Journal of Applied Behavior Analysis 2020, 9999, 1–22 NUMBER 9999 ()

Treating food selectivity as resistance to change in children with

autism spectrum disorder
Jaime G. Crowley, Kathryn M. Peterson, Wayne W. Fisher and
Cathleen C. Piazza
University of Nebraska Medical Center’s Munroe-Meyer Institute

Change-resistant behavior, such as rigid and selective food consumption, is a core symptom of
autism that can have significant negative consequences for the child (Flygare Wallén et al.,
2018; Levy et al., 2019). In the current study, we used a matching-law-based intervention
(Fisher et al., 2019) to treat the change-resistant feeding behavior of 7 young children with
autism. The feeder gave the participant a choice between a change-resistant and an alternative
food during free- and asymmetrical-choice conditions. Alternative-food consumption increased
for 2 participants during asymmetrical choice when the feeder provided a preferred item for con-
suming the alternative food and no programmed consequence for consuming the change-
resistant food. Alternative-food consumption increased for the other 5 participants after the
feeder exposed at least 1 food to single choice in which the feeder guided the participant to put
the bite of alternative food in his or her mouth if he or she did not do so within 8 s of presenta-
tion. Effects of the single-choice contingencies maintained during reversals and generalized to
other alternative foods the feeder did not expose to single choice. These results are important
because participants consumed alternative foods even when their change-resistant foods were
present, which is similar to typical mealtime contexts in which children have choices among
foods.
Key words: autism, avoidant/restrictive food intake disorder, food selectivity, resistance to
change

According to the Centers for Disease Con- symptoms improve (Joseph et al., 2013; Richler
trol and Prevention, 1 in 59 children in the et al., 2010). relevância social

