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| Advancement in the Treatment of Feeding Disorders: Shaping, Fading, Sensory Integration and Parental Adherence |
| Monday, May 29, 2006 |
| 9:00 AM–10:20 AM |
| Kennesaw |
| Area: CBM; Domain: Applied Research |
| Chair: Charles S. Gulotta (Kennedy Krieger Institute) |
| Abstract: There are number of well-researched behavioral treatments for children with pediatric feeding disorders. The complex nature of a feeding disorders etiology requires a range of treatment options. This symposium will continue that trend and will present four papers expanding treatment options for children with pediatric feeding disorders. Our first presentation uses a stimulus fading procedure to reduce the aversive qualities of the meal presentation by fading the distance of the spoon to the child’s mouth. The second presentation compares a behavioral treatment with a sensory integration approach to treat feeding disorders in three children. The third presentation evaluates the efficacy of a shaping procedure on the skill acquisition of food consumption. Finally, our last presentation looks at a systematic method for assessing variables associated with parental adherence to treatment protocols developed for children with a feeding disorder. |
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| An Examination of Stimulus Fading and Escape Extinction in the Treatment of Food Refusal. |
| MELANIE H. BACHMEYER (Marcus Autism Center), Cathleen C. Piazza (Munroe-Meyer Institute), Meeta R. Patel (Clinic 4 Kidz), Kristi D. Murphy (Marcus Autism Center) |
| Abstract: Children with pediatric feeding disorders may display a variety of inappropriate mealtime behaviors (e.g., batting at the spoon, head turning) to avoid eating. It is unclear what properties of eating are aversive to children. It may be that the spoon alone has become aversive because it has been paired with an aversive experience (e.g., gagging, coughing, vomiting). Therefore, children may learn to engage in a variety of behaviors to avoid the presentation of the spoon to the mouth. Previous research has demonstrated the effectiveness of escape extinction in the treatment of food refusal in children with feeding problems. However, escape extinction has also been shown to produce some negative side effects such as extinction bursts and/or emotional responding. Therefore, three studies were conducted to compare the relative effects of escape extinction to a stimulus fading procedure (i.e., manipulating the distance of the spoon to the child’s mouth) in the treatment of food refusal. Results will be discussed in relation to the utility of using stimulus fading as a viable treatment for food refusal. Areas for further study will also be discussed. |
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| A Comparison of the Effects of Escape Extinction Plus Noncontingent Reinforcement and Sensory-Integrative Treatments on Food Consumption and Food Refusal Behavior. |
| LAURA R. ADDISON (Louisiana State University), Cathleen C. Piazza (Munroe-Meyer Institute), Melanie H. Bachmeyer (Marcus Autism Center), Stephanie Stoll (Marcus Autism Center), Allison Martin (Marcus Autism Center), Michele Walker (Marcus Autism Center), Daniela Reyes (Marcus Autism Center), Kristi D. Murphy (Marcus Autism Center) |
| Abstract: Previous research has suggested that the etiology of feeding disorders is multi-factorial. Thus, various treatment hypotheses have been proposed including procedures based on the manipulation of operant variables, as well as procedures based on a sensory integrative approach. The extant literature has suggested that operant conditioning procedures are effective in increasing the acceptance of food; however, less research has been conducted on sensory integrative approaches as treatment for feeding problems. The purpose of this study was to compare the effects of an operant based procedure (i.e., escape extinction plus noncontingent reinforcement) with a sensory integrative therapy as treatment for feeding problems. Participants were three children admitted to an intensive pediatric feeding disorders program for the assessment and treatment of food refusal or poor oral intake. Results indicated that a treatment based on operant procedures was more effective in decreasing inappropriate mealtime behavior and increasing acceptance of food than a sensory integrative approach for all three children. Interobserver reliability exceeded 85% for all participants. |
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| An Evaluation of the Efficacy of a Shaping Procedure to Produce Consumption. |
| KRISTI D. MURPHY (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Cathleen C. Piazza (Munroe-Meyer Institute), Melanie H. Bachmeyer (Marcus Autism Center) |
| Abstract: Shaping is a procedure that has been used in the acquisition of a variety of appropriate behaviors, including appropriate behaviors necessary for food consumption. Although shaping is inherent in many treatments used to increase consumption in children with pediatric feeding disorders, it is rarely explicitly addressed as such. In the current investigation we examined the effects of a shaping procedure on the skill acquisition of necessary components in a behavioral hierarchy of food consumption in two children diagnosed with pediatric feeding disorders. The effects of a shaping procedure on these behaviors were examined within a multiple baseline graph across foods. If these children did not acquire the skills at any point in the behavioral hierarchy with the shaping procedure alone, other procedures were introduced. A general increase in skill acquisition was observed in all participants with the shaping procedure, although other methods were necessary to acquire the terminal response (i.e., swallowing masticated food) for these participants. Two independent observers achieved over 80% agreement on at least 20% of sessions. Implications for the treatment of pediatric feeding disorders and areas for future research will be discussed. |
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| A Systematic Method for Assessing Parental Non-Adherence Following an Intensive Feeding Program: The Parent Adherence Checklist. |
| ELIZABETH A. MASLER (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Tina Sidener (Western Michigan University), Ping Wang (Kennedy Krieger Institute) |
| Abstract: A number of behavioral procedures have been shown to be efficacious in treating children with pediatric feeding disorders. For those children treated intensively in a hospital setting, training parents to implement the treatment effectively is an integral part of the feeding program. In the current study parent integrity measures were examined at the end of parent training for children admitted for an intensive 8-week treatment and at several points of follow-up. Prior to discharge, parents were trained to implement procedures with 80% or higher procedural integrity. At follow-up, parents’ adherence ranged from as low as 50% to as high as 100% protocol adherence. The purpose of the current study was to develop a systematic method for assessing variables associated with parental non-adherence to a treatment protocol, after the parent and child had been discharged from the hospital. This assessment, based on Allen and Warzak’s (2000) categories of non-adherence, examines variables relevant to establishing operations, response acquisition, consequent events, and stimulus generalization. Results will be discussed in terms of identifying barriers to treatment adherence. |
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