mately 100% in the use of contingent preferred food and
physical redirection of elopement behaviors, and only ap-
proximately 50% integrity with providing physical redirec-
tion for play behaviors and ignoring refusal and expulsion
behaviors. Overall, a moderate level of treatment integrity
was maintained when we were present to provide feedback
and guidance. Needless to say, there could have been inade-
quate treatment integrity in our absence, thus influencing
the consistency of the treatment effect on the behavior.
Poor integrity with the intervention for play behaviors
may have resulted from the relative level of importance of
the behavior to the caregivers. For example, two of the
caregivers indicated that the play behaviors were not as im-
portant as the child eating. This may be why the caregivers
were not as diligent with the interventions designed for
play behaviors. Second, the topography of play behavior
was variable and difficult to observe and record. For exam-
ple, play behaviors of the two participants were occasion-
ally subtle, which was demonstrated by the child sucking
on the spoon after taking a bite of food. Not only were
there problems with the integrity of treatment with play
behavior but as mentioned earlier, there was also a lower
interobserver agreement on the occurrence of play behav-
ior. Behaviors such as play also influenced the determina-
tion of the onset and offset of bites, thus leading to lower
agreement on this behavior as well. Scoring the occurrence
of bites was typically more accurate when the caregiver de-
livered each bite of food.

A second problem evident when conducting treat-
ment in the natural setting was that it was more difficult to
control extraneous factors, such as the participant’s inter-
action with a sibling, when the entire family was present.
In addition, providing immediate feedback on his or her
performance during a family meal was difficult and often
discouraged by the caregiver. Therefore, we relied on writ-
ten and verbal instruction prior to and following the ses-
sion, as well as modeling during the session, in order to
train the caregivers in the correct use of the procedures.
A third problem with conducting treatment in the
natural setting dealt with the occurrence of more severe re-
fusal behavior due to the stimulus control of the caregivers
and others present, as well as stimulus control of the set-
ting itself. The possibility of stimulus control was an im-
portant consideration for David’s results. Implementation
of functional treatment for David resulted in an extinction
burst. This burst of refusal behavior involved high levels of
crying, screaming, asking to leave, and squirming in his
seat in an attempt to leave the table, which occurred for ap-
proximately 90 minutes during both treatment sessions.
Intervention for this behavior required the use of a physi-
cal assistance procedure to keep David in his seat, thus not
allowing him to escape the meal. In addition, the &dquo;non-
removal of the spoon&dquo; (escape extinction) procedure was
used to eliminate the avoidance of swallowing a bite of
nonpreferred food. This procedure involved holding an ex-
tremely small portion (the size of a pencil eraser) of the
most acceptable nonpreferred food (stimulus fading) to
David’s lips until acceptance of the bite. Although the care-
givers reported that they were prepared for the burst, in re-
fusal behavior, it seems they did not comprehend the
potential severity of the behavior because when they were
faced with dealing with this intense behavior, they opted to

terminate treatment. Therefore, we were not able to evalu-
ate the results of functional treatment for this participant.
In hindsight, we have to ask what we could have done
differently to deal with these events. Functional treatment
could have been partially evaluated by excluding the escape
223
extinction procedure and by relying on the stimulus fading
procedure with the contingent attention and preferred
foods. However, David’s behaviors frequently resulted in
escape; thus these procedures alone were not likely to be
effective. Lastly, inpatient treatment may have been recom-
mended in order to eliminate the effects of stimulus con-
trol of the environment and the caregiver and to be better
equipped to deal with the extinction burst. One question
raised by this study is, &dquo;Did David’s mealtime behavior
warrant the necessity of an intensive intervention for food
refusal?&dquo; This question broaches some of the theoretical
is-
sues resulting from this study. Two out of the three fami-
lies in this study believed that treatment was acceptable
and that the results were beneficial. However, for the third
family, it is not clear in retrospect that David’s behavior
problems and lack of intake and variety were severe enough
to warrant the more restrictive intervention.
General Discussion
This study addressed some of the gaps in the food re-
fusal literature by evaluating functional assessment and

preference assessment methodologies with inappropriate
mealtime behaviors, by examining the results of brief
functional treatment on three typical children’s mealtime
behaviors in the natural setting with the caregivers as the
change agents, and by gathering treatment integrity and
treatment acceptability data. In this investigation, treat-
ment improved some target behaviors while leaving others
unaffected. Eating behaviors improved for all children
(more nonpreferred foods consumed, more bites per
minute), and some problem behaviors decreased for Roxy
and Brenda, who both completed the study. A floor effect
may have been responsible for the lack of improvement in
the other target behaviors. That is, the behaviors that were
already low in baseline were the ones that did not decrease
further. The behaviors that were occurring at a moderate
to high level all decreased with treatment.
This study has produced a number of important find-
ings :
1. Direct observation of food refusal behaviors
resulted in functional hypotheses that yielded
higher confidence ratings and interobserver
agreement than interview and questionnaire
methods.
2. A stimulus preference assessment was able to
identify preferred foods that could function as
reinforcers.
3. A stimulus avoidance assessment was helpful in
developing a hierarchy of the level of acceptabil-
ity of the nonpreferred foods that were to be
used as the target stimuli for treatment.

4. A functional treatment package implemented
by the caregivers, with moderate treatment
integrity, in the natural setting was effective in
decreasing the occurrence of play and elopement
behaviors, increasing the number of bites per
minute and increasing the percentage of non-
preferred food consumed for the two partici-
pants who continued in the study.
5. The treatment acceptability results suggested
that the caregivers found the treatment package
to be acceptable for the two participants who
continued in the study.
In addition, the results of treatment provided support for
the hypotheses developed from the descriptive assessment.
However, because a functional analysis was not conducted,
the results do not rule out other potential maintaining
factors.
Further research on the function of inappropriate
feeding behavior is warranted in order to reduce the nega-
tive influence on the family during meals and to facilitate
the learning of appropriate and adaptive eating behavior.
Emphasis should be placed on conducting rigorous exper-
iments to ascertain the various factors influencing and
maintaining these behaviors, as well as conducting com-
ponent analyses to evaluate individual treatment compo-
nents. Likewise, more dismantling and constructive
treatment evaluations should be conducted to determine
essential treatment components. Results from rigorous
treatment evaluations, functional assessments, and func-
tional analyses can facilitate the determination of neces-

sary treatment components, hence increasing treatment
efficiency and decreasing unnecessary treatment duration.
ABOUT THE AUTHORS
Tami L. Galensky, MS, is an applied behavior analysis coor-
dinator for the St. Louis County Special School District in St.
Louis, MO. Her interests include teaching language and other
functional behaviors to children with autism. Raymond G.
Miltenberger, PhD, is a professor of psychology at North
Dakota State University with research interests in the func-
tional assessment and treatment of problem behaviors. Jason
M. Stricker, MS, is a behavior analyst at Arlington Develop-
mental Center in Arlington, TN. His research interests are in
the analysis and treatment of difficult behaviors of individu-
als with developmental disabilities. Matthew A. Garling-
house, MS, is a psychologist at Southeast Human Service
Center in Fargo, ND. He has interests in behavioral interven-
tions for persons with developmental disabilities. Address:
Raymond G. Miltenberger, Department of Psychology, North
Dakota State University, Fargo, ND 58105. e-mail: ray-
[email protected] nodak. edu
AUTHORS’ NOTE
This study was conducted as a thesis by the first author. We
thank Rebecca Johnson, John Rapp, and Vicki Lumley for
their assistance in data collection.
224
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Action Editor: Robert L. Koegel

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