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| The Contribution of Motivating Operations in the Treatment of Pediatric Feeding Disorders |
| Tuesday, May 26, 2009 |
| 10:30 AM–11:50 AM |
| North 224 A |
| Area: CBM; Domain: Applied Behavior Analysis |
| Chair: William G. Sharp (The Marcus Autism Center) |
| Discussant: Linda J. Cooper-Brown (The University of Iowa) |
| Abstract: The treatment of pediatric feeding disorders through consequence manipulation has been well documented; however, interventions involving motivating operations (MOs) have garnered less attention. This omission is surprising given that MO manipulations are often implemented in conjuncture with one or more consequence-based strategies rolled into a larger treatment package. The goal of the current symposium is to address this limitation by focusing on the contribution of MOs in the treatment of pediatric feeding disorders. The three studies include participants treated at interdisciplinary feeding programs for severe food selectivity and/or chronic food refusal. In each study, MO manipulations, including variations in tube feedings, food texture, and meal variety, were components of larger treatment packages aimed at increasing oral intake. Single-case research designs were used to evaluate the relative contribution of each treatment procedure on feeding related behaviors (e.g., oral intake; refusal behaviors). Results suggest MO manipulations have the potential to provide practitioners with an expanded repertoire of treatment methods for addressing problematic eating patterns. |
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| Increasing intake through increased variety: A clinical application for children with feeding problems. |
| KEITH E. WILLIAMS (Penn State Hershey Medical Center), Lynette Martin (Penn State Capital Campus), Katherine Riegel (Penn State Milton S. Hershey Medical Center), Candace M. Paul (Penn State Hershey Medical Center), Bianca Pizzo (Penn State Hershey Medical Center), Sara Doyle (Penn State Harrisburg) |
| Abstract: While research conducted with adults has shown that providing a wide variety of foods can increase intake, little related research has been conducted with pediatric populations. In the adult research, the implications of the research findings have often focused on limiting intake or weight management. In the single study involving children, increased food variety decreased the rate of habituation and increased energy intake by up to 42%. The current study involved increasing food variety during meals as a component in a treatment package designed to increase oral intake. The participants were two typically developing children with chronic health issues who were dependent upon supplemental tube feedings. Alternating treatments designs were used to demonstrate that an increased variety of food resulted in increased intake for both children. Both children were weaned from their gastrostomy tube feedings and the use of increased variety as a nonintrusive intervention or a component to a treatment package for the treatment of childhood feeding problems was discussed. |
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| Texture Fading to Increase Consumption in Three Children in an Interdisciplinary Feeding Day Treatment Program. |
| JANE MORTON (The Marcus Autism Center), William G. Sharp (The Marcus Autism Center), David Jaquess (The Marcus Autism Center) |
| Abstract: The use of consequence-based treatment of pediatric feeding disorders have been well documented, including differential reinforcement of appropriate behaviors and escape extinction (EE); however, antecedent manipulations (e.g., bolus size, texture, or variety) often implemented in conjunction with consequence-based procedures have received less empirical attention. In the current study, a texture fading procedure was implemented with three clients enrolled in an interdisciplinary pediatric feeding disorder clinic for the treatment of food selectivity by type and texture. An initial treatment package involving EE was successful in expanding variety, although all foods were at puree texture. Prior to the implementation of fading procedures, texture assessments involving a multi-element design indicated increased problem behaviors associated with foods presented at a higher textures. Systematic texture fading procedures were subsequently employed to increase texture beyond puree. Results from the study are discussed relating to treatment development and generalization of findings to other children with pediatric feeding disorders. |
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| The Role of Appetite on Food Refusal in Young Children. |
| LACEY LEBLANC (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Melissa Luke Gonzalez (Kennedy Krieger Institute) |
| Abstract: Pediatric feeding disorders are serious conditions that affect otherwise typically developing, developmentally delayed, and medically fragile children. If these conditions are not effectively treated, the child may experience other serious medical difficulties including problems with growth and development. Research has demonstrated that behavioral therapy provided within an interdisciplinary treatment package is an effective method for treating children with feeding disorders. Despite the large evidence base supporting behavioral treatment for feeding disorders in children, it is an unfortunate reality that some children do not respond to treatment. This may be especially true for select patients with a history of, or current dependence on, gastrostomy tube feedings. Several case studies highlighting potential motivating operations that may impact successful treatment will be presented. These factors include variables that may have an abolishing affect on appetite or caloric intake. Several subject’s data were examined along with several target variables such weight gain, food acceptance, and percentage of vomiting across the day. Subjects were previous inpatient and day treatment patients enrolled in the Kennedy Krieger Institute’s feeding program to decrease their dependence on tube feeding. Additionally, a future research project designed to systematically investigate the gastrointestinal hormonal profiles of responders versus non-responders to treatment will be discussed. |
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