United States is diagnosed with autism spec-
trum disorder (Baio et al., 2018). Resistance to
change, characterized by emotional outbursts in
response to even small environmental changes,
is a core symptom of autism that occurs fre-
quently in many contexts and stays the same or
worsens without intervention, even when other
Jaime G. Crowley is now at The May Institute.
Kathryn M. Peterson is now at Children’s Specialized
Hospital. Wayne W. Fisher is now at Children’s Special-
ized Hospital–RUCARES and Rutgers Robert Wood
Johnson Medical School. Cathleen C. Piazza is now at
Children’s Specialized Hospital and Rutgers Graduate
School of Applied and Professional Psychology.
Jaime G. Crowley conducted this study in partial fulfill-
ment of the requirements for the degree of Doctor of Phi-
losophy from the University of Nebraska Medical Center.
Address correspondence to: Kathryn Peterson,
17 Cypress Rd. Somerset, NJ 08873. Email: Kathryn.
peterson1@rutgers.edu
doi: 10.1002/jaba.711
© 2020 Society for the Experimental Analysis of Behavior
1
Effective intervention for change-resistant
behavior is important because life can be
unpredictable, preventing change is nearly
impossible, and change-resistant behavior can
have significant short- and long-term negative
consequences (Fisher et al., 2019; Flygare
Wallén et al., 2018; Freedman et al., 1999;
Kamal Nor et al., 2019; Levy et al., 2019).
Children with autism frequently demonstrate
change-resistant behavior at mealtime, such as
insistence on eating the same few unhealthy
foods or engaging in rigid mealtime routines
(Bandini et al., 2010; Cermak et al., 2010;
Heifert et al., 2016; Levin & Carr, 2001; Post-
orino et al., 2015; Schreck & Williams, 2006;
Sharp et al., 2018; Silbaugh et al., 2018).
Hyman et al. (2012) found that children with
autism did not meet recommended intake of
certain nutrients (e.g., Vitamins D, C, E, and
2 Jaime G. Crowley et al.
K), choline, fiber, phosphorus, potassium, and
some children consumed excessive sodium.
The selective diets of children with autism
often consist primarily of processed junk foods
that are low in nutritional content and high in
fat, salt, and sugar (e.g., French fries and
cookies; Bandini et al., 2010). Selective diets
with poor nutritional content can cause further
impairments in behavioral and cognitive func-
tioning, and unhealthy weight gain, which
increases the risk for severe health problems
(e.g., obesity, Type-2 diabetes, and hyperten-
sion; Freedman et al., 1999; Ludwig et al.,
1999). In fact, the prevalence of obesity and
diabetes among individuals with autism, and
the prevalence of hypertension in males with
autism is higher than that of typically develop-
ing peers, which is alarming given the signifi-
cant negative health consequences of these
diseases (Flygare Wallén et al., 2018; Levy
et al., 2019). Children with autism and
change-resistant feeding behavior may also
engage in inappropriate mealtime behavior
(e.g., aggression, crying, pushing food away,
self-injury, spitting food out, and vomiting),
which may discourage the caregiver from
attempting to change the child’s diet (Borrero
et al., 2016; Borrero et al., 2010; Piazza, Fisher
et al., 2003).
Despite the potential negative consequences
of change-resistant behavior, few studies have
evaluated interventions for resistance to change
specifically. In a notable exception, Fisher et al.
(2019) treated the change-resistant behavior of
four participants with autism using a
concurrent-operants arrangement and the con-
ceptual, but not mathematical, framework of
the generalized matching law. Two participants,
Kurt and Glenn (Experiment 2), refused to
wear seasonally appropriate clothing during the
winter and engaged in problem behavior
(e.g., aggression) when prompted to do so. The
alternative responses were wearing long pants
for Kurt and wearing a hat and gloves for
Glenn. During the free- and asymmetrical-
choice conditions, the researcher presented a
choice between the change-resistant and alter-
native responses, which were shorts and long
pants for Kurt, respectively, and pictures of
Glenn not wearing and wearing a hat or gloves,
respectively. Choosing either produced 20 s of
access to a moderately preferred item in the
free-choice condition. Choosing the change-
resistant response produced no differential con-
sequence and choosing the alternative response
produced 20 s of access to the participant’s
most preferred item during the asymmetrical-
choice condition. During the singular-choice
condition, the researcher (a) only presented the
alternative response, (b) guided the participant
to choose the alternative response if he did not
do so independently, and (c) gave the partici-
pant his most preferred item for 20 s after the
participant chose or the researcher guided the
alternative response. The researcher removed
the preferred item if Kurt attempted to remove
the pants or if Glenn attempted to remove the
hat or gloves.
Fisher et al. (2019) hypothesized that
change-resistant behavior persists because chil-
dren with autism have difficulty predicting and
controlling events in their environment
(Gomot & Wicker, 2012). Results of fMRI
studies suggest that children with autism
respond differently to novel stimuli (Gomot
et al., 2011; Gomot & Wicker, 2012), which
may cause unexpected changes to be aversive
and may increase the probability of avoidant
behavior (Fisher et al.). Repeatedly engaging in
change-resistant behavior increases the proba-
bility of predictable consequences and allows
the child to avoid the unpredictable conse-
quences of an alternative behavior. Fisher et al.
proposed that predictable consequences and
avoidance of unpredictable consequences func-
tion as automatic reinforcement for change-
resistant behavior.
Fisher et al. (2019) suggested that Kurt and
Glenn chose the change-resistant response
exclusively during the free-choice condition
 Food Selectivity As Resistance To Change
because it produced higher quality automatic
reinforcement (i.e., predictable consequences,
avoidance of unpredictable consequences).
During the asymmetrical-choice condition, the
value of automatic reinforcement for the
change-resistant response outweighed the value
of the reinforcer for the alternative response for
Kurt, who continued to allocate responding
exclusively to the change-resistant response.
Presumably, the value of the reinforcer for the
alternative response competed with that of the
change-resistant response for Glenn; alternative
responses increased but did not maintain at
clinically acceptable levels over time. The pur-
pose of the singular-choice condition was to
expose participants to the alternative response
and its consequences. Alternative responses
increased to 100% during the singular-choice
condition for both participants. Fisher et al.
hypothesized that repeated exposure to the con-
sequences of the alternative response during the
singular-choice condition increased the predict-
ability of the consequences and eliminated the
participants’ avoidant responses because the
consequences of the alternative response were
no longer unpredictable.
Like Fisher et al. (2019), we hypothesized
that the food selectivity in children with autism
may be maintained by automatic reinforcement
(i.e., the predictable consequences of consum-
ing certain foods versus others). Thus, the cur-
rent study replicated and extended Fisher et al.
by (a) giving participants with autism and food
selectivity a choice between consuming change-
resistant and alternative foods in a concurrent-
operants arrangement during free- and
asymmetrical-choice conditions, (b) giving par-
ticipants their most preferred item for consum-
ing alternative foods during the asymmetrical-
choice condition, (c) repeatedly exposing partici-
pants to alternative foods and their consequences
during the single-choice condition if consump-
tion of alternative foods did not increase during
the asymmetrical-choice condition, (d) using a
multiple baseline across foods design to assess
3
whether the intervention generalized to non-
targeted alternative foods, and (e) using a rever-
sal design to assess whether consumption of
alternative foods maintained in phases of the
asymmetrical-choice condition that followed
phases of the single-choice condition.
Method
Participants
The inclusion criteria for the current study
were (a) a diagnosis of autism spectrum disor-
der via best clinical estimate, (b) a diagnosis of
avoidant/restrictive food intake disorder based
on the Diagnostic Statistical Manual (5th ed.)
criteria (American Psychiatric Association,
2013), (c) age (between the ages of 2 and
8 years), (d) regular consumption of between
3 and 20 foods, based on caregiver report,
(e) consumption of at least 90% of caloric
needs by mouth and no dependence on supple-
mental nutrition (e.g., gastrostomy tube), (f)
weight for height greater than the 5th percentile
(i.e., no growth failure), and (g) safe oral feed-
ing, per physician report. Before enrollment in
the study, a behavior analyst or licensed psy-
chologist interviewed the caregiver about the
participant’s current and past feeding behavior
and medical history, measured and recorded
height and weight, conducted direct observa-
tions of the participant’s chewing skills with
table-texture foods, and excluded participants
who did not demonstrate safe and appropriate
chewing skills.
Study enrollment lasted approximately
20 months between summer 2017 and spring
2019, during which the program admitted
52 children. Most children did not meet study
inclusion criteria because they (a) did not have
a diagnosis of autism spectrum disorder,
(b) were dependent on supplemental nutrition
or did not meet their caloric needs by mouth,
(c) did not have the appropriate chewing skills
to consume table-texture foods, or (d) had a
combination of these factors. Four children
4 Jaime G. Crowley et al.
met the study inclusion criteria and enrolled in
but did not complete the study for the follow-
ing reasons: caregivers of two children with-
drew consent before study initiation, caregivers
of one child did not respond to schedule study
appointments, and one child began swallowing
bites of unmasticated food after the study initi-
ation (i.e., safety concern).
Five males and two females met the inclusion
criteria and completed the study. Six participants
received a diagnosis of autism from a university-
based clinic and one received a diagnosis from a
school psychologist with confirmation from a
psychiatrist. All of the participants ate a few
fruits, most of the participants ate a few proteins
and starches (mostly processed foods such as
macaroni and cheese), all but one of the partici-
pants refused vegetables, all but one of the par-
ticipants engaged in inappropriate mealtime
behavior (e.g., head turns and pushing the spoon
away when caregivers presented novel foods),
four of the participants engaged in other rigid
mealtime routines, and all of the participants
engaged in change-resistant behavior
(e.g., ritualistic play) outside of mealtime.
Setting, Materials, Feeders, and Observers
Feeders conducted sessions at a university-
based medical center in a session room in a
pediatric feeding disorders clinic or in an early
intervention classroom. Session materials
included child-specific reinforcers, computers
for data collection, food scales, a table and
chairs, colored tablecloths for the asymmetrical-
and single-choice conditions, timers, video
cameras, and video-recording computer soft-
ware. Participants used either age-appropriate
(e.g., booster chair) or weight-appropriate seat-
ing that maintained their safety (e.g., Special
Tomato Chair), and age-appropriate utensils
(e.g., toddler forks and spoons). Feeders and
observers were trained therapists with Bache-
lor’s or Master’s Degrees in applied behavior
analysis, psychology, or a related field.
Response Measurement
The primary dependent variable was con-
sumption of alternative foods. Trials with con-
sumption were ones in which the participant
chose the alternative food and had a clean
mouth. Observers used a computer to score
responses on a modified Excel spreadsheet.
Observers scored the occurrence of a choice up
to one time for each trial if the participant
placed a bite inside his or her mouth within 8 s
of presentation. Observers scored whether the
participant chose the change-resistant or alter-
native food during free- and asymmetrical-
choice conditions, and whether the participant
chose the alternative food during the single-choice
condition. Observers scored mouth clean up to
