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Preferences for Edible and Electronic Leisure Items: A Systematic Replication

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Title: Preferences for Edible and Electronic Leisure Items: A Systematic Replication
Language: English
Authors: Scheithauer, Mindy, Martin, Clarissa, Bottini, Summer
Source: Focus on Autism and Other Developmental Disabilities. Sep 2022 37(3):135-145.
Availability: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 11
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Preferences, Food, Developmental Disabilities, Electronic Equipment, Evaluation Methods, Best Practices, Autism Spectrum Disorders, Reinforcement, Toys, Leisure Time, Clinics, Behavior Problems, Toilet Training, Handheld Devices, Telecommunications, Musical Instruments, Stimuli, Therapy
DOI: 10.1177/10883576221081084
ISSN: 1088-3576
1538-4829
Abstract: Early studies evaluating the relative preference for leisure compared with edible items suggested that, for most participants (>80%), edible items are more preferred than leisure items. Recent studies suggest more variability in the percentage of participants with this preference. The rationale for this variability could be sampling, setting, availability of items outside of the study, or the items included. As a systematic replication, we conducted preference assessments of leisure, edible, and leisure/edible items combined of 13 children with developmental disabilities. As an inclusion criterion, all participants had an electronic item as the top-preferred leisure item. An edible item ranked first in the combined assessment for 46.2% of participants. This replicates recent findings while accounting for access to edibles outside of the study. These outcomes are important to guide use of preference assessments across reinforcer classes in clinical and school settings.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1349705
Database: ERIC
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  Value: <anid>AN0158319590;fdd01sep.22;2022Aug04.06:24;v2.2.500</anid> <title id="AN0158319590-1">Preferences for Edible and Electronic Leisure Items: A Systematic Replication </title> <p>Early studies evaluating the relative preference for leisure compared with edible items suggested that, for most participants (>80%), edible items are more preferred than leisure items. Recent studies suggest more variability in the percentage of participants with this preference. The rationale for this variability could be sampling, setting, availability of items outside of the study, or the items included. As a systematic replication, we conducted preference assessments of leisure, edible, and leisure/edible items combined of 13 children with developmental disabilities. As an inclusion criterion, all participants had an electronic item as the top-preferred leisure item. An edible item ranked first in the combined assessment for 46.2% of participants. This replicates recent findings while accounting for access to edibles outside of the study. These outcomes are important to guide use of preference assessments across reinforcer classes in clinical and school settings.</p> <p>Keywords: autism spectrum disorder; developmental disability; preference assessment; electronics; displacement</p> <p>Best practice recommendations include the use of preference assessments that rely on direct observation of client choice to identify items to use as potential reinforcers in behavioral interventions ([<reflink idref="bib11" id="ref1">11</reflink>]; [<reflink idref="bib18" id="ref2">18</reflink>]). Identification of accurate preference hierarchies is important in multiple ways. First, high-preference items provided contingent on appropriate/correct behavior are more likely to result in behavior change and are less likely to shift in their value if they are found to serve as reinforcers ([<reflink idref="bib5" id="ref3">5</reflink>]), so identifying the most preferred items early in intervention development is key to stable behavior change. Intervention programming may also benefit from establishing a hierarchy of preferred items, in addition to identifying a single top-preferred item. For example, providers (e.g., therapists, teachers, and behavior analysts) may provide top-preferred items for targeted behaviors (e.g., independent correct responding) and moderately preferred items for behaviors being shaped toward the target (e.g., prompted correct responding; [<reflink idref="bib20" id="ref4">20</reflink>]).</p> <p>Providers must also balance the reinforcement value of the item with social validity considerations. For instance, different classes of reinforcers (e.g., leisure vs. edible items) have different advantages and disadvantages to consider. Including frequent access to edible items in behavioral programming may be problematic if the items are unhealthy or weight gain is a significant concern. Alternatively, access to leisure items may be expensive (e.g., access to video games or new toys) or detract from learning time if long durations of access are required for the item to be sufficiently reinforcing ([<reflink idref="bib6" id="ref5">6</reflink>]). A thorough understanding of relative preference among different classes of items may also inform generalization efforts as the intervention progresses. For example, a highly preferred unhealthy edible item may be required early in treatment, but once a behavior is established, it may be beneficial to fade toward leisure items or healthier options. As such, providers should carefully consider items from multiple classes of potential reinforcers.</p> <p>When evaluating items from different classes, it is possible that items from one class will displace another (e.g., [<reflink idref="bib7" id="ref6">7</reflink>]; [<reflink idref="bib8" id="ref7">8</reflink>]), that is, individuals may consistently select items from one class of stimuli before selecting items from another class. Past research defines <emph>total displacement</emph> as an individual selecting all items from one class over all items from another, and suggests total displacement can be common among certain classes of stimuli. Namely, past researchers have found that edible items tend to displace leisure items ([<reflink idref="bib2" id="ref8">2</reflink>]; [<reflink idref="bib8" id="ref9">8</reflink>]). Of note, displaced items can still serve as reinforcers for response acquisition for some individuals but may have less reinforcing value than items from the more preferred class of stimuli (e.g., [<reflink idref="bib3" id="ref10">3</reflink>]; [<reflink idref="bib9" id="ref11">9</reflink>]). Given the possibility of displacement combined with the importance of identifying accurate preference hierarchies while considering social validity, it is important to evaluate preference for items both within and across classes. In doing so, providers can program an intervention fully informed of the items most preferred within each class as well as the relative preference across classes. However, current recommendations regarding the use of preference assessments do not consistently outline the evaluation of potential reinforcer classes both separately and combined (e.g., [<reflink idref="bib12" id="ref12">12</reflink>]; [<reflink idref="bib19" id="ref13">19</reflink>]). To promote clinical recommendations to this effect, it is important to consider past research on the prevalence and potential mechanisms of displacement in different samples.