Treatment of Liquid and Medication Refusal in an Adult With Intellectual Disability, Epilepsy, and Challenging Behavior

The effectiveness of a behavioral intervention was evaluated in an adult with intellectual disability, epilepsy, and challenging behavior who had ceased oral intake of liquids and medications. The intervention consisted of fading, designed to gradually increase the volume of water accepted; backward chaining, involving bringing a cup to the lips, introducing liquid into the mouth, and ultimately swallowing; and differential reinforcement. A descriptive functional assessment revealed that the most common consequences of intake refusal were access to preferred conversation topics from parents and hospital staff and escape. Baseline measures showed little or no acceptance of liquids or medications. Following fading and differential reinforcement, swallowing was established and increased to 90 ml of water, while medication intake reached 100% success. Treatment gains were maintained in both clinic and home settings. The study replicated the findings of Hagopian et al. (1996) and extended their generality to an adult client and the oral intake of medication. Social validity scores were favorable for both parents.