one time for each trial when no food larger than a
grain of rice was in the participant’s mouth 30 s
after the bite entered the mouth, not including
when no food was in the mouth because the par-
ticipant expelled (spit out) the bite. From this
point forward, consumption refers to trials in
which the participant both chose the alternative
food and had a clean mouth. Observers also
scored consumption in the guided-choice condi-
tion if Genevieve deposited the bite inside her
mouth from the point at which the feeder
guided her hand with the spoon. The first
author calculated percentage of alternative-food
consumption by examining the data for each
session, counting the trials in which both a
choice and a mouth clean occurred for the
alternative food, dividing the number of trials
with choices and mouth clean of the alternative
food by the number of trials in the session, and
converting the ratio to a percentage.
Reliability and Intervention Integrity
Secondary observers collected data in a
room equipped with one-way observation
and two-way communication adjacent to the
session room and one early intervention
classroom. On some occasions, observers col-
lected data while seated next to the
 Food Selectivity As Resistance To Change
participant and feeder in an early interven-
tion classroom. A second observer indepen-
dently scored 33% (range, 15% to 50%) of
sessions across participants, foods, condi-
tions, and sessions to assess interobserver
agreement for choices and mouth clean.
An agreement for choice occurred if both
observers agreed the participant made a choice
and agreed on which food the participant
chose, or both observers agreed the participant
did not make a choice. An agreement for
mouth clean occurred if both observers agreed
a mouth clean occurred and agreed for which
food the participant had a mouth clean or both
observers agreed a mouth clean did not occur.
The first author calculated interobserver agree-
ment for choice and mouth clean by dividing
the number of trials with an agreement by the
total number of trials for each session, calculat-
ing the mean across sessions, and converting
the ratio to a percentage. Mean interobserver
agreement for choice was 100% for Steven,
99% (range, 80% to 100%) for Titus, 86%
(range, 0% to 100%) for Alfonzo, 98% (range,
80% to 100%) for Zachary, 97% (range, 80%
to 100%) for Micah, 98% (range, 20% to
100%) for Kelsey, and 98% (range, 40% to
100%) for Genevieve. Mean interobserver
agreement for mouth clean was 100% for Ste-
ven, 98% (range, 60% to 100%) for Titus,
91% (range, 0% to 100%) for Alfonzo, 97%
(range, 40% to 100%) for Zachary, 99%
(range, 80% to 100%) for Micah, 98% (range,
0% to 100%) for Kelsey, and 98% (range, 0%
to 100%) for Genevieve.
Interobserver agreement was below 80% for
choice in one session for Kelsey and three ses-
sions for Genevieve. Interobserver agreement
was below 80% for mouth clean in one session
for Titus, one session for Zachary, one session
for Kelsey, and four sessions for Genevieve.
Interobserver agreement was below 80% for
consumption, meaning both choice and mouth
clean in the same session for four sessions for
Alfonzo, one session for Kelsey, and one session
5
for Genevieve. Low interobserver agreement
occurred most often when the primary and sec-
ondary observers were viewing the session from
different locations (e.g., the feeder was the pri-
mary observer and was in the early intervention
classroom and the second observer was in the
adjacent observation room), and the secondary
observer was not able to discriminate between
the change-resistant and alternative foods. The
first author conducted periodic retraining with
the observers when reliability was below 80%
for more than one session. During retraining,
the first author reviewed operational defini-
tions, modeled data collection, watched the
observer practice data collection, and ensured
reliability for practice sessions was 80% or
above before the observer could resume study
data collection.
The Excel spreadsheet calculated percentage
of alternative-food consumption for 100% of
participants, foods, conditions, and sessions to
assess interobserver agreement. A secondary
author compared the first author’s and the
Excel spreadsheet’s calculations for percentage
of alternative-food consumption for 33% of
sessions for each participant. An agreement
occurred when the first author and the Excel
spreadsheet calculated the same value for per-
centage of alternative-food consumption for a
session. A disagreement occurred when the first
author and the Excel spreadsheet calculated a
different percentage of alternative-food con-
sumption for a session. The author then
divided the total number of sessions with an
agreement by the total number of sessions used
for reliability and converted to a percentage.
Interobserver agreement was 100% for Zachary
and Micah, 96% for Steven, 97% for Titus,
Alfonzo, and Kelsey, and 98% for Genevieve.
Observers scored correct intervention integ-
rity if the feeder implemented all major proto-
col steps correctly or incorrect intervention
integrity if the feeder made an error on any
step. The major steps of the protocol changed
depending on the condition but generally
6 Jaime G. Crowley et al.
included assessment of: a presession-rule state-
ment; bite presentation; prompts; reinforcer
placement; consequences for choices, mouth
clean, expulsion, packing, and inappropriate
mealtime behavior; implementation of hand-
over-hand guidance and nonremoval of the
spoon; and re-presentation of expelled bites.
Observers scored intervention integrity for
47% of sessions across participants. Mean
integrity was 99% (range, 80% to 100%) for
Steven, 99% (range, 80% to 100%) for Titus,
100% for Alfonzo and Zachary, 98% (range,
75% to 100%) for Micah, 99% (range, 40%
to 100%) for Kelsey, and 98% (range, 40% to
100%) for Genevieve. The criterion for correct
implementation of nonremoval of the spoon
required the feeder to keep the utensil touching
the participant’s lips, independent of the rate of
inappropriate mealtime behavior. Lower levels
of intervention integrity occurred primarily
when the participant had high rates of inappro-
priate mealtime behavior (e.g., head turns).
Although the feeder kept the utensil close to
the lips, the utensil was not touching the par-
ticipant’s lips. Intervention integrity was below
80% in one session for Micah and Kelsey, and
two sessions for Genevieve. The first author
conducted periodic observations with immedi-
ate feedback throughout the study and pro-
vided retraining when intervention integrity
was below 80% for more than one session.
During retraining, the first author reviewed and
modeled the protocol, role-played with the feeder,
observed the feeder conducting the protocol with
the participant, and immediately checked the
intervention-integrity data to ensure it was 80%
or above before the feeder conducted the protocol
without the first author present.
General Procedure
Participants came to the clinic for the study
2 to 5 days per week for one to four meals per
day. The total number of meals per week was
10 for Steven, Micah, and Kelsey, 20 for Titus,
four for Alfonzo, and five for Zachary and Gen-
evieve. Each meal was between 40 to 45 min
and consisted of multiple, five-trial sessions
with a 1- to 2-min break between each session.
The number of sessions per day depended on
the participant’s schedule and behavior during
each session. Mean number of sessions per day
was 13 for Steven, 12 for Titus, nine for
Alfonzo, eight for Zachary, Micah, and Kelsey,
and 10 for Genevieve.
The feeder presented one food in each ses-
sion of the preassessment, one change-resistant
food and one alternative food in each session of
the free- and asymmetrical-choice conditions,
and one alternative food in each session of the
single-choice condition. The feeder presented
one bite per trial in the preassessment, one
change-resistant bite and one alternative bite
per trial in the free- and asymmetrical-choice
conditions, and one alternative bite per trial in
the single-choice condition. The size of each
bite was 0.6 cm by 0.6 cm by 0.6 cm, except
as described in the preassessment of the
change-resistant foods. Data from previous
studies suggest that food variety and consump-
tion can be increased safely and effectively
using this bite size (Peterson et al., 2019; Peter-
son et al., 2016). Before the study, caregivers
selected four alternative foods for each partici-
pant. Alternative foods were baked beans, broc-
coli, sandwich (deli meat, lettuce, bread), and
strawberry for Steven; chicken, green beans,
peas, and potato for Titus; avocado, cauli-
flower, chicken, and potato for Alfonzo;
chicken, corn, green beans, and lasagna for
Zachary; baked beans, peas, pineapple, and
white rice for Micah; green beans, peas, potato,
and yam for Kelsey; and carrot, cheese, pan-
cake, and pear for Genevieve.
The feeder stated the contingencies before
each session (see below in intervention evalua-
tion). The feeder started each trial by pre-
senting each bite on a utensil in a bowl within
arm’s reach of the participant approximately
every 30 s. The feeder provided praise
 Food Selectivity As Resistance To Change
(e.g., “Good job taking a bite”) for participant
choices. The feeder removed the bowl(s) after
the participant placed the bite in his or her
mouth, set a timer for 30 s, and conducted a
mouth check when 30 s elapsed by saying,
“Show me aah” and examining the contents of
the participant’s mouth. The feeder provided
praise for mouth clean or said, “Swallow your
bite” if food larger than a grain of rice was in
the participant’s mouth at the mouth check.
The feeder started the next trial after the mouth
check. The bite size was small enough that a
participant could have five bites in his or her
mouth simultaneously without compromising
his or her safety (i.e., the size of five 0.6-cm by
0.6-cm by 0.6-cm bites is smaller than the size
of one bite a child the same age as study partic-
ipants would typically consume). After the fifth
trial, the feeder conducted mouth checks every
30 s if food larger than a grain of rice was in
the participant’s mouth until no food larger
than a grain of rice was in the participant’s
mouth. No participant held food in his or her
moth longer than two 30-s intervals after the
fifth trial. The feeder did not provide any dif-
ferential consequences for coughing, gagging,
negative vocalizations, or vomiting.
Preassessment
Preference Assessment. Therapists con-
ducted a paired-stimulus preference assess-
ment to identify the participants’ most
preferred items (Fisher et al., 1992). Edible
items used in the preference assessment did
not constitute a large portion of the partici-
pants’ daily diets based on caregiver-recorded
3-day food logs. The most preferred item was
an iPad for Steven, Kelsey, and Genevieve;
Skittles for Titus, Alfonzo, and Micah; and
Hot Cheetos for Zachery. Participants did
not have free access to their preferred items
between sessions. The therapist asked care-
givers to restrict access to the items at home;
however, we did not assess compliance with
this request.
7
Preassessment of Change-Resistant
Response. Caregivers identified change-
resistant foods for their child. Children with
change-resistant feeding behavior often refuse
preferred foods presented in a format that is
different from that which they typically eat the
food (e.g., pizza cut into small pieces versus a
pizza slice). Therefore, we conducted an assess-
ment to ensure that participants would con-
sume the caregiver-identified change-resistant
foods in the study’s presentation format, which
was a 0.6-cm by 0.6-cm by 0.6-cm bite. The
purpose of presenting the change-resistant food
in this format was to equate the size of the
change-resistant and alternative bites during the
study.
The conditions of the assessment were a
free-operant presentation with a fixed-time pre-
sentation and bite-size fading to a 0.6-cm by
0.6-cm by 0.6-cm bite. If the participant con-
sumed at least 60% of the change-resistant food
in one condition, the feeder presented the food
in the next condition. If the participant con-
sumed 59% or less of the change-resistant food
in any condition, the feeder asked the care-
givers to identify a different change-resistant
food. The feeder continued the procedure of
presenting change-resistant foods in the free-
operant condition and progressing foods
through the conditions or replacing foods based
on participant consumption until the partici-
pant consumed at least two change-resistant