</p> <p>Researchers evaluate displacement by conducting three different preference assessments. The first two preference assessments include items separately for each class; the third combines the top items from each prior assessment to determine relative preference between items from different classes. [<reflink idref="bib8" id="ref14">8</reflink>] were one of the first to study this phenomenon using the multiple stimulus without replacement (MSWO) preference assessment. They conducted individual MSWOs with seven edible and seven leisure items with 14 adults diagnosed with intellectual disabilities (profound <emph>n</emph> = 13, moderate <emph>n</emph> = 1) residing in a treatment facility for self-injury. In the MSWO, the researcher presented all items in front of the participant and asked the participant to choose an item. The participant then consumed the item selected (i.e., ate a small piece of the edible or played with the leisure item for 30 s). Next, the researcher re-presented the remaining items and asked the participant to make another choice. This process continued until the participant selected all items or went 30 s without making a selection (which denoted the end of a series of trials). The researcher repeated this process for five series with each class of items. The researchers ranked items based on selection order and designated the top 3 to 4 items from each category to include in a combined MSWO. In this study, 85.7% of participants (12 of 14) selected an edible item first in the combined assessment and 57.1% of participants (eight of 14) demonstrated total displacement of leisure by edible items (i.e., these participants selected all edible before any leisure items). In contrast, only two of 14 participants selected a leisure item first in the combined assessment and no total displacement of edible by leisure items occurred. One potential explanation proposed was that participants did not have free access to food outside of the study, resulting in a potential establishing operation for edible items.</p> <p>[<reflink idref="bib2" id="ref15">2</reflink>] sought to replicate the findings of [<reflink idref="bib8" id="ref16">8</reflink>] and further explored the impact of access to food by conducting assessments before and after meals. Participants were four adults with severe intellectual disabilities in a residential setting. The researchers implemented similar MSWO procedures as DeLeon and colleagues, with the exception that Bojak and Carr completed 10 series of the combined MSWO, five before and five after a meal, to control for the establishing operation of deprivation or satiation of food. Each participant selected all edible items over all leisure items (total displacement for 100% of participants) with no significant differences based on whether the combined assessment occurred before or after a meal. These findings suggest that establishing operations alone likely do not account for displacement.</p> <p>[<reflink idref="bib9" id="ref17">9</reflink>] conducted an additional replication with 12 individuals (ages 5–22 years) in a school setting. Seven were diagnosed with autism spectrum disorder (ASD) and the remaining were diagnosed with an intellectual and/or developmental disability of another origin (one participant each was diagnosed with Dandy Walker syndrome; Down syndrome; Klinefelter syndrome; intellectual disability; and intellectual disability, attention-deficit/hyperactivity disorder, and microcephaly). An edible item was selected first for 10 of 12 participants (83.3%) and total displacement of leisure by edible items occurred in nine of 12 (66.7%). No participants exhibited total displacement of edible by leisure items. The researchers noted no differences in responding based on age or diagnosis. To this point in time, all studies showed a very high prevalence of edible items displacing leisure items in preference assessments.</p> <p>Recently, [<reflink idref="bib7" id="ref18">7</reflink>] extended these studies by replicating procedures with children diagnosed with ASD receiving applied behavior analysis (ABA) services. Participants were 26 children (ages 2–12 years) who had been diagnosed as having ASD. The authors did not report participants' intellectual functioning or communication level. The authors included an electronic item in the leisure array for all participants, which was a novel extension from past studies. Conine and Vollmer implemented brief MSWO procedures, similar to those described above, with the exception of three series instead of five. Results suggested that 65% of participants (17 of 26) selected an edible item first and only 23% (six of 26) demonstrated total displacement of leisure by edible items. Total displacement of edible by leisure items also occurred for 8% of participants (two of 26), the first time this direction of displacement has been observed in an empirical evaluation. Compared with past studies, these findings suggest less displacement of leisure by edible items when electronic items are included.</p> <p>[<reflink idref="bib16" id="ref19">16</reflink>] replicated [<reflink idref="bib7" id="ref20">7</reflink>] with 16 individuals ages 4 to 12 years diagnosed with ASD. The majority of participants (14 of 16) primarily spoke using vocal communication and attended an ASD treatment clinic in Italy. Similar to Conine and Vollmer, Slanzi and colleagues included an electronic item in the leisure array for all participants. Interestingly, the electronic item was in the top-preferred leisure items for only 50% of participants (compared with 81% in the Conine & Vollmer study). Despite this difference, results were similar to those of Conine and Vollmer and similarly identified less displacement compared with earlier studies ([<reflink idref="bib2" id="ref21">2</reflink>]; [<reflink idref="bib8" id="ref22">8</reflink>]; [<reflink idref="bib9" id="ref23">9</reflink>]). Specifically, 56% of participants (nine of 16) selected an edible item first and 38% of participants (six of 16) demonstrated total displacement of leisure by edible items. Moreover, two of the 12 participants (17%) demonstrated total displacement of edible by leisure items.