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The M & M Kids - Food and Behavior Management

Written by: Michael S. True, M.Ed

This article is copy protected and should only be reproduced by permission of the author. For information contact me at: .

     Without a doubt, one of the biggest "little" controversies that I have heard during my years working with severely handicapped children and adults, have been the "food issues". I mean, we all get hungry. So what's the issue here?

     Using candy to "tempt" a child has been considered contrary to the value system of some families. Perhaps, from a fundamentalistic perspective, this kind of "priming" looks bad. The idea of giving anyone "something for nothing" is the way early intervention often appears. As an example, I would take the matter of a young child who has been behaving aggressively or causing some property damage. The "negative" behavior must be stopped or the risk of significant damage or injury becomes too great to manage. What's a parent or teacher to do?

     In these kind of instances, there is no substitute for seeking out a medical doctor or specialist, (neurologists, allergy specialist, psychiatrist, etc.), to discuss the matter. Most behavioral interventions take place in conjunction with some level of prescribed medication. It is very important to know each of these medicines and their possible side-effects.

     With children or adults, some medications can cause a constant thirst. Using sips of juice can be useful not only as a reinforcement for your "alternative behavior", but provides hydration as it is needed. If there are allergies involved, assess all food likes and dislikes within the structure of the diet, a diet less the body system stressors, of course. Choose the foods that gets the most attention from him/her. Even to children who are "picky eaters", the necessity of hunger, as it is to all of us, dictates that they find things to eat. Buy it, make it, bag it in very small pieces, and store it for easy accessibility.

     Many alternatives to sugar foods are necessary for those who are "hyper-active". I use this term only because it is familiar. Many different behavior characteristics fall under this umbrella. Again, it is important to get the opinion of a doctor if you are not certain.

     I have seen trained behavior specialists working with autistic children and adults actually cut an M & M in quarters, to be given out at intervals of ten seconds to every five to ten minutes, based on the individual's behavior. The maximum length of these sessions are up to four hours. This is known as an "intensive training intervention". The idea, is to keep the child or adult's attention focused on a series of activities. (The structure and length of these activities is a topic for another paper). Suffice it to say, if there is a positive response, (appropriate levels of engagement in an activity), prior to the giving of an edible reinforcer, that edible will provide an immediate and acceptable "payoff" for participating in the routine.

     Let me go back to the beginning of this paper now. Considering the fact that we all get hungry, what amount of motivation do we have for satisfying that hunger. If you're not sure, observe an infant over the period of two or three days. You will see a variety of communicative exchanges. The baby, unless ill, will visually focus on the mother, more so if breast feeding is ongoing. Or if being fed by bottle, the mother or caregiver's hands and the bottle itself will quickly become recognized as something good. If vision is good, eyes will fix on faces or offering hands. Smiling, cooing, and reaching out toward the bottle or breast come soon thereafter. Natures perfect alarm system, a baby's cry, will also be associated with hunger, as well as other primary needs. Necessity is the mother of language, as well as invention!

     Indeed, these are the "primary" reinforcers. Food, water, (drink), sunshine, air, warmth, (clothing and a place to stay dry), freedom from harm,(security), and toileting opportunities. These are the basics. 90% of our time is spent directly or indirectly "working toward" or engaging in activities around these powerful forces. If we work outside the home, we acquire money, a "token" reinforcer, which can later be exchanged for the basic needs. Kids trade cards, collect comic books, trade lunches at school, each in an effort to get one of the primary needs or a secondary need met. The secondary needs include: friendship, acceptance, love, a positive self-image, "creature comforts", and the pursuit of happiness, amongst others.

     As a little side-note, if one or more of the primary needs are unmet in a child or an adult, the distraction of that missing element will greatly reduce any chances that you may have to modify the behavior. In other words, insure that the environment in the home, school, or special program setting is able to meet all of these needs. Most behaviors are directly the result of a real or "perceived" notion that something is wrong, something is missing. As soon as it is possible, give each of these activities a verbal or "signed" label, a name. Pose the question frequently, do you need (to), ( or drink, go outside, help, (with something), dress, (appropriately for the situation), or go to the bathroom)?" Shaping these one-word or "yes-no" responses should be the first thing that is reinforced! If you can ask, "Are you...hungry, (or thirsty, hot, cold, scared, etc.), providing for that need will be an immediate reinforcement for the communication of the need. If, however, you are unable to meet the need for a significant length of time, this should be considered if it becomes difficult to manage the individual's behavior.

     So, how do we use food as a reinforcement? Once preferences are noted, it becomes a matter of determining the portions to be given and how to maintain the balance between "treats" and the eating of regular meals. This is an individual decision which must be made prior to the use of edible reinforcers. Let me give another example: a teenaged subject, (sorry that sounds so clinical), OK, I'll say "Joe", wants to eat any time he feels hungry. He is raiding cupboards, refrigerator, and cabinets, and has gained weight as a result. To stop this behavior do you... a) remove all food from accessible cabinets?, b) lock it all up? c) set verbal limits but allow him to have snacks frequently? d) or give him his favorite food very frequently if he does not exhibit the behavior of "raiding the refrigerator"?

