On the Efficacy of Treating Escape-Maintained Inappropriate Mealtime Behaviour with and Without Escape Extinction: A Meta‐Analysis of Escape‐Based Interventions

Abstract

It is estimated that approximately 70% to 89% of children with developmental disabilities and 20% to 50% of neurotypical children exhibit some type of feeding challenge. Inappropriate mealtime behaviour (IMB) is a type of feeding challenge within the broader class of food refusal behaviour. Although there have been some single-case studies examining the extent to which behavioural interventions can aide in reducing IMB, the relative efficacy and generality of these studies is unclear. The purpose of this systematic review was to evaluate the available literature to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of single-subject experimental designs. Through a systematic search of the extant literature, we identified 38 studies involving 307 cases in which IMB was treated with a behavioural intervention. We coded descriptive data and calculated log response ratio as an effect size measure of the efficacy of these interventions. Results indicated that combined escape extinction and non-escape extinction interventions had greater effect sizes than escape extinction alone or non-escape extinction alone. Escape extinction alone had greater effects sizes compared to non-escape extinction; however, escape extinction resulted in a higher percentage of negative side effects than interventions in which escape extinction was combined with non-escape extinction interventions or to non-escape extinction interventions alone. We suggest that escape extinction should not be used as the sole intervention for IMB, rather, in cases where IMB warrants a behavioural intervention, a combination of escape extinction and non-escape extinction interventions should be used.