Association for Behavior Analysis International

Previous investigations have identified techniques for assessing and treating behaviors associated with pediatric feeding disorders. The current symposium will focus on extensions of previous research, and will provide data ranging from small-n analyses of common feeding procedures to larger analyses of treatment and program outcomes. The first presentation describes a comparison of two functional analysis procedures to identify the reinforcers maintaining inappropriate mealtime behavior among three children with autism. The second presentation is an examination of outcome data on the treatment of food selectivity among 13 children with autism. The third presentation will examine expulsion during liquid refusal, specifically the efficacy of re-presentation as a treatment for expulsion among 21 children. The final presentation describes outcome data from 227 participants over a 12-year period who received services in a home-based multidisciplinary treatment program. Dr. Nate Call will serve as the discussant and will provide a synthesis of these studies within the context of examining outcome data in the area of feeding disorders and other childhood behavior disorders.

Food selectivity and refusal behavior remain a prevalent problem in children, and especially those diagnosed with an autism spectrum disorder. The purpose of the current project was to compare two different functional analysis methodologies from prior research in the assessment of inappropriate mealtime behavior. In particular, procedural variations for social-positive and social-negative test conditions have varied across prior studies. The current study evaluated those variations using a within-subject analysis to identify functions of inappropriate mealtime behavior for three children diagnosed with autism. Results indicated certain conditions used in prior functional analysis literature might not control for all relevant variables (e.g., motivating operations), thus producing potential false positive identification of behavioral functions; specifically, a social-positive function was only identified in the attention-test condition in which implicit demands to consume nonpreferred foods were placed. The idiosyncratic pattern of responding across subjects will be discussed as well as how those patterns relate to implications for research and clinical practice in the assessment and treatment of pediatric feeding problems.

Autism is defined by social communication deficits and restrictive and/or repetitive patterns of behavior. One way in which restrictive behavior might present in this population is via the selective consumption of foods. If left untreated, food selectivity may result in poor nutrition and other issues, such as problematic behavior and poor socialization. Research in applied behavior analysis has identified several methods for effectively treating food selectivity in individuals with autism but, to date, that literature has focused on small sample sizes, and presumably, has focused only on successful treatment outcomes. The current study will present data from individuals with autism and co-morbid food selectivity who were treated in an outpatient clinic (n=13). Data will be reviewed regardless of treatment success. Case examples as well as an overall effect size will be presented as a means of documenting treatment outcomes. Treatment integrity data (exceeding 90% in all cases) and interobserver agreement (exceeding 80%) also will be provided. The results will be discussed in relation to a preliminary decision-making model for efficiently selecting treatments to treat food selectivity based on client characteristics.

Treating food or liquid refusal with escape extinction procedures reliably results in increased acceptance and decreased inappropriate mealtime behavior. However, problematic behaviors may emerge or persist in response to treatment, interfering with consumption. Coe et al. (1997) and Sevin et al. (2002) showed that treatment of refusal with a putative escape extinction procedure, nonremoval of the utensil, resulted in emergence of expulsion. Both investigators used re-presentation, in which the feeder scooped up expelled food and placed it into the participants mouth, to decrease expulsion to near-zero levels. Their results raise the question of whether emergence of expulsion is a common corollary effect during treatment of refusal with nonremoval of the utensil. The current investigation sought to determine whether expulsion emerged during treatment with nonremoval of the cup and to evaluate the efficacy of re-presentation as treatment for expulsion with 21 children with liquid refusal. Results indicated that 19 (90%) children exhibited expulsion during the nonremoval of the cup evaluation. The incorporation of re-presentation resulted in lower expels per opportunity and higher mouth clean for 13 (68%) and 14 (74%) of the 19 children, respectively, relative to nonremoval of the cup alone. Implications and directions for future research will be discussed.

Feeding problems are common in children with autism and other disabilities and may also be evident in typically developing children with a variety of medical issues (e.g., gastroesophageal reflux, food allergies etc.). Feeding problems may result in poor weight gain, deficiencies in vitamins/minerals as a result of poor nutrition, and/or tube dependency. In some cases, children may not advance to age-typical textures as a result of selectivity or a skill deficit (e.g., chewing). Since there are a variety of problems displayed by children with feeding issues, it is imperative that treatment be provided by a team of professionals (i.e., pediatric gasteroenterologist, occupational/speech therapist, nutritionist, social worker and/or behavior analyst). Typically these services are provided in a clinic/hospital environment; however, a similar model is also used in the home environment. The purpose of this presentation is to give the audience an overview of how intensive treatment can be initiated for children with feeding problems in the home environment using an interdisciplinary model. Data will be presented for at least 227 patients who were admitted to the Clinic 4 Kidz Pediatric Feeding Disorders Program in the last 12 years. Preliminary data suggests that this type of intensive home-based program is effective at increase weight, increasing variety, and decreasing tube dependency. Data also shows a high percentage of children getting to age-typical eating patterns by discharge. Outcome data will also be presented specifically on children with autism and the treatment approach used to treat feeding problems in these children. Case study video clips will also be included in the presentation so you can see treatment from the beginning to discharge for two different types of feeding problems. Data will be discussed in relation to training and the importance of the interdisciplinary approach when working with children with complicated medical histories.