Journal of Autism and Developmental Disorders

, Volume 49, Issue 2, pp 721–728 | Cite as

Decreasing Food Stealing of Child with Prader-Willi Syndrome Through Function-Based Differential Reinforcement

  • Joseph M. LambertEmail author
  • Naomi Parikh
  • Kristen C. Stankiewicz
  • Nealetta J. Houchins-Juarez
  • Vivian A. Morales
  • Erin M. Sweeney
  • Molly E. Milam
Original Paper


Challenging behaviors involving food are common for individuals with Prader-Willi syndrome (PWS) and often lead to obesity and other chronic health conditions. Efforts to decrease these behaviors, such as isolation during meals and strict monitoring of food consumption, can be stigmatizing. To decrease the food stealing of a 7 year-old girl with PWS, therapists conducted a latency-based functional analysis in a clinic setting before implementing a function-based intervention to facilitate her inclusion at the family dinner table. Intervention components entailed differential reinforcement procedures which incorporated a token board and schedule thinning. The intervention successfully generalized to the home setting and across food preferences and implementers.


Differential reinforcement Functional analysis Latency Prader-Willi syndrome Tokens 



We thank the Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) for contributing space and resources.

Author Contributions

JL conceived of the study, participated in its design, coordination, and implementation, and drafted the manuscript; NP conceived of the study, participated in its design, coordination, and implementation, and drafted the manuscript; KS conceived of the study and participated in its design, coordination, and implementation; NH-J conceived of the study and participated in its design, coordination, and implementation. VM conceived of the study and participated in its design, coordination, and implementation. ES conceived of the study and participated in its design, coordination, and implementation. MM conceived of the study and participated in its design, coordination, and implementation. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical Approval

This research has been approved by the appropriate Institutional Research Ethics Committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

The participant’s guardians provided informed consent for participation before we initiated study-related activities.


