Journal of Autism and Developmental Disorders

, Volume 42, Issue 8, pp 1574–1581 | Cite as

Using Individualized Reinforcers and Hierarchical Exposure to Increase Food Flexibility in Children with Autism Spectrum Disorders

  • Robert L. Koegel
  • Amber A. Bharoocha
  • Courtney B. Ribnick
  • Ryan C. Ribnick
  • Mario O. Bucio
  • Rosy M. Fredeen
  • Lynn Kern Koegel
Original Paper


Inflexibility is a major characteristic of autism. In the present study we addressed inflexible mealtime behaviors and collected longitudinal data across 48 foods for 3 children, ages 6.4–7.8 years, diagnosed with autism spectrum disorder, for up to 22 weeks. Participants exhibited severe challenges with adherence to an extremely restricted repertoire of foods. We employed clinical replication and multiple baseline designs across participants to assess the effects of individualized reinforcement and hierarchical exposure to increase flexibility. Results showed that following intervention, all participants expanded their food repertoire and spontaneously requested new foods during follow up/generalization. Implications for clinical practice and directions for further research are discussed.


Food refusal Inflexibility Rigidity Autism Positive reinforcement Stimulus fading 



The authors wish to acknowledge Lisa Rini, M.Ed., for her help and support in data collection and developing this research study and Natasha Elliott, for her assistance in completing the research project. We would also like to thank the families for participating in this project. Research and preparation of this manuscript were partially supported by NIH Grant Number DC010924.


Lynn Kern Koegel and Robert L. Koegel are also partners in the private firm, Koegel Autism Consultants, LLC.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Robert L. Koegel
    • 1
  • Amber A. Bharoocha
    • 1
    • 2
  • Courtney B. Ribnick
    • 1
  • Ryan C. Ribnick
    • 1
  • Mario O. Bucio
    • 1
  • Rosy M. Fredeen
    • 1
    • 3
  • Lynn Kern Koegel
    • 1
  1. 1.Koegel Autism Center, Gevirtz Graduate School of EducationUniversity of California, Santa BarbaraSanta BarbaraUSA
  2. 2.Santa Maria Bonita School DistrictSanta MariaUSA
  3. 3.Holdsambeck and AssociatesFresnoUSA

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