foods in the 0.6-cm by 0.6-cm by 0.6-cm bite-
presentation condition.
During free-operant sessions, the feeder pres-
ented the change-resistant food in the same for-
mat the caregivers typically used (e.g., pancakes
cut into 1.5-cm by 1.5-cm by 1.5-cm triangles
with syrup and butter). The feeder said, “It’s
time for a snack. You can have as much or as
little of this snack as you want,” and set the
timer for 5 to 10 min, based on the amount of
food presented and on caregiver report of typi-
cal meal length. During the fixed-time sessions,
the feeder followed the general procedure, but
8 Jaime G. Crowley et al.
the bite size was 1.5 cm by 1.5 cm by 1.5 cm.
During bite-size-fading sessions, the feeder
followed the general procedure and gradually
reduced the bite size across sessions from
1.5 cm by 1.5 cm by 1.5 cm to 0.6 cm by
0.6 cm by 0.6 cm. Each participant consumed
at least two change-resistant foods in the
0.6-cm by 0.6-cm by 0.6-cm presentation for-
mat. These consisted of banana and quesadilla
for Steven; chicken nugget, French fries,
Nutella on bread, and apple for Titus; Fruit
Loops, Captain Crunch, tropical fruit, and pan-
cake for Alfonzo; hot dog and Cheerios for
Zachary; Fruit Loops, Captain Crunch, and
waffle for Micah; pancake, hot dog, pear, and
strawberry for Kelsey; and Fruit Loops, Captain
Crunch, and chicken nugget for Genevieve.
Intervention Evaluation
Free Choice. The feeder used random selec-
tion and counterbalancing to select an alterna-
tive food to present in each session. The feeder
rotated the pairings of change-resistant and
alternative foods by randomly selecting a
change-resistant food to present in each session.
The stated contingencies were, “I’ll place both
bites in front of you and say, ‘Take one bite’. If
you take a bite, I’ll say, ‘Good job.’” The feeder
presented a bite of the change-resistant food
and a bite of the alternative food and said,
“Take one bite.” The feeder followed the gen-
eral procedure and did not provide any differ-
ential consequences for inappropriate mealtime
behavior or expulsion. The feeder removed the
bowls if the participant did not make a choice.
The feeder blocked the participant’s attempt to
place a second bite in his or her mouth if the
participant had already placed one of the bites
in his or her mouth.
Asymmetrical Choice. The feeder placed a
colored table cloth (e.g., orange) on the table.
The bowls and utensils were the same color as
the table cloth and the color remained the same
for this condition throughout the study. The
stated contingencies were, “I’ll place both bites
in front of you and say, ‘Take one bite’. If you
take a bite of (alternative food), you get (pre-
ferred item).” The contingencies were identical
to free choice with the following modifications:
the feeder held or placed the preferred item in
the participant’s sight, approximately 10 cm
behind the bowl with the alternative food; the
feeder provided 30 s of access to the iPad for
Steven, Kelsey, and Genevieve, one Skittle to
Titus, Alfonzo, and Micah, and one piece of
Hot Cheeto to Zachary if they consumed the
bite of the alternative food. The feeder removed
both bowls and the preferred item, and pres-
ented the next pair of bites if the participant
did not make a choice. The feeder removed the
preferred item and followed the general proce-
dure if the participant chose the change-
resistant food.
Single Choice. The stated contingencies
were, “I’ll place one bite in front of you and
say, ‘Take one bite’. If you take a bite of (alter-
native food), you get (preferred item).” The
procedure was identical to asymmetrical choice
with the following modifications. The table
cloth, bowls, and utensils were a different color
from those in asymmetrical choice. The feeder
presented a bite of the alternative food and
said, “Take one bite.” If the participant did not
choose the alternative food, the feeder physi-
cally guided the participant to touch the utensil
to his or her lips and hold the utensil touching
the lips until he or she opened his or her
mouth such that the feeder could guide the
participant to put the bite in his or her mouth,
or 10 min from session initiation elapsed
(Peterson et al., 2016). If the participant did
not grip the utensil during hand-over-hand
guidance, the feeder held the utensil and
followed the same procedure without hand-
over-hand guidance.
The feeder re-presented expelled bites by
scooping up the bite or retrieving a fresh bite
with the utensil and touching the utensil to the
participant’s lips until the feeder could deposit
the bite into the participant’s mouth, or
 Food Selectivity As Resistance To Change
10 min from session initiation elapsed. If the
participant was expelling the bite at the mouth-
check interval for Trials 1 to 4, the feeder re-
presented the bite until it remained in the
mouth for 3 s and started the next trial. If the
participant was expelling the bite at the mouth-
check interval for Trial 5, the feeder re-
presented the bite until the participant had no
food in the mouth larger than a grain of rice,
or 10 min from session initiation elapsed.
The feeder used his or her forearm and an
open hand to gently block the participant from
contacting the utensil. A second therapist
assisted if the feeder could not maintain the
participant’s safety during the session (e.g., the
participant was at risk of falling out of the chair),
which occurred for four participants during the
single-choice condition with their first alternative
food. The second therapist stood directly behind
the participant and placed his or her outstretched
arms with open hands on either side of the partic-
ipant so that they were hovering above the partici-
pant’s arms when the feeder initiated hand-over-
hand guidance and discontinued blocking when
the trial ended. The purpose of the second thera-
pist was to minimize the participant’s contact with
the utensil and to prevent the participant from
upending the chair or otherwise harming him or
herself. We removed the blocker after three con-
secutive sessions of five or fewer instances of inap-
propriate mealtime behavior.
Guided Choice. We used guided choice
with Genevieve because the percentage of con-
sumption was low during the single-choice con-
dition. The procedure was identical to single
choice with the addition of a backward-
chaining procedure and a manipulation of
preferred-item access. The feeder implemented
one step in a session (e.g., guided the bite to
Genevieve’s lips on every trial of the session).
When consumption was 80% or greater for
four of five sessions for one backward-chaining
or preferred-item access step, the feeder
implemented the next step. When consump-
tion was below 80% for five sessions for one
9
backward-chaining or preferred-item-access
step, the feeder implemented the previous step.
The steps of the backward-chaining proce-
dure were (a) place bite in mouth, (b) touch
utensil to lips, (c) bring utensil 2.5 cm from
lips, (d) bring utensil halfway between bowl
and lips, (e) bring utensil 2.5 cm from bowl,
and (f) place hand on utensil. The feeder pres-
ented the bite and immediately guided Gen-
evieve to perform the prescribed step in the
backward-chaining procedure. The feeder dis-
continued guidance after Genevieve’s hand was
in the prescribed position, provided 30 s of
iPad access if the bite entered Genevieve’s
mouth within 8 s of presentation, and provided
another 30-s access if Genevieve had a mouth
clean. The feeder guided Genevieve to place
the bite in her mouth if she did not do so
within 8 s of presentation and did not provide
iPad access.
Next, the feeder manipulated iPad access by
providing (a) 30 s of iPad access for choices
and another 30-s access for mouth clean and
(b) 30 s of iPad access for choices but not for
mouth clean. The feeder then implemented the
single-choice contingencies.
Experimental Design
We used a combination of a concurrent mul-
tiple baseline across foods and reversal designs.
The feeder implemented the asymmetrical-
choice contingencies with one alternative food
when levels of consumption were low and sta-
ble across alternative foods during the free-
choice baseline, and implemented the single-
choice contingencies if levels of alternative-food
consumption did not increase during asymmet-
rical choice. The feeder reversed to the previous
contingencies if percentage of alternative-food
consumption increased to 80% or above for
three consecutive sessions. When percentage of
alternative-food consumption maintained at
80% or above in the least effortful intervention
condition, the feeder repeated the sequence of
conditions necessary to increase consumption
10 Jaime G. Crowley et al.
to 80% or above with the next alternative food.
The feeder repeated this process until percent-
age consumption was 80% or above for four
alternative foods. The feeder conducted rever-
sals with subsequent alternative foods as time
permitted. The feeder implemented guided
choice with Genevieve when carrot consump-
tion did not increase during single choice but
otherwise followed the sequence described
above. The feeder implemented free, asymmet-
rical, guided, and single choice with cheese and
free, asymmetrical, and single choice with pan-
cake and pear.
Results
Figure 1 displays the percentage of trials with
consumption for Steven for baked beans, straw-
berry, broccoli, and sandwich. Steven’s pattern
of responding was similar across foods. During
the initial free-choice condition, mean percent-
age consumption was 0% across foods. Mean
percentage consumption increased to high, sta-
ble levels for all foods during the initial expo-
sure to asymmetrical choice (mean, 93%;
range, 20% to 100%). Consumption decreased
to 0% across foods during the reversal to free
choice. Mean percentage consumption
increased to high, stable levels for all foods in
the return to asymmetrical choice. The feeder
did not implement single choice because levels
of consumption increased across foods during
asymmetrical choice.
Figure 2 displays the percentage of trials with
consumption for Titus for green beans,
chicken, potato, and pea. Titus’ pattern of
responding was similar across foods and like
that of Steven. Mean percentage consumption
was either low or mainly low but variable in
the initial free choice condition for all foods
(mean, 8%; range, 0% to 100%). Mean per-
centage consumption increased to high levels
for all foods during the initial exposure to
asymmetrical choice (mean, 84%; range, 0% to
100%). Consumption decreased to
zero (chicken, potato, and peas) or near zero
(green beans) levels during the reversal to free
choice. Mean percentage consumption
increased to high levels for all foods in the
return to asymmetrical choice. Like Steven, the
feeder did not implement single choice because
of the high levels of consumption across foods
during asymmetrical choice.
Figure 3 displays the percentage of trials with
consumption for Alfonzo for potato, cauli-
flower, avocado, and chicken. During the initial
free-choice condition, mean percentage con-
sumption was zero (potato, cauliflower, avo-
cado) or near zero (chicken) for all foods. Mean
percentage of consumption increased to moder-
ate (potato) to high levels (cauliflower, avocado,
and chicken) in the initial exposure to asym-
metrical choice. Alfonzo’s pattern of responding
was similar for cauliflower, avocado, and
chicken in that consumption increased during
the initial exposure to asymmetrical choice.
Mean percentage of potato consumption then
increased to high, stable levels in the single-
choice condition and maintained at 100% in
the reversal to asymmetrical choice. Mean per-
centage consumption decreased for all foods in
the reversal to free choice (mean, 17%; range,
0% to 100%), but returned to high, stable
levels in the final asymmetrical choice condi-
tion (mean, 94%; range, 40% to 100%).
Figure 4 displays the percentage of trials with
consumption for Zachary for chicken, lasagna,
green beans, and corn. During the initial free-
choice condition, mean percentage of con-
sumption was zero (chicken, lasagna, and green
bean) or near zero (corn) for all foods. Zachary
never consumed chicken or lasagna during the
initial exposure to asymmetrical choice, but
percentage of consumption increased (mean,
71%; range, 0% to 100%) during the subse-
quent phase of single choice for both foods.
Mean percentage of consumption also
maintained at high levels during the reversal to
asymmetrical choice (mean, 97%; range, 60%
to 100%), decreased during the reversal to free
 Food Selectivity As Resistance To Change 11

