Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Bobby’s mom. In case you are new to our blog, we wrote about Bobby last year. You may read his story here.
Bobby’s mom asked,
“Bobby is over-stuffing his mouth with food and chewing for long periods. He is not swallowing, but adding more food until he can no longer add more. We ask him to swallow and we prevent him from adding more. Then he melts down and soupy, half-eaten food goes everywhere. A simple dinner is now lasting 2 hours and this has been happening for about the last 2 weeks.”
So, if you’ll remember from our previous post, Bobby is one of those kinds of children who like to control. It is important to prevent him from controlling the meals like he has done in the past. On the other hand, because this behavior is fairly new, it tells me one of two things:
- Is he sick or having a reaction to something?
- Is everyone in all environments following protocol? All it takes is for one person to let him get away with not eating and he will attempt it with everyone.
Before you start anything new, rule out underlying medical conditions. Is he sick? Does he have any cold symptoms? Has his bowel movements changed suddenly? (e.g., more constipated? looser? more often?) Does he have a rash or other physical sign of a reaction to something?
If all of that is clear and there is no underlying medical condition causing the behavior, then assess the environment. Is there a new teacher? a new assistant teacher? a new behavior therapist? Is everyone on the team following the protocol?
Once you have completed your assessment, then it is time to make changes. The fact that he has been doing this for 2 weeks means that you need to intervene quickly so the behavior stops sooner and does not become engrained in his mealtime.
- I know it is hard but you (and school staff) will need to sit next to him for a few meals in a row until this behavior is back under control. Make sure that he takes an appropriate size bite. He does not get any more food until he finishes the first bite. Move the plate away from him if you need to.
- If he continues to chew slowly, then put on a timer and say, if you chew and swallow within 30 seconds, you can have ________. Then give him the reinforcer when he swallows. Do not give the reinforcer until the food is completely swallowed.
- Any food that is expelled must be represented unless it is contaminated. If it is contaminated then you need to replace the bite with an identical clean bite.
- Consider using a short picture schedule that shows:
- small bite
Fade Reinforcement and Proximity
As Bobby begins to experience reinforcement for appropriate behavior, you will begin to see an increase in appropriate behavior. This should also result in a decrease in the inappropriate behavior, especially when expelling results in an identical bite.
As Bobby is able to eat one bite, then put two bites on the plate and teach him to wait to take the second bite until he swallows the first bite. He will need to put the utensil down on the table while he is chewing. At this time, he will only receive tangible reinforcement when he chews and swallows both bites. Be sure to provide verbal praise when he swallows the first bite.
When he is able to eat two bites, then increase it to 3 bites on the plate. Begin fading the verbal feedback after the first bite and move to verbal feedback after the second bite with tangible reinforcement after the 3rd bite. If he can safely eat 3 bites without assistance and without stuffing, then begin fading the proximity of the helper.
Good luck and please let us know how it goes!
If you have a question about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.