Using Graduated Exposure and Differential Reinforcement to Increase Food Repertoire in a Child with Autism

Food selectivity is often seen in children with autism spectrum disorder and can lead to severe nutritional deficiencies. Food selectivity can be specific to food texture, colour, shape, presentation, type, brand or container. Often food selectivity is treated using escape extinction in conjunction with other procedures, which can be challenging to implement for the therapist or caregiver, aversive for the child, and requires adequate supervision from a professional to ensure fidelity of the procedure. A preference assessment, parent interview and food journal determined the child's food repertoire consisted of four different foods in total (pasta, fish crackers, dry cereal and yogurt), and the child was selective by brand, texture, temperature and utensil requirement. A 12-step graduated exposure food hierarchy was constructed, the child was lead through the hierarchy, and parent training was implemented for generalization. After 9 months of treatment, the participant's food repertoire increased from four items to more than 50 items. Additionally, food refusal behaviour decreased to rates of zero during intervention and parents report significant decreases in mealtime behaviour at home. The importance of using an alternative strategy to escape extinction for treating food selectivity in children with autism spectrum disorder will be discussed.