Figure 1
Percentage of Trials with Consumption for Steven for Baked Beans (First Panel), Strawberry (Second Panel), Broccoli (Third
Panel), and Sandwich (Fourth Panel) in Free and Asymmetrical Choice.

choice (mean, 14%; range, 0% to 80%), and
increased to 100% during the final return to
asymmetrical choice for both foods. Percentage
of consumption increased during the initial
exposure of green beans and corn (mean, 97%;
range, 60% to 100%) in the asymmetrical
choice phase.
Figure 5 displays the percentage of trials with
consumption for Micah for baked beans, pine-
apple, white rice, and peas. During the initial
free-choice condition, mean percentage con-
sumption was zero (baked beans and pineapple)
or low (white rice and peas) for all foods.
Micah never consumed baked beans or peas
during the initial exposure to asymmetrical
choice, but percentage consumption was high
in asymmetrical choice for white rice and pine-
apple (mean, 84%; range, 40% to 100%).
Mean percentage of consumption increased
during single choice (mean, 79%; range, 0% to
100%) and maintained at high levels during
the first reversal to asymmetrical choice (mean,
84%; range, 40% to 100%) for baked beans
and peas. Percentage of consumption decreased
during the reversal to free choice across all
foods. Mean percentage of consumption
increased in the second return to asymmetrical
choice for all foods except baked beans. Baked
beans were exposed to single choice again
before maintaining at high, stable levels in the
final asymmetrical-choice condition (mean,
94%; range, 80% to 100%).
12 Jaime G. Crowley et al.

