|Current Advances in Treatment of Pediatric Feeding Problems
|Tuesday, May 31, 2016
|9:00 AM–10:50 AM
|Columbus Hall CD, Hyatt Regency, Gold East
|Area: PRA/CBM; Domain: Translational
|Chair: Laura J. Seiverling (St Mary's Hospital for Children)
|Discussant: Keith E. Williams (Penn State Hershey Medical Center)
|CE Instructor: Laura J. Seiverling, Ph.D.
|Abstract: The following presentations address several important areas within the field of pediatric feeding disorders. Two studies examine the effects of innovative interventions for treating food refusal and teaching chewing skills while one study compares the effects of two interventions for food refusal and the final study examines the effects of a caregiver training package on both caregiver and child behavior. In the first study, authors examined the role of a visual cue in the treatment of a child's food refusal. In the second study, authors used modeling, positive reinforcement, shaping, fading, and physical prompting to teach tongue lateralization and biting to establish chewing. Across the course of treatment, the child moved from consuming pureed food only to table food. In the third study, authors used an alternating treatments design to compare the effects of differential reinforcement and response cost treatment packages on percentage of bites/drinks accepted and interruptions in a child with food refusal. Lastly, the fourth study examined the effects of combining behavioral skills training and general-case training to teach caregivers how to implement a food selectivity intervention with their children.
|Keyword(s): caregiver training, chewing, food refusal, visual cue
|Examining the Role of a Visual Cue in the Treatment of Food Refusal
|Whitney Harclerode (Penn State Medical Center), Laura Creek (Penn State University--Harrisburg Campus), Katherine Riegel (Penn State Milton S. Hershey Medical Center), KEITH E. WILLIAMS (Penn State Hershey Medical Center)
|Abstract: Food refusal in a nine-year-old boy was addressed using interventions consisting of in-meal reinforcement, a visual cue, fading, and praise. Across the course of treatment, the participant increased his intake of both solids and liquids, learned to chew crunchy foods, and decreased his tube feeding by 54%. Multi-element designs were used to assess the most efficient method of drinking and to compare his consumption of soft table foods versus crunchy table foods. An ABCBADC reversal design was used to conduct a component analysis to assess the effectiveness of a visual cue which signaled post-meal reinforcement in increasing food consumption. The data showed that neither the in-meal reinforcement nor visual cue and post-meal reinforcement alone were sufficient to increase the number of bites consumed, but an intervention consisting of both in-meal reinforcement and the visual cue did result in increased bites consumed suggesting a multiplicative effect. Many interventions for feeding problems consist of “treatment packages” or combinations of several intervention components. This study showed that the necessity of having more than one component in an effective treatment for food refusal.
|Teaching Tongue Lateralization and Biting to Establish Chewing
|Whitney Harclerode (Penn State Medical Center), Keith E. Williams (Penn State Hershey Medical Center), KATHERINE RIEGEL (Penn State Milton S. Hershey Medical Center), Shannan Lamparski (Penn State University--Harrisburg Campus)
|Abstract: Chewing was taught to a seven-year-old girl whose diagnoses included autism and intellectual disability through the use of a multi-component treatment package including modeling, positive reinforcement, shaping, fading, and physical prompting. Shaping was used to teach her to both lateralize food from her tongue to her teeth and to repeatedly bite through foods. Initially, these skills were taught in separate sessions and when she met criteria for each skill, then these two skills were combined into a single chain of behaviors. A multiple probe treatment design was used to access treatment efficacy. Assessments were used to determine skill levels for tongue lateralization and biting of different textures of foods. Across the course of treatment, the child moved from consuming pureed food only to table food. Maintenance of her chewing skills was also demonstrated. This study was unique in its direct instruction of tongue lateralization and the integration of tongue lateralization into the instruction of chewing.
A Comparison of Differential Reinforcement of Alternative Behaviors and Response Cost in a Treatment Package for Food Refusal
|CHRISTINA ALAIMO (St. Mary's Hospital for Children), Laura J. Seiverling (St Mary's Hospital for Children), Peter Sturmey (The Graduate Center and Queens College, City University of New York), Kisha Anderson (St Mary's Hospital for Children)
Food refusal is a severe feeding problem in which children refuse to eat all or most foods which often leads to insufficient caloric intake and malnutrition. Food refusal can be effectively treated using a variety of multicomponent intervention packages. The purpose of the present study was to use an alternating treatments design to compare two intervention packages-- differential reinforcement (DRA) with escape extinction and response cost (RC) with escape extinction for treating food refusal in a 2-year-old boy with developmental delays and failure to thrive (FTT). There were not differences across conditions in the childs level of acceptance and interruptions initially; however, the childs acceptance was consistently higher and percentage of interruptions were consistently lower in the DRA condition after implementation of a phase in which empty spoons were presented in both treatment conditions. In addition, the childs total volume of solids and liquids was greater in the DRA condition. Potential explanations for results as well as suggestions for future researchers will be discussed.
The Effects of Behavioral Skills Training and General-Case Training on Caregiver Implementation of a Food Selectivity Intervention With Their Children
|Christina Alaimo (St. Mary's Hospital for Children), LAURA J. SEIVERLING (St Mary's Hospital for Children), Peter Sturmey (The Graduate Center and Queens College, City University of New York), Jaimie Sarubbi (Queens College (City University of New York))
This study used a multiple baseline design to examine the effects of a combined behavioral skills training (BST) and general-case training (GCT) package for teaching caregivers how to implement an intervention to treat food selectivity in their children. Following baseline during which caregivers were given written instructions of the intervention, experimenters implemented BST training which involved instructions, modeling, rehearsal and feedback as well as GCT which involved the experimenter following scripts which simulated the range of child responses (e.g. accepting bites, expelling, refusal, etc.) caregivers could encounter during post-training sessions with their child. The food selectivity intervention involved having caregivers implement single-bite taste sessions with several target foods using exit criterion. Following training, all caregivers increased their percentage of correct steps performed of the intervention compared to their performance in baseline. In addition, all children demonstrated increases in the cumulative number of bites accepted under 30 s during post-training compared to baseline.