Food was used as a reward in both ABA (a type of behavioural therapy) and PECS (a system used for speech therapy) for my autistic son. In both situations I felt very uncomfortable with this type of reward, for a variety reasons, including that I didn’t want to associate food with reward (the problems of the obesity epidemic get drummed into you as a parent-to-be); I didn’t want to be giving him his favourite foods as often as the reward systems required (his most motivating food was chocolate drops); and frankly, it felt like I was treating him as a dog. I also worried that we would be setting up a life-long dependence on physical / external rewards for behaviour, which was counter to how the world really operates; often you just have to do things because it’s the right thing to do, or because it has to simply get done.
In both situations – PECS and ABA – the people implementing the system explained to me why we were using that particular reward, and though it still concerned me at an emotional level, it allayed my concerns enough to give it a go. I still read about other people worrying over this system of reward, to the point that it puts them off trying these therapies at all, which I think is a real shame. So I’ve decided to share what I learnt re why the food reward works so well, and why you need not fear about long-term consequences of such a reward system.
The first step for setting up any reward system, is to first confirm that the reward matters to the child. If the child is not motivated by any foods, then using foods would be pointless. Where there are multiple potential rewards – eg a toy or food – it is better to choose the food option. This is because the food is taken then used up in a short space of time; there is nothing to “take away” in order to re-set the reward. So if you used a toy for example, there would need to be a limit on how long the child played with the toy – more specifically, to be able to use that toy as a reward again you’d have to take it away, and that might (very likely would) cause a melt-down, and there goes your learning session. Also, the distraction of having and playing with the toy (or any other non-consumable) is a significant distraction from the learning session. Usually you’ll have chosen a time in the day when the child is receptive to learning (they’re well rested, alert), so you want to make the most of that window in time, and not have it all taken up in play-time with the reward.
The amount of food need not be significant, so your child’s diet isn’t going to be ruined by too many sweets, and it’s not going to make them obese. In fact, it is best for the food to be very small amounts so it can quickly be consumed (return to the next lesson), and leave the child desiring more (a full and fully satisfied child isn’t going to be as responsive to the reward).
The food reward is also only an initial stage of learning, to set up a close and strong relationship between desired behaviour or learnt skill, and a positive emotion. Once the idea has been taught – for example that using a PECS card can get you what the picture shows, or linking the behaviour of sitting down with the request to sit down – then the reward can either be phased out or replaced. In PECS, the idea is easily phased out once the child learns that picture X means you get item X, because you can move on to item and picture Z. More complicated steps follow – when the PECS cards move on from a system of request, to a system of communication more generally – but it needs to start with that initial established link between a picture card and an outcome that the child desires.
In ABA, the food reward can be replaced with social praise, which should have always happened simultaneously with the food reward from the start – in turn reinforcing the importance and relevance of social praise (which is a challenge for many autistic children). More importantly, with ABA, learning that verbal instructions or requests are linked to performed actions (“please sit”, child sits – initially with physical help from instructor, eventually by themself – gets food and praise), is in itself a rewarding experience for the child; their world starts to make more sense and by performing requested actions (eg sitting) they get more of what they want in the world independently of the food reward (eg being read their favourite book since they sat down when asked and where required).
So, in summary, the negative reaction many of us parents have to using food as a reward – concerns over obesity, the type of food, and making it feel like our child is a dog – need not concern us when we understand the reality of this system of reinforcement: Not only are the food rewards small, they are also phased out as the initial skills of each therapy are learnt. They are also highly effective, because they provide immediate positive reinforcement, and are consumables, allowing the lessons to continue, and making the most of that window of learning. The outcomes from successful (and correct) implementation of such therapies, are so strong and positive, that they are worth that initial and brief emotional discomfort as a parent. Which is not to say that every implementation of these therapies is done well / correctly, nor that every child will respond as well as our son did to these therapies; merely to say that the food reward system in itself, is not a reason to turn away from these therapy options.