The relationship between food refusal and self-injurious behavior: a case study.

Food refusal and self-injurious behavior often co-occur in children with developmental disabilities and mental retardation. The subject of the case study was a 3-yr-old boy with food refusal, self-injurious behavior and developmental delay. Using an alternating treatment design, positive reinforcement for acceptance combined with either nonremoval of the spoon or guidance for refusal increased food acceptance and resulted in a decrease in self-injurious behavior despite not being targeted. Although the contingencies for acceptance, refusal and self-injurious behavior remained constant, self-injurious behavior increased with an increase in grams consumed. A combined treatment of positive reinforcement for acceptance, guidance for refusal, position change and gastrojejunal feedings resulted in a decrease in self-injurious behavior and an increase in grams consumed.