Initial Reaction to the Intervention
Upon the first consideration of the intervention used by Vaz, Volkert & Piazza (2011), the initial reaction was the effect of the intervention on the nutritional status of the child and behavior modeling. Concerning the child’s nutritional status, the concern is that the negative reinforcement through the avoidance of non-preferred foods resulted in the inadvertent positive reinforcement through the presentation of preferred foods. If the preferred foods cannot provide a balanced diet, then the use of the intervention can have counterproductive results. With regards to behavior modeling, the concern is that the child might enjoy the attention of the adult more than the other planned activities. This might result in the development of challenging behaviors during meal times (Bachmeyer, 2009). The conditional access to preferential food which amounts to positive reinforcement might shape and maintain the inappropriate behavior of the child when presented with meals (Bachmeyer, 2009). Additionally, the coercive introduction of food into the child’s mouth does not inspire good ethical judgment.
Opposition to the Intervention
In opposing the intervention, the enduring concern is the effect of the intervention, particularly the positive reinforcement on the behavior modeling of the child, and the probable occurrence and reinforcement of challenging mealtime behaviors. This concern is informed by the findings by Bachmeyer (2009) who found that the setting conditions for the child to get preferential foods might aid the development and maintenance of challenging mealtime behaviors. These findings are also corroborated by Borrero et al., (2010) who found through the descriptive analysis of the conditional probabilities of avoidance and the attention related to interventions for refusal to eat that the refusal to eat was the most prevalent predecessor for attention and escape.
The refusal to eat gained the child some adult attention through sustained attempts to get them to eat. Escape got the child, even more, attention from the adult. The resultant positive reinforcement can have undesired effects through the development of challenging behavior during mealtimes. There is also the ethicality of the intervention approach, especially the coercive introduction of food into the child’s mouth. It is arguable that this approach is in contravention of the justice principle of ethical decision making, where the treatment of people who are reported with eating disorders requires the use of interventions that have the least restrictive measures while ensuring the safety and promoting positive outcomes (Matusek & Wright, 2012). The use of avoidance prevention strategies during the intervention has been reported to stimulate challenging behaviors (Ricciardi, Luiselli & Camare, 2006).
Supporting the Intervention
There is evidence that the paired choices approach coupled with negative reinforcement could be effective to aid self-feeding in the child. Firstly, Vaz, Volkert & Piazza (2011) reported that the manipulations effectively helped to increase the self-feeding behavior of the child. A study by O’Reilly, Lancioni & Sigafoos (2004) where a paired choice assessment was used to determine the factors that maintained sleeping difficulties in a child showed that the use of sleeping scheduling paired with an attention resulted in a decrease in one of the manifestations of the sleeping difficulties. This is an indication of the effectiveness of the paired choices intervention to achieve the desired effect.
Reflection
Even after the objective review of the supporting and opposing sides, the initial concerns regarding the possible effects of the intervention and the ethicality of some of its approaches remain unchanged. While reporting the success of their intervention, Vaz, Volkert & Piazza (2011) relayed the limitation that they did not prove the necessity of the quality manipulations and response efforts. There is also an enduring concern regarding the appropriateness of the approaches from a justice ethics perspective considering that for the marginal success in improving self-feeding, there is a real potential for the development of challenging behaviors during meal times.
References
Bachmeyer, M. (2009). Treatment of selective and inadequate food intake in children: A review and practical guide. Behavior Analysis in Practice, 2(1): 43-50.
Borrero, C., Woods, J., Borrero, J., Masler, E. and Lesser, A. (2010). Descriptive analyses of pediatric food refusal and acceptance. Journal of Applied Behavior Analysis, 43(1): 71- 88.
Matusek, J. and Wright, M. (2012). Ethical Dilemmas in Treating Clients with Eating Disorders: A Review and Application of an Integrative Ethical Decision-making Model. Retrieved from http://www.marshall.edu/psych/files/2012/06/Eating-Disorders.pdf
O’Reilly, M., Lancioni, G. and Sigafoos, J. (2004). Using paired-choice assessment to identify variables maintaining sleep problems in a child with severe disabilities. Journal of Applied Behavior Analysis, 37(2): 209-212.
Ricciardi, J., Luiselli, J. and Camare, M. (2006). Shaping approach responses as intervention for specific phobia in a child with autism. Journal of Applied Behavior Analysis, 39(4): 445- 448.
Vaz, P., Volkert, V., and Piazza. C. (2011). Using Negative Reinforcement to Increase Self- Feeding in a Child with Food Selectivity. Journal of Applied Behavior Analysis. 44(4): 915-920.
