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| The Assessment and Treatment of Feeding Problems in Children |
| Saturday, May 23, 2009 |
| 2:30 PM–3:50 PM |
| North 222 C |
| Area: CBM/DDA; Domain: Applied Behavior Analysis |
| Chair: Meeta R. Patel (Clinic 4 Kidz) |
| Discussant: Michael E. Kelley (University of Southern Maine) |
| CE Instructor: Al Murphy, Ph.D. |
| Abstract: This symposium will include three data-based presentations on the assessment and treatment of feeding problems in children. Data will be presented from both clinic and home-based programs. |
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| An Examination of Stimulus Fading and Escape Extinction in the Treatment of Food Refusal |
| MICHELLE L. WADDELL (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz), Jennifer Leigh King (Clinic 4 Kidz), Angela Pruett (Clinic 4 Kidz) |
| Abstract: Children with pediatric feeding disorders may display a variety of inappropriate behaviors to avoid eating. It is likely that the spoon alone has become aversive because it has been paired with something negative (e.g., choking, vomiting). Previous research has shown the utility of escape extinction as an effective treatment to decrease food refusal. However, escape extinction alone has also been shown to produce some negative side effects such as extinction bursts and/or emotional responding. Therefore, the purpose of this study was to develop a treatment protocol to decrease the aversive properties of eating by evaluating antecedent variables. In this study we compared the effects of stimulus fading (i.e., manipulating different foods/liquids and volumes on the spoon) plus escape extinction in the treatment of food refusal. First, an antecedent assessment was conducted to determine the starting point for the stimulus fading treatment component. During the treatment evaluation, stimulus fading steps plus escape extinction were evaluated in a multiple probe and multiple baseline across participants designs. Data from the antecedent assessment showed that each participant had a different starting point (e.g., empty spoon, full spoon with yogurt etc.) for treatment. The data from the treatment evaluation indicated that acceptance increased with stimulus fading plus escape extinction and inappropriate behaviors decreased. These data are discussed in relation to negative reinforcement and establishing operations. |
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| Home-Based Treatment of Food Refusal Using Shaping and Other Behavioral Procedures |
| KIMBERLY V. BECK (ABA Solutions, Inc.), Raymond G. Miltenberger (University of South Florida), Betsy M. Zamora (University of South Florida), Jessica Thompson (University of South Florida) |
| Abstract: Feeding related problems occur frequently in children with developmental delays and typical development. Much of the research on treatment of pediatric feeding disorders occurs in clinic settings. The present study took place in the home of a typically developing three year old boy displaying food refusal behavior resulting in extremely selective eating. The goal was to increase the intake of a wide variety of non-preferred foods. With the first 2 interventions, involving differential reinforcement of bites with attention and preferred foods, he increased his intake of fruit but still refused other foods. The next intervention involved shaping eating behavior with 40 successive approximations to eating a bite of food. Each approximation was reinforced with preferred food and other reinforcers. Refusal to engage in the behavior resulted in guided compliance (escape extinction and negative reinforcement). Partial success with an all positive approach and challenges and limitations to in home treatment will be discussed. |
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| Implementation of a Chin Prompt to Reduce Expulsion |
| LARA BARNETT (University of Nebraska Medical Center, Munroe-Meyer Institute), Candice M. Jostad (Munroe Meyer Institute), Heather Kadey (Munroe-Meyer Institute, University of Nebraska Med), Victoria Stewart (University of Nebraska Medical Center), Kristi Rivas (Munroe-Meyer Institute), Cathleen C. Piazza (Munroe-Meyer Institute) |
| Abstract: Pediatric feeding disorders are manifested in a variety of ways, including refusal behaviors. These behaviors may take on the form of spitting out the food (i.e., expulsion). The etiology of refusal behavior may be either medical, oral motor, behavioral, or a combination of some or all of these factors. Therefore, the purpose of the current investigation was to examine the implementation of a procedure (i.e., chin prompt) that may have functioned to treat oral motor skill deficits in conjunction with escape extinction. The participants were two children admitted to a Pediatric Feeding Disorders Program for the assessment and treatment of food refusal. Initial treatment consisted of re-presentation of expelled food. The chin prompt was added to the re-presentation procedure when re-presentation alone proved unsuccessful. The chin prompt consisted of the feeder providing gentle pressure under the child’s chin following presentation of bites or during re-presentation of expelled food. Results indicated that for all participants, the most effective treatment to reduce expulsions was one in which re-presentation and the chin prompt were combined. |
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