A Synthesis of Research on the Effects of the High-Probability Instructional Sequence in Children with Feeding Disorders
The high-probability (high-p) instructional sequence is an intervention commonly used to increase compliance. It involves delivering a series of requests with a high probability of compliance prior to the delivery of a request with a low probability of compliance. Researchers have evaluated whether the high-p sequence can increase compliance with low probability (low-p) mealtime demands to consume nonpreferred foods in children with pediatric feeding disorders, for example, by delivering multiple high-p mealtime demands to consume a preferred food prior to the delivery of a low-p mealtime demand (e.g., to consume a bite of a nonpreferred food). The effects of the high-p sequence have varied across studies, and a systematic synthesis of the literature to guide practice and further research is lacking. We conducted a systematic multistep search, identified seven studies that met inclusion criteria, and synthesized participant and study characteristics. The results suggest that (a) the high-p sequence can improve compliance with low-p mealtime demands in young children with feeding disorders but more research is needed to clarify when and for whom the intervention is likely to be effective, and (b) additional research should examine the effects of the high-p on feeding in older children or adults with disabilities as more intrusive procedures such as escape extinction-based become inappropriate. We conclude with preliminary practice guidelines.