Evaluation of an Individualized Levels System to Increase Consumption for an Adolescent with Food Refusal

A levels system is an intervention that uses a combination of behavioral principles, such as differential reinforcement and response cost, in order to increase appropriate behaviors and simultaneously decrease problem behaviors. Within a levels system, an individual must meet a pre-determined behavioral criterion in order to gain access to various levels of reinforcement. For example, engaging in higher rates of inappropriate behavior will result in access to highly preferred items or activities, while higher rates of inappropriate behavior will access to lesser preferred activities. Although levels systems have been applied in group settings, as well as in the individual treatment of severe problem behavior, their use has not been explored in the treatment of food refusal. The current study implemented a levels system to target increasing the variety and volume of food consumed by a 12-year-old female diagnosed with fetal alcohol spectrum disorder (FASD) effects, mild intellectual disability, and attention-deficit/hyperactivity disorder (ADHD). At the end of her admission, the participant had increased her variety consumed at an age-appropriate volume significantly, as well as the volume of food consumed.