Figure 2
Percentage of Trials with Consumption for Titus for Green Beans (First Panel), Grilled Chicken (Second Panel), Potato
(Third Panel), and Peas (Fourth Panel) in Free and Asymmetrical Choice.

Figure 6 displays the percentage of trials with
consumption for Kelsey for potato, peas, green
beans, and yam. During the initial free-choice
condition, mean percentage consumption was
zero (potato, peas, and green beans) or near
zero (yam) for all foods. Percentage of con-
sumption increased to moderate levels during
the initial exposure to asymmetrical choice for
potato and peas (mean, 59%; range, 0% to
100%); remained at zero for green bean; and
increased to high, stable levels for yam (mean,
94%; range, 80% to 100%). Mean percentage
consumption increased to high levels during
the subsequent phase of single choice for
potato, peas, and green bean (mean, 86%;
range, 40% to 100%). These high levels of
consumption maintained in the reversal to
asymmetrical choice for potato and green bean,
but not for peas. Percentage of peas consump-
tion increased during the return to single
choice (M = 82%; range, 0% to 100%), and
maintained at high, stable levels during a final
reversal to asymmetrical choice (M = 97%;
range, 80% to 100%).
Figure 7 displays the percentage of trials with
consumption for Genevieve for carrot, cheese,
pancake, and pear. During the initial free-
choice condition, mean percentage consump-
tion was zero (carrot and cheese) or near
zero (pancake and pear) for all foods. Percent-
age of consumption remained at zero during
the asymmetrical-choice condition for both
 Food Selectivity As Resistance To Change 13

Figure 3
Percentage of Trials with Consumption for Alfonzo for Potato (First Panel), Cauliflower (Second Panel), Avocado (Third
Panel), and Chicken (Fourth Panel) in Free, Asymmetrical, and Single Choice.

carrot and cheese but increased to high levels
for pancake and pear (mean, 82%; range, 20%
to 100%). Percentage of carrot consumption
remained at zero during single choice, but
increased during guided choice and maintained
at high, stable levels in a reversal to single
choice. Similar to carrot, percentage of
cheese consumption increased in guided
choice and maintained in single choice. Per-
centage of cheese consumption also
maintained in the reversal to asymmetrical
choice, but percentage of carrot consumption
did not. Carrot required additional exposure
to single choice following the reversal to
asymmetrical choice to increase consumption
again. Of the foods with a reversal to free
choice (cheese, pancake, pear), all decreased
to low levels during this reversal (mean,
22%; range, 0% to 60%). During the final
reversal to asymmetrical choice, all foods
increased to high levels, although percentage
of pancake consumption was variable (mean,
93%; range, 40% to 100%).
Discussion
The procedures in the current study are
novel relative to preparations researchers typi-
cally use in intervention-outcome studies on
pediatric feeding disorders. In most studies, a
feeder presents individual (e.g., LaRue et al.,
2011; Patel et al., 2002) or multiple bites of
14 Jaime G. Crowley et al.