  1. Bianchine, J. W., Stambler, A.A., & MacGregor, M. I. (1971). The Prader-Willi syndrome with cardiorespiratory complications. Birth Defects Original Article Series, 7, 301–302.Google Scholar
  2. Burd, L., Martsolf, V. B., & Kerbashian, J. (1990). Prader prevalence study of Prader-Willi syndrome in north Dakota. American Journal of Medical Genetics, 37, 97–99.CrossRefGoogle Scholar
  3. Butler, J. V., Whittington, J. E., Holland, A. J., Boer, H., Clarke, D., & Webb, T. (2002). Prevalence of, and risk factors for, physical ill-health in people with Prader-Willi syndrome: A population-based study. Developmental Medicine & Child Neurology, 44, 248–255.CrossRefGoogle Scholar
  4. Butler, M. (2011). Prader-Willi syndrome: Obesity due to genomic imprinting. Current Genomics, 12, 204–215.CrossRefGoogle Scholar
  5. Butler, M. G. (1990). Prader-Willi syndrome: Current understanding of cause and diagnosis. American Journal of Medical Genetics, 35, 319–332.CrossRefGoogle Scholar
  6. Caruthers, C. E., Lambert, J. M., Tygielski, K. M., Harbin, E. R., & Houchins-Juarez, N. J. (2015). Latency-based FA as baseline for subsequent treatment evaluation. Behavior Analysis in Practice, 8, 48–51. Scholar
  7. Dempsey, C. M., Iwata, B. A., Fritz, J. N., & Rolider, N. U. (2012). Observer training revisited: A comparison of in vivo and video instruction. Journal of Applied Behavior Analysis, 45, 827–832. Scholar
  8. Dixon, M. R., Hayes, L. J., Binder, L. M., Manthey, S., Sigman, C., & Zdanowski, D. M. (1998). Using a self-control training procedure to increase appropriate behavior. Journal of Applied Behavior Analysis, 31, 203–210. Scholar
  9. Echeverria, F., & Miltenberger, R. G. (2013). Reducing rapid eating in adults with intellectual disabilities. Behavioral Interventions, 28, 131–142. Scholar
  10. Einfeld, S. L., Kavanagh, S. K., Smith, A., Evans, E. J., Tonge, B. J., & Taffe, J. (2006). Mortality in Prader-Willi syndrome. American Journal on Mental Retardation, 111, 193–198.CrossRefGoogle Scholar
  11. Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. Cambridge: Prentice Hall.CrossRefGoogle Scholar
  12. Fox, R., & Rotatori, A. F. (1982). Prevalence of obesity among mentally retarded adults. American Journal of Mental Deficiency, 87, 228–230.Google Scholar
  13. Griggs, J. L., Sinnayah, P., & Mathai, M. L. (2015). Prader-Willi syndrome: From genetics to behaviour, with special focus on appetite treatments. Neuroscience and Biobehavioral Reviews, 59, 155–172. Scholar
  14. Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47, 16–36. Scholar
  15. Ho, A. Y., & Dimitropoulos, A. (2010). Clinical management of behavioral characteristics of Prader–Willi syndrome. Neuropsychiatric Disease and Treatment, 6, 107–118.Google Scholar
  16. Iwata, B., Dorsey, M., Slifer, K., Bauman, K., & Richman, G. (1982/1994). Towards a functional analysis of self- injury. Journal of Applied Behavior Analysis, 27, 197–209. Scholar
  17. Johnston, J. G., & Robertson, W. O. (1977). Fatal ingestion of table salt by an adult. Western Journal of Medicine, 126, 141–143.Google Scholar
  18. Lambert, J. M., Bloom, S. E., Samaha, A. L., & Dayton, E. (2017). Serial functional communication training: Extending serial DRA to mands and problem behavior. Behavioral Interventions, 32, 311–325. Scholar
  19. Lambert, J. M., Bloom, S. E., Samaha, A. L., Dayton, E., & Rodewald, A. (2015). Serial alternative response training as intervention for target response resurgence. Journal of Applied Behavior Analysis, 48, 765–780. Scholar
  20. Laraway, S., Snycerski, S., Michael, J., & Poling, A. (2003). Motivating operations and terms to describe them: Some further refinements. Journal of Applied Behavior Analysis. Scholar
  21. Madden, G. J., & Johnson, P. S. (2010). A delay-discounting primer. In G. J. Madden & P. S. Johnson (Eds.), Impulsivity: The behavioral and neurological science of discounting (pp. 11–37). Washington, DC: American Psychological Association. Scholar
  22. Maglieri, K. A., DeLeon, I. G., Rodriguez-Catter, V., & Sevin, B. M. (2000). Treatment of covert food stealing in an individual with Prader-Willi syndrome. Journal of Applied Behavior Analysis, 33, 615–618. Scholar
  23. McAdam, D. B., Sherman, J. A., Sheldon, J. B., & Napolitano, D. A. (2004). Behavioral interventions to reduce the pica of persons with developmental disabilities. Behavior Modification, 28, 45–72. Scholar
  24. McAllister, C. J., Whittington, J. E., & Holland, A. J. (2011). Development of the eating behaviour in Prader–Willi syndrome: Advances in our understanding. International Journal of Obesity, 35, 188–197. Scholar
  25. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the united states, 2011–2012. Journal of the American Medical Association, 311, 806–814. Scholar
  26. Page, T. J., Finney, J. W., Parrish, J. M., & Iwata, B. A. (1983a). Assessment and reduction of food stealing in Prader-Willi children. Applied Research in Mental Retardation, 4, 219–228. Scholar
  27. Page, T. J., Stanley, A. E., Richman, G. S., Deal, R. M., & Iwata, B. A. (1983b). Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult. Journal of Behavior Therapy and Experimental Psychiatry, 14, 261–268. Scholar
  28. Rimmer, J. H., & Yamaki, K. (2006). Obesity and intellectual disability. Mental Retardation and Developmental Disabilities Research Reviews, 12, 22–27.CrossRefGoogle Scholar
  29. Schlichenmeyer, K. J., Roscoe, E. M., Rooker, G. W., Wheeler, E. E., & Dube, W. V. (2013). Idiosyncratic variables that affect functional analysis outcomes: A review (2001–2010). Journal of Applied Behavioral Analysis, 46, 339–348. Scholar
  30. Smith, R. G., & Churchill, R. M. (2002). Identification of environmental determinants of behavior disorders through functional analysis of precursor behaviors. Journal of Applied Behavior Analysis, 35, 125–136.CrossRefGoogle Scholar
  31. Thomason-Sassi, J. L., Iwata, B. A., Neidert, P. L., & Roscoe, E. M. (2011). Response latency as an index of response strength during functional analyses of problem behavior. Journal of Applied Behavior Analysis, 44, 51–67. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Joseph M. Lambert
    • 1
    Email author
  • Naomi Parikh
    • 1
  • Kristen C. Stankiewicz
    • 1
  • Nealetta J. Houchins-Juarez
    • 1
  • Vivian A. Morales
    • 1
  • Erin M. Sweeney
    • 1
  • Molly E. Milam
    • 1
  1. 1.Department of Special EducationVanderbilt UniversityNashvilleUSA

Personalised recommendations