</p> <p>Taken together, there is significant variability in the percentage of participants who prefer edible over leisure items across studies, with total displacement found in 57.1% ([<reflink idref="bib8" id="ref24">8</reflink>]), 100% ([<reflink idref="bib2" id="ref25">2</reflink>]), 67% ([<reflink idref="bib9" id="ref26">9</reflink>]), 23% ([<reflink idref="bib7" id="ref27">7</reflink>]), and 38% ([<reflink idref="bib16" id="ref28">16</reflink>]) of participants. There are several possible explanations for the variability. First, the studies included participants of different ages and diagnoses receiving services in different settings. In studies with less displacement, all participants had an ASD diagnosis (Conine & Vollmer; Slanzi et al.). Thus, it is possible the prevalence of repetitive behaviors and food selectivity in children with ASD ([<reflink idref="bib13" id="ref29">13</reflink>]) may contribute to results. However, this explanation may be unlikely, given a recent study with 15 typically developing children that found only 40% preferred an edible over leisure items ([<reflink idref="bib3" id="ref30">3</reflink>]) and results from [<reflink idref="bib9" id="ref31">9</reflink>] that suggested no impact of diagnosis. Other demographic variables to consider are age and intellectual disability. For example, participants in past studies with more displacement of leisure by edible items included either exclusively adults with intellectual disabilities ([<reflink idref="bib2" id="ref32">2</reflink>]; [<reflink idref="bib8" id="ref33">8</reflink>]) or a mix of children and adults with and without intellectual disabilities ([<reflink idref="bib9" id="ref34">9</reflink>]).</p> <p>Second, the inclusion of electronic items in the two most recent studies may have influenced the decrease in displacement ([<reflink idref="bib7" id="ref35">7</reflink>]; [<reflink idref="bib16" id="ref36">16</reflink>]). The items included in earlier studies did not consistently include electronics ([<reflink idref="bib9" id="ref37">9</reflink>]) or did not specify it ([<reflink idref="bib2" id="ref38">2</reflink>]; [<reflink idref="bib8" id="ref39">8</reflink>]). However, Slanzi and colleagues replicated results of less displacement, despite several participants who did not have an electronic item as the most preferred leisure item, suggesting some counter evidence to this explanation.</p> <p>Third, [<reflink idref="bib7" id="ref40">7</reflink>] suggested that motivating operations may influence results. The authors postulated that their sample from an ABA clinic had more access to food outside of the study compared with past studies in school ([<reflink idref="bib9" id="ref41">9</reflink>]) and residential settings ([<reflink idref="bib2" id="ref42">2</reflink>]; [<reflink idref="bib8" id="ref43">8</reflink>]). Despite Bojak and Carr manipulating assessments before and after meals, it is possible that the number and type of edibles delivered in the context of intervention across the day may impact displacement (e.g., dense delivery of highly preferred edibles may be more likely during behavioral intervention than a prepared lunch).</p> <p>Additional research is needed to explore these potential hypotheses. The purpose of this study is to replicate past work on the displacement of leisure by edible items with children diagnosed with ASD. We also limited access to edible items outside of the study and only included participants with an electronic item as the top-preferred leisure item to quarry further these potential explanations for varied results in past studies.</p> <hd id="AN0158319590-2">Method</hd> <p></p> <hd id="AN0158319590-3">Participants and Setting</hd> <p>We recruited participants from a day clinic for the treatment of challenging behavior and/or toileting. Clients in this clinic are ages 4 to 21 years and are required to have (a) a primary presenting concern of either challenging behavior or toileting incontinence and (b) a diagnosis of an intellectual or developmental disability. Participants attended the clinic 5 days a week for 6 hr a day for time-limited admissions (approximately 12 weeks for the presenting concern of challenging behavior and 2 weeks for toileting). Specific goals are set at the start of each admission to determine the behaviors that are most impeding adaptive skill development in other settings (e.g., school, home) and clients are discharged to return to the school setting after these goals are met. The clinic includes bachelor's degree–level behavioral therapists supervised by a board-certified behavior analyst at the master's or doctoral level. Therapists implemented study procedures in the first 2 weeks of the child's admission in either an individual treatment room or the corner of a shared common area. Materials included a table, chairs, and all items needed for the preference assessments.</p> <p>We recruited all participants for whom the clinical team elected to conduct a brief MSWO preference assessment during the child's admission and for whom the leisure MSWO (described below) resulted in an electronic item as most preferred. Based on caregiver report, the participants (<emph>n</emph> = 13) were predominantly male (<emph>n</emph> = 10), with a mean age of 8.4 years (<emph>SD</emph> = 3.45), and they identified as White (38.5%) or Black (61.5%). All participants had a developmental disorder (11 ASD, one Jacobsen syndrome, and one general developmental delay). Participant records were largely missing formal assessments of intellectual functioning; however, parental reported mode of communication at the time of the admission suggested that six participants were nonverbal (no meaningful vocal speech). Of the remaining seven, two spoke in full sentences and were conversational, two spoke in two- to three-word phrases to request items, two spoke single words to request items, and one repeated single words but did not use vocal language functionally (see Table 1 for participant demographics).</p> <p>Graph</p> <p>Table 1. Participant Demographics for Study on Displacement of Leisure by Edible Items.