|Further Developments in the Assessment and Treatment of Pediatric Feeding Disorders
|Saturday, May 24, 2008
|2:30 PM–3:50 PM
|Area: DDA/EAB; Domain: Applied Research
|Chair: Anjali Barretto (Gonzaga University)
|Discussant: Cathleen C. Piazza (Munroe-Meyer Institute)
|Abstract: The most frequently used treatment for food refusal in young children is escape extinction which is based primarily on the negative reinforcement function of the target behavior. However some studies have shown that other antecedents and consequences may alter the effects of escape extinction used to treat food refusal. The effects of these variables are usually assessed via functional analyses or during treatment evaluation. In this symposium we will present three studies that discuss these antecedent and consequent variables as they relate to the effectiveness of treatment of food refusal. Betsy Zamora from the University of South Florida will present data on the treatment of food refusal conducted in the home setting. Melanie Bachmeyer from the University of Iowa will present on the interaction between escape extinction, noncontingent reinforcement, and deprivation during treatment of food refusal. Finally, Kristi Murphy from University of Nebraska Medical Center will present on the effects of matched treatments on multiply controlled feeding behaviors.
|Home-Based Functional Assessment and Intervention for Food Refusal.
|BETSY M. ZAMORA (University of South Florida), Raymond G. Miltenberger (University of South Florida), Jessica Thompson (University of South Florida)
|Abstract: This presentation will discuss assessment and intervention for a feeding disorder exhibited by a 20-month-old boy. Food refusal began following a severe reflux problem as an infant and resulted daily supplemental feeding with a gastric tube. Although the reflux was abated with medication, functional assessment data collected via interview and direct observation at meals indicated that food refusal behaviors were maintained by parent attention and the receipt of preferred foods. Intervention implemented by the parents in the home at regular meals involved extinction for refusal behaviors, attention for bites of non-preferred foods, and preferred foods delivered contingent on eating a portion of non-preferred food with the portion size increasing over time. Meals were videotaped to provide feedback to parents regarding their implementation of the intervention and for data collection. The results showed that refusal behaviors decreased markedly, eating increased to goal levels, and the supplemental G-tube feedings were stopped. We discuss factors related to success of the intervention implemented by parents in the home.
|A Systematic Evaluation of the Interactions between Escape Extinction, Noncontingent Reinforcement, and Deprivation in the Treatment of Food Refusal.
|MELANIE H. BACHMEYER (University of Iowa), David P. Wacker (University of Iowa), Linda J. Cooper-Brown (University of Iowa), Brenda J. Engebretson (University of Iowa)
|Abstract: Children diagnosed with pediatric feeding disorders often require eternal nutritional support (e.g., nasogastric or gastrostomy tube feeds) to sustain their growth. As oral feedings are introduced, it is likely that satiation-related effects during oral feedings may occur (e.g., decreased motivation to consume foods, increased refusal). Alternatively, reducing the overall volume of tube feedings may minimize satiation-related effects and increase motivation for consumption (via deprivation). This study examined the effects of operant-based procedures commonly used in the treatment of feeding problems (i.e., escape extinction and noncontingent reinforcement) on food acceptance and consumption while the volume of overnight tube feedings was systematically manipulated. During deprivation phases, the total volume of overnight tube feeds was reduced (57%). By contrast during satiation phases, overnight tube feeds comprised of 100% of the child’s daily caloric needs were administered. Two independent observers achieved over 90% agreement on over 30% of sessions. Results suggested an interaction between satiation and deprivation and the necessity for each operant-based procedure, individually. Results will be discussed in terms of the role of biologic motivating operations in the treatment of pediatric feeding disorders.
|The Relative Effects of Matched Treatment Packages on Multiply Controlled Feeding Behaviors.
|KRISTI D. MURPHY (Munroe-Meyer Institute), Cathleen C. Piazza (Munroe-Meyer Institute), Heather Kadey (Munroe-Meyer Institute)
|Abstract: Pediatric feeding disorders may be manifested in a variety of ways including high levels of inappropriate mealtime behavior and low levels of consumption. Prior research has shown that functional analysis methods can be used to identify the maintaining variables of inappropriate mealtime behavior. This research indicated that for a large percentage of the children who displayed differentiated functional analysis results (80%), inappropriate mealtime behavior was maintained by access to multiple environmental variables (negative and positive reinforcement). However, the results of past research have focused only on negative reinforcement as the major maintaining variable of feeding problems. Therefore, the purpose of the current investigation was to systematically examine treatments consisting of extinction and reinforcement components that were individually matched to all maintaining variables of multiply-controlled inappropriate mealtime behaviors. Results indicated that for all participants with multiply-maintained inappropriate mealtime behavior, the most effective treatment was one in which the extinction and reinforcement components were matched to all maintaining variables (escape and attention) of inappropriate mealtime behavior.