Figure 4
Percentage of Trials with Consumption for Zachary for Chicken (First Panel), Lasagna (Second Panel), Green Beans (Third
Panel), and Corn (Fourth Panel) in Free, Asymmetrical, and Single Choice.

target foods simultaneously (e.g., Penrod et al.,
2010) to evaluate the effects of the experimen-
tal manipulation. However, in typical mealtime
situations, children have choices among foods,
such as in the school cafeteria or when
searching the pantry for a snack. In these situa-
tions, children with food selectivity are likely to
consume their change-resistant food rather than
an alternative food. The preparation in the cur-
rent study more closely approximated a typical
mealtime situation in which a child has a
choice among foods. In fact, we pitted the
alternative food against the participant’s
change-resistant food in a paired-choice
arrangement. The goal was to teach the partici-
pant to consume the alternative food even
when the change-resistant food was available
concurrently. We conceptualized consumption
as the participant choosing the alternative food
by picking up the utensil with the bite of alter-
native food, placing the bite in his or her
mouth within 8 s of presentation, and chewing
and swallowing the bite of alternative food
(mouth clean). The participant had the option
of consuming the change-resistant food in free-
and asymmetrical-choice conditions or making
no response in all conditions instead of con-
suming the alternative food.
In the current study, we used the prepara-
tion and conceptual framework of Fisher et al.
(2019), who based their intervention for
change-resistant behavior in children with
 Food Selectivity As Resistance To Change 15

Figure 5
Percentage of Trials with Consumption for Micah for Baked Beans (First Panel), Pineapple (Second Panel), White Rice
(Third Panel), and Peas (Fourth Panel) in Free, Asymmetrical, and Single Choice.

autism conceptually, but not mathematically,
on the generalized matching law. Basic research
on the matching law shows that individuals
allocate their responses to options that produce
relatively more frequent or higher value of rein-
forcement. These reinforcement parameters
predict the value of a reinforcing consequence.
The matching law states that responses that
produce proportionally more frequent or more
valued reinforcement will occur more fre-
quently than other responses that are available
concurrently (McDowell & Caron, 2010;
Petry & Heyman, 1994; Pierce & Epling,
1983). The systematic relation between relative
rates of responding and relative reinforcer value
is one of the most robust findings in behavior
analysis.
Fisher et al. (2019) proposed that children with
autism prefer predictable consequences and avoid
unpredictable consequences. These preferred conse-
quences function as automatic reinforcement for
change-resistant behavior. Participants in the cur-
rent study consistently consumed the change-
resistant food when given a choice between a
change-resistant and an alternative food in the free-
choice condition, with a few exceptions. Consump-
tion of the change-resistant foods occurred almost
exclusively in free choice because it had a long his-
tory of producing multiple sources of automatic
reinforcement, and no programmed reinforcement
was available for consuming alternative foods.
Consumption of the change-resistant food
might have persisted until the participant
repeatedly received a higher quality reinforcer
16 Jaime G. Crowley et al.

Figure 6
Percentage of Trials with Consumption for Kelsey for Potato (First Panel), Peas (Second Panel), Green Beans (Third Panel),
and Yam (Fourth Panel) in Free, Asymmetrical, and Single Choice.

for consuming the alternative food. Providing
reinforcement in the asymmetrical-choice con-
dition for consuming alternative foods was suf-
ficient to change responding from the change-
resistant to the alternative foods for Steven and
Titus. Levels of consumption of the first alter-
native food presented in asymmetrical choice
was inconsistent but greater than in free choice
for Alfonzo and Kelsey. These results are novel
because consumption of alternative foods
increased consistently during asymmetrical
choice for two participants and inconsistently
for two participants, even though the partici-
pants’ change-resistant foods were available
concurrently. Thus, providing an empirically
identified reinforcer for alternative-food
consumption may be sufficient to change
responding for some participants from almost
exclusive consumption of change-resistant foods
to exclusive or increased consumption of alter-
native foods. Alternatively, presession rules may
have contributed to or controlled responding
for Steven and Titus. They were among the
oldest participants (i.e., ages 7 and 8), had the
most sophisticated verbal repertoires, and dis-
played more adaptive skills (e.g., toileting, self-
dressing) than the other participants. Future
researchers could evaluate whether presession
rules contribute to or control responding in
similar concurrent-operants arrangements.
Percentage consumption of foods in the first
panel of the multiple baseline, chicken, baked
 Food Selectivity As Resistance To Change 17

Figure 7
Percentage of Trials with Consumption for Genevieve for Carrot (First Panel), Cheese (Second Panel), Pancake (Third Panel),
and Pear (Fourth Panel) in Free, Asymmetrical, Single, and Guided Choice.