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Participant</th><th align="center">Age</th><th align="center">Gender</th><th align="center">Race</th><th align="center">Developmental disorder</th><th align="center">Verbal vocal skills (primary communication)</th></tr></thead><tbody><tr><td>1</td><td>8</td><td>Male</td><td>White</td><td>ASD</td><td>Short phrase (vocal)</td></tr><tr><td>2</td><td>4</td><td>Female</td><td>Black</td><td>ASD</td><td>Nonfunctional single words (gestures)</td></tr><tr><td>3</td><td>16</td><td>Male</td><td>White</td><td>Jacobsen syndrome</td><td>Nonverbal (sign and gestures)</td></tr><tr><td>4</td><td>8</td><td>Male</td><td>Black</td><td>ASD</td><td>Full sentences (vocal)</td></tr><tr><td>5</td><td>8</td><td>Male</td><td>White</td><td>ASD</td><td>Full sentences (vocal)</td></tr><tr><td>6</td><td>13</td><td>Male</td><td>White</td><td>ASD</td><td>Nonverbal (gestures)</td></tr><tr><td>7</td><td>7</td><td>Male</td><td>Black</td><td>ASD</td><td>Nonverbal (communication device)</td></tr><tr><td>8</td><td>9</td><td>Male</td><td>Black</td><td>ASD</td><td>Nonverbal (signs)</td></tr><tr><td>9</td><td>9</td><td>Male</td><td>Black</td><td>ASD</td><td>Single word mands (vocal)</td></tr><tr><td>10</td><td>5</td><td>Female</td><td>Black</td><td>Developmental delay–unspecified</td><td>Single word mands (gestures)</td></tr><tr><td>11</td><td>7</td><td>Male</td><td>Black</td><td>ASD</td><td>Nonverbal (gestures)</td></tr><tr><td>12</td><td>5</td><td>Female</td><td>White</td><td>ASD</td><td>Short sentences (vocal)</td></tr><tr><td>13</td><td>4</td><td>Male</td><td>Black</td><td>ASD</td><td>Nonverbal (gestures)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. ASD = autism spectrum disorder.</p> <p>Participants had limited access to the edible items assessed outside of the study. Other than a 30-min lunch, participants in the toileting program had access to a small piece of food (e.g., one Skittle) after continent voids. On the day of the combined assessment, participants consumed a mean of 3.23 small portions of the edible item (range = 0–15, median = 1). Therapists did not conduct edible assessments immediately after lunch. Although therapists often conducted the combined MSWO on the same day as the edible MSWO, satiation was unlikely, given the relatively small amount of edible in each presentation (e.g., a single Skittle, half of a chip, and a quarter of a cookie), and that we conducted only three series in each assessment. The therapist selected items based on caregiver interviews and clinical observations (see Table 2). Electronic items were defined as tablets, computers, smartphones, or gaming devices.</p> <p>Graph</p> <p>Table 2. Results of Each Preference Assessment With Items Listed in Rank Order.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Participant</th><th align="center">Edible MSWO</th><th align="center">Leisure MSWO</th><th align="center">Combined</th></tr></thead><tbody><tr><td>1</td><td>Sour Cream & Cheddar (SCC) chips, plain Lays, Doritos, Goldfish, Oreos</td><td>iPad, trains, musical radio, cars, guitar</td><td>iPad, musical radio, train, plain Lays, Doritos, SCC chips</td></tr><tr><td>2</td><td>Cheez-Its, Pop tart, plain Lays, popcorn, Cheetos, Goldfish</td><td>iPad, guitar, drum, music box, bubblies, radio</td><td>iPad, Cheez-Its, drum, Pop tart, plain Lays, music box</td></tr><tr><td>3</td><td>Pudding, ice cream, cookie, jello, apple sauce, banana</td><td>iPad, basketball, school bus, blocks, music ball, music box</td><td>Ice cream, pudding, basketball, cookie, iPad, school bus</td></tr><tr><td>4</td><td>SCC chips, Sour Cream & Onion chips, Oreos, cookies, plain chips, frosted flakes, cinnamon toast crunch</td><td>iPad, Wii U, bouncy ball, basketball, scooter, football</td><td>Wii U, iPad, Oreos, sour cream and onion chips, SCC Chips, bouncy ball</td></tr><tr><td>5</td><td>M&Ms, Swedish Fish, popcorn, Chex Mix, chocolate chip cookies</td><td>iPad, board game, books, coloring books, puzzles</td><td>M&Ms, iPad, Swedish Fish, board game, popcorn, books</td></tr><tr><td>6</td><td>Kit Kat, M&Ms, Doritos, plain chips, BBQ chips</td><td>iPad, Play-Doh, spinning ball, jingle bug, spikey ball</td><td>Kit Kat, iPad, M&Ms, Doritos, Play-Doh, spinning toy</td></tr><tr><td>7</td><td>Oreo, gummy, M&Ms, Goldfish, jellybeans, Gummy Bears</td><td>iPad, dump trucks, trampoline, guitar, puzzle, shape board</td><td>Gummy, Oreo, M&Ms, dump truck, iPad, trampoline</td></tr><tr><td>8</td><td>Tic Tac, lollipop, apple chip, banana chip, potato chip</td><td>iPad, drawing toy, dinosaur, music cube, guitar</td><td>iPad, Tic Tac, Lollipop, dinosaur, drawing toy, apple chip</td></tr><tr><td>9</td><td>Cookies, Chex Mix, Cheetos, oranges, peaches fruit cup, pineapple fruit cup, apple</td><td>iPad, basketball, cars, action figure, legos</td><td>Cookies, iPad, basketball, Chex Mix, Cheetos, cars</td></tr><tr><td>10</td><td>Jello, apple sauce, Mac & Cheese, pears, Go-Gurt</td><td>iPad, drum set, puzzle, bubbles, car</td><td>Puzzle, Mac & Cheese, drum set, apple sauce, iPad, jello</td></tr><tr><td>11</td><td>Oreo, popcorn, M&Ms, cookies, gummy worm, Goldfish</td><td>iPad, storm trooper, magnets, trampoline, bubbles, music cube</td><td>iPad, M&Ms, magnets, popcorn, Oreo, Storm Trooper</td></tr><tr><td>12</td><td>M&Ms, gummies, Oreos, Goldfish, Lays</td><td>iPad, music dog, school bus, bubbles, drawing toy, elephant toy</td><td>iPad, M&Ms, Oreo, gummies, school bus, music dog</td></tr><tr><td>13</td><td>M&Ms, gummies, fruit snacks, cookies, plain chips, BBQ chips</td><td>iPad, jingle bug, truck, blocks, figurines, dinosaurs</td><td>M&Ms, fruit snacks, iPad, gummies, jingle bug, truck</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. The first item listed represents the top-ranked item in that assessment, the second item listed represents the second-ranked item in that assessment, and so forth. MSWO = multiple stimulus without replacement.</p> <hd id="AN0158319590-4">Data Collection and Interobserver Agreement (IOA)</hd> <p>Data collectors recorded the item selected, which was defined as the individual touching, pointing, or verbally requesting an item within 30 s of presentation. The data sheet included a table with a row representing each presentation. Therapists either wrote in the item selected on that presentation or marked if there was no response. We then ranked items based on selection order within each series (one for the first item selected, two for the second item selected) and averaged across three series. Thus, items with lower average rankings represent items selected earlier in the preference assessment (the more preferred items). A second data collector independently scored 89.69% of edible, 79.38% of leisure, and 92.31% of combined trials. We calculated IOA by dividing the number of trials with agreement (same item recorded as selected) by the total number of trials, yielding a mean IOA of 99.54% (range = 88.89%–100%).