28 May 2022


Alternating Treatment Design Report

Format: APA

Academic level: Master’s

Paper type: Research Paper

Words: 567

Pages: 2

Downloads: 0

In the report, two treatment packages were compared; one comprising of negative reinforcement contingency that involved three children who suffered from chronic food refusal. One of the treatments consisting of guiding a child to accept food while the other treatment required the non-removal of the spoon until the child finally gave in to take the food. After baseline, alternating treatment comparisons were implemented across the subjects in multiple baselines. Each child was exposed through some sessions on each treatment where later I analyzed and selected the treatment package that was most preferred. 


Food acceptance mainly resulted in access to favorite toys and social interaction. Refusal of the food led to no access to social interaction or preferred stimuli and the removal of the spoon from the lower lip. Maladaptive behaviors were ignored, and the disruptive behaviors blocked. However, the children’s hands were not restrained. Additionally, foods that were expelled were not replaced. 

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Upon the admission of the children, an occupational therapist evaluated each child for an appropriate feeding position, food utensils which were a cup and a spoon, and a seating device. The feeding sessions were conducted in one of two rooms that were devoid of distractions. 


Non-Removal of the Spoon 

The scheduled contingencies and protocol for this treatment were similar to those in baseline but with some exceptions. For instance, at the beginning of the session, the therapist gave instructions that the child would take all the food. Additionally, anytime the spoon was placed under the child’s lower lip, and the food was expelled, the therapist would attempt to catch the food. Finally, when the child allowed the food to be placed in their mouth without expulsion, access to stimuli of their choice and social interaction were allowed. 

Physical guidance 

Here, the similar contingencies as of those of the baseline were scheduled with some exceptions. For instance, the children were instructed by the therapists that they would help them take the bites on their failure to take the bites. Additionally, if the child did not take the bite within five seconds after the spoon was placed on the lower lip, the therapist would physically guide the child by opening their mouth by applying pressure gently. Access to the stimuli of their choice were procedures that were purposed to reduce anxiety and also in modifying the cognitive behaviors. 


The alternative treatment comparisons which were the physical guidance and the non-removal of the spoon were implemented across the subjects in multiple baseline designs. The alternating treatment comparisons commenced after at least five baseline meals with acceptance below 45%. Feeding therapists that were fully trained and three in number implemented each treatment condition through random assignment. After the children had been exposed to each of the treatment conditions, for at least ten sessions, and food acceptance levels had increased to 85% and above for at least four sessions in one type of situation, the caregivers selected the preferred treatment. 

Results and Conclusion 

Both interventions which composed of non-removal of the spoon and physical guidance increased food acceptance to 80% and above. There was evidence that physical guidance was more effective than the other treatment which involved the non-removal of the spoon. A steeper curve (treatment 2) for physical guidance was produced. This indicates that physical guidance resulted in the attainment of the criterion of 80% and above. Figure 1 shows the graph obtained for the report. 

Figure 1 : Frequency of non-compliance graph 

Limitations of ATD 

Alternating treatments Designs seeks to answer the question on which method is best-preferred treatment among two treatments. However, some limitations are associated with this design. For example, the alternating treatment design is not the most appropriate design for behaviors that are learned in stages. Also, the design cannot be used for treatments that are administered continuously with an aim of making them effective. 


Chawarska, K., Klin, A., & Volkmar, F. R. (2008).    Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment . New York: Guilford Press. 

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StudyBounty. (2023, September 15). Alternating Treatment Design Report.


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