beans, and carrot, was 0% during the first
exposure to asymmetrical choice for Zachary,
Micah, and Genevieve, respectively. Persistent
change-resistant responding may have
prevented participants from contacting rein-
forcement for alternative-food consumption.
Thus, reinforcement for alternative-food con-
sumption remained low and the consequence
for alternative-food consumption remained
unpredictable. Levels of chicken and baked
beans consumption increased for Zachary and
Micah, respectively, during single choice. Pre-
senting the alternative food in the absence of
the change-resistant food during single choice
exposed the participants to the predictable,
favorable consequences of alternative-food
consumption. The high levels of high quality
reinforcement may have increased the value of
consequences for alternative-food consumption.
Repeated exposure to the alternative food dur-
ing single choice may also be important because
exposure is one method by which humans
develop preferences for foods (Birch, 1989,
1999; Birch & Marlin, 1982; Birch et al.,
1987; Capaldi, 1996). Genevieve showed a
similar response pattern but required backward
chaining and preferred-item manipulation plus
single choice to increase carrot consumption.
Although consumption of potatoes increased
for Alfonzo, and consumption of potatoes and
peas increased for Kelsey during asymmetrical
choice, levels of alternative-food consumption
18 Jaime G. Crowley et al.
were not clinically valid until the feeder pres-
ented these foods in a single-choice condition.
Results for Alfonzo, Zachary, Micah, and
Kelsey are consistent with previous literature
demonstrating that nonremoval of the spoon, a
component of the single-choice contingencies
in the current study, may be necessary to
increase consumption for some participants
(Patel et al., 2002; Piazza, Patel et al., 2003;
Reed et al., 2004). Results for Genevieve are
similar to those obtained with Bryce in Peter-
son et al. (2016). Bryce’s acceptance of alterna-
tive foods increased only after the researchers
added backward chaining to nonremoval of the
spoon, suggesting that some participants
require intervention components in addition to
nonremoval of the spoon to change their feed-
ing behavior. Intervention dosage also could
have affected Genevieve’s results as her appoint-
ments were more spaced apart across the week.
Similarly, Peterson et al. hypothesized that
intervention dosage contributed to the results
for individual participants in their study and
likely affects outcomes for children with autism
receiving early intensive behavioral intervention
(Lovaas, 1987; McEachin et al., 1993).
The current study adds to the literature because
the results demonstrated that single choice had
beneficial effects even after we reversed those con-
tingencies. Participants continued to consume
alternative foods during asymmetrical-choice con-
ditions that followed single-choice conditions even
though discriminative stimuli were paired with
asymmetrical- and single-choice conditions. The
value of reinforcement for alternative-food con-
sumption may have increased during single choice
because alternative-food consumption produced
predictable and favorable consequences. The value
maintained at the increased level and was higher
than that of change-resistant-food consumption
during the return to asymmetrical choice. We rep-
licated this finding with every participant for
whom we presented at least one food in the
single-choice contingencies and for every food
presented in the single-choice contingencies.
Levels of consumption of the food in the
first panel of the multiple baseline did not
increase until the feeder implemented single
choice for Alfonzo, Zachary, Micah, and Kelsey
or guided choice for Genevieve. However,
levels of consumption increased during asym-
metrical choice without exposure to single
choice for some alternative foods in subsequent
panels of the multiple baseline. Consumption
increased for cauliflower, avocado, and chicken
in panels 2, 3, and 4, respectively, for Alfonzo;
for green beans and corn in panels 3 and
4, respectively, for Zachary; for pineapple and
white rice in panels 2 and 3, respectively, for
Micah; and for yam and pear in panel 4 for
Kelsey and Genevieve, respectively. Thus, we
presented one food for Alfonzo, two foods for
Zachary and Micah, and three foods for Kelsey
in single choice before they began consuming
other food(s) during asymmetrical choice. We
presented carrot and cheese in panels 1 and
2 in guided choice and pancake in panel 3 in
single choice with Genevieve, and her con-
sumption of pear in panel 4 increased during
asymmetrical choice.
Note that Micah’s pattern of responding was
different from that of Alfonzo and Zachary.
After alternative-food consumption increased
during asymmetrical choice with one food in
the multiple baseline (e.g., panel 2 food) for
Alfonzo and Zachary, consumption of alterna-
tive foods in subsequent panels (e.g., panels
3 and 4) of the multiple baseline also increased
during asymmetrical choice. By contrast, the
feeder implemented single choice with peas in
panel 4 for Micah, even though he was con-
suming foods during asymmetrical choice in
panels 2 and 3. Micah’s history of vegetable
refusal may not account for the findings
because he consumed peas in the free-choice
baseline. An alternative explanation is that peas
look like green Skittles, which were a preferred
item. He may have consumed peas initially in
the free-choice condition because of their visual
similarity to Skittles, but pea consumption
 Food Selectivity As Resistance To Change
extinguished after he discriminated the differ-
ence. Thus, exposure to the reinforcer for pea
consumption during single choice was necessary
to reestablish responding. Titus’ pattern of
baseline consumption of peas, which also
decreased over time during free choice, and his
preference for Skittles provides support for this
explanation. Researchers should investigate
whether the visual properties of foods affect
consumption (Wadhera & Capaldi Phillips,
2014) for children with autism.
One limitation of the study is that we did
not test participants’ ability to discriminate the
colored stimuli or biases for the colors associ-
ated with asymmetrical- and single-choice con-
ditions. We also do not know whether the
preassessment affected participants’ consump-
tion of or preference for the change-resistant
foods or their resistance to change. The gradual
changes made to the change-resistant foods
may have decreased participants’ preferences for
the change-resistant foods or their resistance to
change. Future studies should evaluate partici-
pants’ ability to discriminate between and pref-
erence for colored stimuli. Future researchers
should also conduct baseline and preference
assessments with change-resistant and alterna-
tive foods before and after the preassessment to
determine whether the preassessment affects
food preferences, resistance to change, or both.
Another limitation is that we did not con-
duct a preference assessment with the change-
resistant and alternative foods. Consumption of
alternative foods was zero or near zero percent
during free choice, suggesting that participants
preferred the change-resistant foods. The cur-
rent study did not evaluate whether partici-
pants’ preferences correlated with their
decreased consumption of change-resistant
foods and increased consumption of alterna-
tive foods. Food preference could contribute
to the value of the reinforcing consequences of
change-resistant and alternative-food con-
sumption. Said simply, humans consume
foods they prefer more often and in greater
19
quantities than foods they do not prefer
(Capaldi, 1996).
Although the purpose of the current study
was to evaluate the effects of a matching-law
based intervention, the ultimate clinical goal is
for participants to consume a diet that is age,
nutritionally, and calorically appropriate (U.S.
Department of Health and Human Services
and U.S. Department of Agriculture, 2015).
Thus, a next step would be for researchers to
assess whether intervention effects generalize to
other feeders, environments, and maintain over
time. Following the conclusion of the current
study, we taught caregivers to implement
single-choice contingencies using the procedure
described by Ibañez et al. (2019) because previ-
ous literature has demonstrated renewal of
inappropriate mealtime behavior during context
changes (Ibañez et al., 2019; Kelley et al.,
2018; Kelley et al., 2015).
Participants received clinical services after the
study to progress to age-typical feeding. Steven,
Alfonzo, and Kelsey graduated from the clinical
program consuming age, nutritionally, and
calorically appropriate meals. Caregivers
increased the volume of food Titus consumed
during outpatient therapy but dropped out of
therapy before Titus was eating age-appropriate
volumes of food. Zachary continued to receive
early intervention services, and Micah and
Genevieve continued to receive outpatient ser-
vices; the variety and amount of foods con-
sumed have increased for all three. The goal is
to continue until participants are eating age
appropriately.
The current study replicated and extended
Fisher et al. (2019) by evaluating the effects of
an intervention for the change-resistant feeding
behavior of participants with autism conceptu-
ally based on the generalized matching law.
This intervention (a) increased every partici-
pant’s alternative responses and reduced
change-resistant responses, (b) maintained
effects with the simpler, less effortful
asymmetrical-choice condition for participants
20 Jaime G. Crowley et al.
who required the single-choice contingencies,
and (c) demonstrated generalization to foods
experimenters did not target in the single-
choice condition. Results suggest that behavior
analysts can use this intervention to change the
environment in systematic ways to decrease the
occurrence of change-resistant behavior
(Makrygianni et al., 2018; Reichow, 2012;
Smith & Iadarola, 2015) and to increase the
occurrence of behavior that is variable, flexible,
and adaptable (Jennett & Hagopian, 2008).
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Received April 25, 2019
Final acceptance February 19, 2020
Action Editor, Dorthea Lerman