     Joe could be doing any other inappropriate behavior. The behavior, however, should be a "target behavior", or require immediate intervention due to its severity. Then, if edibles are to be used, each of the above conditions must be included in the intervention. Non-essential foods must be put out of reach, (some folks have an extra refrigerator in the garage where food can be locked away). Verbal limits can be set, but must be reasonable. Food items that are generally considered between meal snacks, can be put in an accessible area. The amount should be restricted, in any case. At this point, if food seems to be an appropriate reinforcement, planning is very important. Giving the right amount at the right time is extremely important.

     My advice in these types of situations is to be ready for several possible outcomes ahead of time, not afterwards. At least in the beginning, have three alternatives in your edibles pouch or container(s). Be sure they are separated so a choice can be given. This makes the "payoff" even more significant to Joe. Do not give more choices than two or three. Too many choices can become overwhelming.

     Insure, if it is any issue at all, that other preferred food items are not available. Move them or lock them up. However, do keep some food, such as canned goods, milk, fruit, vegetables, in appropriate places. It is important to the "security" element that food, dishes, towels, and other personal items be available in their appropriate places. Training may certainly include times when using these items is very important. Developing a routine which includes their use gives Joe those "alternative" activities he needs to occupy himself. This is what we want him doing instead of the target behavior. It cannot be stressed enough how important it is to any attempts to change behavior, that a substitute activity be provided. Young or old, we will all go back to the "same old routine", if nothing more enticing comes along.

     Now, on to the food! I hope we have done three things prior to starting 1) selected three food items high on the preference list. 2) checked with appropriate doctors or specialists regarding diet. 3) Made sure that there is enough food to last for the time period you wish to do this intervention. Remember, this will probably be a long term project. Changes in behavior do not happen overnight.

      Divide the food items into small, easily eaten bites. If this is not the case, say you have provided a whole apple pie to be eaten during the "training time"), then you run the risk of Joe eating all or most of the pie the first time he sees it, or at least eating as much as he needs to take away his hunger. This is known as "saturation". When we can eat as much as we want or are given too much too fast, we simply stop wanting any more. The "strength" of the reinforcer decreases very quickly after that. Again, this becomes an opportunity to return to the old routine. In order to sustain interest, the food given has to be big enough to attract attention yet small enough not to fill Joe up. A reasonable size is a portion no bigger than a walnut.

     Whether you agree or not, here are some of my personal favorites: popcorn, orange slices, thin slices of any fruit, (fresh or dried), small pieces of granola bars, spoonfuls of fruit flavored yogurt, small sips of juice or milk, (adding chocolate to milk or the use of soft drinks, powdered mixes, milk shakes, etc. are possible but increase the caloric intake, (if that is an issue), and certain dried cereals, (Honey Nut Cheerios, granola, Kix), have worked for me. Be cautious of the amounts of sugar most cereals have). In the home, everything from lasagna to apple pie can be portioned out for use.

     This brings me to the subject of meals. Three meals a day, of course, is what most people expect. If a person who needs to use food as a reinforcement feels the need, he/she can opt for dividing up the foods that would normally be eaten during a meal into portions which can be eaten between meals. The same amount of food can be used, especially if there is a diet involved. It may even be an idea to make very small mini-meals, again to offer choices. Foods that are not consumed can be added back to the amounts served during the traditional "breakfast, lunch, and dinner times." These small portioned meals can be used most effectively if periods between reinforcement average about every half of an hour.

     As I noted briefly above, the time period between giving these "treats" can vary greatly. In some instances Joe might be someone who would settle for a pizza on Friday if it's been a "good" week. In others, if the food does not appear in a matter of seconds, the habitual negative behavior returns. This is especially true for younger autistic persons and persons with severe mental retardation. The attention span of an individual is a good indicator.

     The ability to associate the food with the activity is another important factor. If the activity lasts five minutes, but the edible is only offered every one half hour, no sound connection is made. In order to assure an association is made between the activity and the reinforcement, the reinforcer must be made available at least once, at the conclusion of the activity, or else a number of times, during separate steps of the task.

     Once a multi-step task begins to get mastered by our friend Joe, the amount of food presented during the steps of the activity should be decreased. This, in turn, will decrease the possibility of a dependency on the reinforcement in the future. It is a simple matter to add other tasks to the routine which would get immediate and frequent reinforcement. In time, a routine is learned and the target behavior has vanished!

     To sum it all up, I would say, the use of edibles is a credible and reliable alternative to other possible reinforcements. It is not the only choice, however. If Joe has a special diet or other special needs, these need to be considered first. If edibles are to be used, they should be nutritious, as well, as taste good. There should be an adequate supply of food but portioned out in very small bite-sized amounts. Consider the food to be given as a part of the daily meals. Subtract it from the amounts served at the traditional meal times, (this includes items normally given as snacks between meals). Plan what alternative activities are going to be, and how and when the treats are to be given out.

     Finally, let me add that every reinforcement that may be used should also be accompanied by an encouraging word and soft touch, if possible. Other things, (favorite toys, personal items, tv shows, play activities, time alone, or time with a favorite person), to name but a few, can also be used as reinforcements, if they work! Sometimes, even the favorite things loose their ability to motivate or reinforce a behavior. Be on the lookout. Always keep an eye out for what they like and dislike. The Premack Principal notes, (I paraphrase), "anything an individual spends a great deal of time doing, (or wanting to do), can be considered a prime candidate for a good reinforcement." This goes for food preferences, as well.

     Choice-making is a form of empowerment. Use the basic need reinforcements to teach the ability to communicate needs, wants, and desires. This is the path towards self-sufficiency and ultimately, independence.

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