</p> <hd id="AN0158319590-5">Procedure</hd> <p>Therapists conducted three preference assessments: edible items only, leisure items only, and combined items (both edible and leisure). Therapists conducted brief MSWO preference assessments with three series, using the same procedure as past research (e.g., [<reflink idref="bib7" id="ref44">7</reflink>]; [<reflink idref="bib16" id="ref45">16</reflink>]). Specifically, for each MSWO, the therapist preexposed participants to each item by prompting consumption of edible items or approximately 5 s of engagement with each leisure item. Next, the therapist presented all items in an array in front of the participant and instructed the participant to "pick one." If the participant did not select an item within 30 s or attempted to select multiple items, all items were removed and then re-presented with the repeated instruction of "pick one." If the participant selected an item, the therapist delivered the selected item for 30 s (leisure items) or until consumption (edible items). The therapist then removed the selected item from the array and presented remaining items in a new array for the next trial of the assessment. The therapist repeated this process until the participant selected all items or did not select an item within 30 s for two consecutive presentations/trials. In total, there were 668 trials across all participants (219 edible, 215 leisure, and 234 combined), with a mean of 5.71 trials per series per participant (range = 3–8). The therapist rearranged the order of items in the array between each presentation to account for side biases in selection.</p> <p>If the participant did not select an item after two presentations, the remaining items were marked with an "X" on the data sheet. For the purpose of averaging the rank order of selection, they were entered as tied for last place (i.e., if there were six items in the MSWO and two items were not selected, they were both marked as six for the average rankings). No selection occurred on only 17 trials (2.54% of total trials). We used the order of selection for the rank order without consideration of consumption. However, the data collector noted on the data sheet whether an item was selected and not consumed, which occurred on only seven trials. In these situations, the therapist kept the item within arm's reach of the child for 30 s and then removed the item and proceeded to the next trial.</p> <p>We did not conduct any training or baseline assessments for the "pick one" instruction used in the procedures. However, given the relatively small number of trials with no selection, it is likely that the behavioral prerequisite skills needed to follow the "pick one" instruction were in the participants' behavioral repertoires prior to the study.</p> <p>The therapist administered separate brief MSWOs for edible and leisure items, followed by a combined brief MSWO using the top-ranked three items from the initial assessments. If two items tied for the third-ranked spot, we randomly selected one item for inclusion in the combined assessment. For Participant 2, the second-ranked leisure item broke prior to the combined assessment; thus, the therapist included the first-, third-, and fourth-ranked items in the combined assessment.</p> <hd id="AN0158319590-6">Results</hd> <p>We present the results of the individual and combined preference assessments for all participants in Figure 1 (rank order) and Figures 2 and 3 (selection percentage). Participant graphs are ordered to show all participants with a leisure item ranked first in the combined assessment together (graphs in Columns 1 and 2) followed by all participants with an edible item ranked first in the combined assessment (Columns 3 and 4).</p> <p>Graph: Figure 1. Average stimulus rank from the edible only, leisure only, and combined MSWOs. Figure 1b provides the legend for Figure 1a. Note. MSWO = multiple stimulus without replacement; SCC = sour cream and cheddar chips; SCO = sour cream and onion chips.</p> <p>Graph: Figure 2. Percentage of presentations with selection for each item in the combined preference assessment for participants with a leisure item as the most preferred. Note. SCC = sour cream and cheddar chips; SCO = sour cream and onion chips.</p> <p>Graph: Figure 3. Percentage of presentations with selection for each item in the combined preference assessment for participants with an edible item as the most preferred.</p> <p>Six out of 13 (46.2%) participants' most preferred item in the combined assessment was an edible item. One of these participants (P7) selected all edible items over all leisure items (exhibiting displacement). Seven participants (53.9%) selected a leisure item first in the combined assessment. None exhibited displacement of edible items by leisure items (see Figure 1). Figure 4 shows the relative percentage of participants with a top-ranked edible item in the combined assessment compared with past studies. Results from this study are most similar to those of the two most recent studies ([<reflink idref="bib7" id="ref46">7</reflink>]; [<reflink idref="bib16" id="ref47">16</reflink>]), identifying a smaller percentage of participants with a preference for edible compared with leisure items than in other past studies ([<reflink idref="bib2" id="ref48">2</reflink>]; [<reflink idref="bib8" id="ref49">8</reflink>]; [<reflink idref="bib9" id="ref50">9</reflink>]).</p> <p>Graph: Figure 4. Percentage of participants with edible items ranked among highest preferred items in the combined assessment across studies.</p> <hd id="AN0158319590-7">Discussion</hd> <p>The results of this study replicate and extend prior research evaluating relative preference for edible and leisure items ([<reflink idref="bib7" id="ref51">7</reflink>]; [<reflink idref="bib16" id="ref52">16</reflink>]) in that it indicated that fewer participants preferred edible compared with leisure items than was the case in older research ([<reflink idref="bib2" id="ref53">2</reflink>]; [<reflink idref="bib8" id="ref54">8</reflink>]; [<reflink idref="bib9" id="ref55">9</reflink>]). Our participants had limited access to edible items outside of the study. Thus, our procedures in this way were more similar to those of earlier studies ([<reflink idref="bib2" id="ref56">2</reflink>]; [<reflink idref="bib8" id="ref57">8</reflink>]; [<reflink idref="bib9" id="ref58">9</reflink>]) in comparison with more recent studies where their participants had access to edibles between study procedures ([<reflink idref="bib7" id="ref59">7</reflink>]). Our results suggest that variability in displacement across studies is likely not fully attributable to differences in the availability of edibles in the study setting, further supporting results from Bojak and Carr. This is an important finding as this explanation has been commonly mentioned in past studies ([<reflink idref="bib7" id="ref60">7</reflink>]; [<reflink idref="bib8" id="ref61">8</reflink>]).