The role of re-presentation in the treatment of liquid expulsion

Children with feeding difficulties often engage in expulsion (i.e., spitting out) of liquid. Expulsion is problematic because it limits the volume of liquid that a child will consume. Researchers have used re-presentation as an embedded component of escape extinction to treat expel. Although studies have demonstrated that re-presentation can effectively reduce expel, it is unclear whether it should always be included with escape-extinction-based treatments. We describe a program evaluation project designed to examine the effects of re-presentation on liquid expulsion for children with severe feeding difficulties. We conducted a prospective consecutive controlled case series to compare the effects of a function-based treatment with and without re-presentation and reported on the outcomes obtained for 17 children. Various patterns of responding emerged across participants. However, re-presentation resulted in the greatest increases in mouth clean (i.e., swallowing) and lowest levels of expel for 10 participants. We discuss implications for research and practice.