</p> <p>There are several alternative explanations for less displacement of leisure by edible items in recent evaluations ([<reflink idref="bib7" id="ref62">7</reflink>]; [<reflink idref="bib16" id="ref63">16</reflink>], and our results) compared with others ([<reflink idref="bib2" id="ref64">2</reflink>]; [<reflink idref="bib8" id="ref65">8</reflink>]; [<reflink idref="bib9" id="ref66">9</reflink>]). Namely, the inclusion of electronic items may serve as an explanatory function if electronic items are more preferred than nonelectronic leisure items. Electronic items may be more preferred than other leisure items if they provide multiple sources of reinforcement in one item (e.g., a child may watch videos, listen to music, and play games on a tablet) as this might create the opportunity for choice within the item and reduce satiation. In considering this possible explanation, it is important to consider that only four participants from Slanzi et al. chose an electronic item as the top leisure item, yet they still found less displacement than older studies. Thus, it is possible that electronic items (defined as a tablet, smartphone, or laptop) are not an all-inclusive explanation of our findings. A related explanation not explored in this study is the advancement of leisure items in general. For instance, several toys we did not define as electronics still had technological advancements that could increase the reinforcing value of the toy. These electronic advancements were likely less prolific in studies done in the 1990s. For example, the toy bus in this study both lights up and makes noise, and some puzzles had pieces that make noise when put in the correct spot. It is possible that this was also the case for items included by Slanzi and colleagues. Future research needs to explore the impact on displacement of items with technological advancements outside of those traditionally defined as electronics.</p> <p>Another alternative explanation is the sample differences across studies. Participants in recent studies, with less displacement of leisure by edible items, included all or mostly participants diagnosed with ASD, compared with previous studies with individuals with intellectual disabilities but no ASD diagnosis ([<reflink idref="bib2" id="ref67">2</reflink>]; [<reflink idref="bib8" id="ref68">8</reflink>]). It is possible that diagnostic characteristics and comorbidities of ASD, including repetitive interests and food selectivity, will alter individuals' reinforcement histories and subsequent preference for items from various classes. Although all of the participants in our sample were diagnosed with a developmental delay, two participants did not have ASD (one with Jacobsen syndrome and one with a general developmental delay–unspecified). Unfortunately, we did not have a sufficient sample size to evaluate the impact of diagnosis on preference, which is an important area for future study.</p> <p>It is also possible that differences in reinforcement history for children and adults with intellectual and developmental disabilities could shift across time. For example, toys advertised for their sensory aspects (e.g., scented beads and slime—both included in [<reflink idref="bib16" id="ref69">16</reflink>]) may be more commonly included for children with disabilities in recent studies due to increased awareness of items and activities that focus on sensory stimulation (e.g., [<reflink idref="bib1" id="ref70">1</reflink>]; [<reflink idref="bib10" id="ref71">10</reflink>]). In addition, due to recent insurance reform that has enhanced coverage of early intervention services ([<reflink idref="bib4" id="ref72">4</reflink>]), participants in recent studies could experience early exposure to a variety of leisure items through increased access to early intervention services that may include appropriate toy play as a target ([<reflink idref="bib14" id="ref73">14</reflink>]). These explanations are still very preliminary and require further investigation.</p> <p>Finally, it is possible that an interactive effect between several of the abovementioned variables best explains the different results across studies. For example, past research has suggested that individuals with ASD spend more time on electronics than their typically developing peers ([<reflink idref="bib15" id="ref74">15</reflink>]). Children with ASD are also more likely to experience early intervention services ([<reflink idref="bib17" id="ref75">17</reflink>]). Thus, there could be an interaction between diagnostic characteristics, preference for electronic items, and a history of exposure to more leisure items, which combined to account for variability in results of past studies.</p> <hd id="AN0158319590-8">Limitations</hd> <p>There are several limitations of the present study. First, we did not include a reinforcer assessment to verify results. Future research may bolster findings by conducting reinforcer assessments with the top edible and leisure items to determine whether displaced items still function as reinforcers. Understanding the prevalence of when displaced items still serve as reinforcers may further facilitate the development of guidelines surrounding when to conduct separate and combined preference assessments.</p> <p>In addition, although similar in size to past studies on this topic, our sample size is relatively small (<emph>n</emph> = 13). Replications with more participants might allow for additional analyses about which variables contribute to the occurrence of displacement. For example, participants in our sample spanned a large age range, but our sample was too small to evaluate the impact of age on preference. Future research with a larger sample in various age ranges should evaluate this potential variable.</p> <p>Studies to date, including the present study, also have the limitation of variations in settings and a lack of information regarding participants' cognitive and social functioning. Our study includes participants' primary mode of communication, which builds on past research by providing one measure of adaptive functioning. However, this is not a proxy for global cognitive functioning, and future research needs to include additional detail (including standardized cognitive assessments with nonverbal measures). The results of our study did not suggest differential patterns of responding in the combined assessment based on verbal functioning level. For example, the two individuals who spoke in full sentences in this study exhibited different patterns of responding in the combined assessment. Similarly, [<reflink idref="bib9" id="ref76">9</reflink>] did not identify differences based on diagnosis. It is possible that these variables play a role in predicting displacement, but a larger sample is necessary to detect potentially complex relationships statistically. Thus, future research would benefit from documenting standardized participant information and/or comparing preferences and displacement across groups with differing characteristics using larger samples.</p> <p>Finally, we did not conduct separate combined assessments with and without electronic items. It is possible to determine a proxy for what a combined assessment might have looked like without electronic items by evaluating the rank order with these items removed from the data. However, future research might consider replicating preference assessment procedures with and without electronic items to further evaluate the impact of inclusion of electronics on displacement.</p> <hd id="AN0158319590-9">Conclusion</hd> <p>The results of this study suggest that displacement of leisure by edible items may be less prevalent than previously thought in a sample of children with developmental delays when including electronic items as part of the leisure assessment. Although the reason behind this variability continues to require additional research, there are several practical implications of our findings for providers. First, given the potential explanation of inclusion of electronic items resulting in less displacement of leisure by edible items, providers should include electronics in preference assessments, especially if use of a leisure item (compared with an edible item) in treatment or school settings is more socially valid for the client. It may also be beneficial for providers to expose clients or students to a range of leisure items that vary in their advancement and level of technology (e.g., number of sensory components, availability of choices, and multi-functionality) prior to or during preference assessments. Thorough evaluation of varied types of leisure items may help decrease displacement and overreliance on edible items during intervention programming.</p> <p>When interested in assessing multiple classes of reinforcers, providers should evaluate classes, both separately and combined, to identify the most preferred items for programming until future research can shed additional light on the likelihood of displacement and preference under various circumstances. In conducting both separate and combined assessments, providers can also ensure they identify a full hierarchy of preferred items both within and across classes of reinforcers. Given that more highly preferred items may remain stable in their reinforcing value across time ([<reflink idref="bib5" id="ref77">5</reflink>]), but displaced items ranked lower on a combined assessment may still function as reinforcers for some clients, information from both separate and combined assessments will allow providers to make the most informed decisions possible while creating reinforcer hierarchies for behavioral programming.</p> <p>Finally, our findings replicate others that show exposure to edibles does not seem to impact the occurrence of displacement. Although providers should always consider whether motivating operations may impact assessment results, the need to purposefully time preference assessments around the delivery of edibles for other reasons may not be as important as previously thought.</p> <ref id="AN0158319590-10"> <title> References </title> <blist> <bibl id="bib1" idref="ref70" type="bt">1</bibl> <bibtext> Autism Speaks. (2018). Ten toys and games for autistic toddlers and children. https://<ulink href="http://www.autismspeaks.org/news/ten-autism-toys">www.autismspeaks.org/news/ten-autism-toys</ulink></bibtext> </blist> <blist> <bibl id="bib2" idref="ref8" type="bt">2</bibl> <bibtext> Bojak S. L., Carr J. E. (1999). On the displacement of leisure items by food during multiple-stimulus preference assessments. Journal of Applied Behavior Analysis, 32(4), 515–518. https://doi.org/10.1901/jaba.1999.32-515</bibtext> </blist> <blist> <bibl id="bib3" idref="ref10" type="bt">3</bibl> <bibtext> Carter A. B., Zonneveld K. L. M. (2019). A comparison of displacement and reinforcer potency for typically developing children. Journal of Applied Behavior Analysis, 53(2), 1130–1144. https://doi.org/10.1002/jaba.636</bibtext> </blist> <blist> <bibl id="bib4" idref="ref72" type="bt">4</bibl> <bibtext> Choi K. R., Knight E. A., Stein B. D., Coleman K. J. (2020). Autism insurance mandates in the US: Comparison of mandated commercial insurance benefits across states. Maternal and Child Health Journal, 24, 894–900. https://doi.org/10.1007/s10995-020-02950-2</bibtext> </blist> <blist> <bibl id="bib5" idref="ref3" type="bt">5</bibl> <bibtext> Ciccone F. J., Graff R. B., Ahearn W. H. (2007). Long-term stability of edible preferences in individuals with developmental disabilities. Behavioral Interventions, 22(3), 223–228. https://doi.org/10.1002/bin.238</bibtext> </blist> <blist> <bibl id="bib6" idref="ref5" type="bt">6</bibl> <bibtext> Clark S. B., Call N. A., Simmons C. A., Scheithauer M. C., Muething C. S., Parks N. (2020). Effects of magnitude on the displacement of leisure items by edible items during preference assessments. Behavior Modification, 44(5), 727–745. https://doi.org/10.1177/0145445519843937</bibtext> </blist> <blist> <bibl id="bib7" idref="ref6" type="bt">7</bibl> <bibtext> Conine D. E., Vollmer T. R. (2019). Relative preferences for edible and leisure stimuli in children with autism. Journal of Applied Behavior Analysis, 52, 557–573. https://doi.org/10.1002/jaba.525</bibtext> </blist> <blist> <bibl id="bib8" idref="ref7" type="bt">8</bibl> <bibtext> DeLeon I. G., Iwata B. A., Roscoe E. M. (1997). Displacement of leisure reinforcers by food during preference assessments. Journal of Applied Behavior Analysis, 30(3), 475–484. https://doi.org/10.1901/jaba.1997.30-475</bibtext> </blist> <blist> <bibl id="bib9" idref="ref11" type="bt">9</bibl> <bibtext> Fahmie T. A., Iwata B. A., Jann K. E. (2015). Comparison of edible and leisure reinforcers. Journal of Applied Behavior Analysis, 48(2), 331–343. https://doi.org/10.1002/jaba.200</bibtext> </blist> <blist> <bibtext> Good Housekeeping. (2018). The best toys for children with autism. https://<ulink href="http://www.goodhousekeeping.com/childrens-products/g21596632/autism-toys/?slide=215966321">www.goodhousekeeping.com/childrens-products/g21596632/autism-toys/?slide=215966321</ulink></bibtext> </blist> <blist> <bibtext> Green C. W., Reid D. H., Canipe V. S., Gardner S. M. (1991). A comprehensive evaluation of reinforcer identification processes for persons with profound multiple handicaps. Journal of Applied Behavior Analysis, 24(3), 537–552. https://doi.org/10.1901/jaba.1991.24-537</bibtext> </blist> <blist> <bibtext> Karsten A. M., Carr J. E., Lepper T. L. (2011). Description of a practitioner model for identifying preferred stimuli with individuals with autism spectrum disorders. Behavior Modification, 35(4), 347–369. https://doi.org/10.1177/0145445511405184</bibtext> </blist> <blist> <bibtext> Leader G., Ruohy E., Chen J. L., Mannion A., Gilroy S. P. (2020). Feeding problems, gastrointestinal symptoms, challenging behavior and sensory issues in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50, 1401–1410. https://doi.org/10.1007/s10803-019-04357-7</bibtext> </blist> <blist> <bibtext> MacDonald R., Parry-Cruwys D., Dupere S., Ahearn W. (2014). Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Research in Developmental Disabilities, 35(12), 3632–3644. https://doi.org/10.1016/j.ridd.2014.08.036</bibtext> </blist> <blist> <bibtext> Mazurek M. O., Wenstrup C. (2013). Television, video game and social media use among children with ASD and typically developing siblings. Journal of Autism and Developmental Disorders, 43, 1258–1271. https://doi.org/10.1007/s10803-012-1659-9</bibtext> </blist> <blist> <bibtext> Slanzi C. A., Graziano M., D'Angelo G., Vollmer T. R., Conine D. E. (2020). Relative preference for edible and leisure stimuli in children with autism: A replication in Italy. Journal of Applied Behavior Analysis, 53(4), 2429–2439. https://doi.org/10.1002/jaba.666</bibtext> </blist> <blist> <bibtext> Trump C. E., Ayres K. M. (2020). Autism, insurance, and discrimination: The effect of an autism diagnosis on behavior-analytic services. Behavior Analysis in Practice, 13(1), 282–289. https://doi.org/10.1007/s40617-018-00327-0</bibtext> </blist> <blist> <bibtext> Tullis C. A., Cannella-Malone H. I., Basbigill A. R., Yeager A., Fleming C. V., Payne D., Wu P. (2011). Review of the choice and preference assessment literature for individuals with severe to profound disabilities. Education and Training in Autism and Developmental Disabilities, 46(4), 576–595.</bibtext> </blist> <blist> <bibtext> Virués-Ortega J., Pritchard K., Grant R. L., North S., Hurtado-Parrado C., Lee M. S. H., Temple B., Julio F., Yu C. T. (2014). Clinical decision making and preference assessment for individuals with intellectual and developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 119(2), 151–170. https://doi.org/10.1352/1944-7558-119.2.151</bibtext> </blist> <blist> <bibtext> Vladescu J. C., Kodak T. (2010). A review of recent studies on differential reinforcement during skill acquisition in early intervention. Journal of Applied Behavior Analysis, 43(2), 351–355. https://doi.org/10.1901/jaba.2010.43-351</bibtext> </blist> </ref> <ref id="AN0158319590-11"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> </ref> <aug> <p>By Mindy Scheithauer; Clarissa Martin and Summer Bottini</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib11" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib18" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib20" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref12"></nolink> <nolink nlid="nl5" bibid="bib19" firstref="ref13"></nolink> <nolink nlid="nl6" bibid="bib16" firstref="ref19"></nolink> <nolink nlid="nl7" bibid="bib13" firstref="ref29"></nolink> <nolink nlid="nl8" bibid="bib10" firstref="ref71"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref73"></nolink> <nolink nlid="nl10" bibid="bib15" firstref="ref74"></nolink> <nolink nlid="nl11" bibid="bib17" firstref="ref75"></nolink>
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  Data: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: <searchLink fieldCode="DE" term="%22Preferences%22">Preferences</searchLink><br /><searchLink fieldCode="DE" term="%22Food%22">Food</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+Equipment%22">Electronic Equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+Methods%22">Evaluation Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Best+Practices%22">Best Practices</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Reinforcement%22">Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Toys%22">Toys</searchLink><br /><searchLink fieldCode="DE" term="%22Leisure+Time%22">Leisure Time</searchLink><br /><searchLink fieldCode="DE" term="%22Clinics%22">Clinics</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Toilet+Training%22">Toilet Training</searchLink><br /><searchLink fieldCode="DE" term="%22Handheld+Devices%22">Handheld Devices</searchLink><br /><searchLink fieldCode="DE" term="%22Telecommunications%22">Telecommunications</searchLink><br /><searchLink fieldCode="DE" term="%22Musical+Instruments%22">Musical Instruments</searchLink><br /><searchLink fieldCode="DE" term="%22Stimuli%22">Stimuli</searchLink><br /><searchLink fieldCode="DE" term="%22Therapy%22">Therapy</searchLink>
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  Data: Early studies evaluating the relative preference for leisure compared with edible items suggested that, for most participants (>80%), edible items are more preferred than leisure items. Recent studies suggest more variability in the percentage of participants with this preference. The rationale for this variability could be sampling, setting, availability of items outside of the study, or the items included. As a systematic replication, we conducted preference assessments of leisure, edible, and leisure/edible items combined of 13 children with developmental disabilities. As an inclusion criterion, all participants had an electronic item as the top-preferred leisure item. An edible item ranked first in the combined assessment for 46.2% of participants. This replicates recent findings while accounting for access to edibles outside of the study. These outcomes are important to guide use of preference assessments across reinforcer classes in clinical and school settings.
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      – SubjectFull: Preferences
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      – SubjectFull: Developmental Disabilities
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      – TitleFull: Preferences for Edible and Electronic Leisure Items: A Systematic Replication
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            – Type: volume
              Value: 37
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Focus on Autism and Other Developmental Disabilities
              Type: main
ResultId 1