|Advancements in the Assessment and Treatment of Pediatric Feeding Disorders
|Sunday, May 29, 2016
|2:00 PM–3:50 PM
|Crystal Ballroom C, Hyatt Regency, Green West
|Area: CBM/DDA; Domain: Translational
|Chair: Suzanne M. Milnes (Munroe-Meyer Institute, University of Nebraska Medical Center)
|Discussant: Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center)
|CE Instructor: Cathleen C. Piazza, Ph.D.
When left untreated, pediatric feeding problems can result in poor weight gain, weight loss, malnutrition, dehydration, cognitive impairment, compromised immune function, and dependency on tube feedings (Cohen, Piazza, & Navanthe, 2006). Therefore, it is imperative that clinicians and researchers continue to develop effective treatment procedures and disseminate their findings to a larger audience. This symposium combines 4 data-based presentations on the assessment and treatment of pediatric feeding problems from 4 different programs: Munroe-Meyer Institute, University of North Carolina Wilmington, Marcus Autism Center, and University of Kansas. Following the 4 presentations, Dr. Cathleen Piazza (Munroe-Meyer Institute) will discuss the presentations and the implications of each presenters findings. The first presentation will focus on the use of applied behavior analysis to treat feeding problems in children with autism spectrum disorder. The second presentation will compare descriptive and functional analyses in the treatment of feeding disorders. The third presenter will discuss the use of alternative bite presentation methods in the treatment of expulsion and packing. The final presenter will discuss the use of response blocking to distinguish between motivational and skill deficits in pediatric feeding disorders.
|Keyword(s): feeding disorders, food refusal, food selectivity
Treatment of Feeding Problems in Children With Autism Spectrum Disorder: Applied Behavior Analysis Versus Wait-List Control
|VIVIAN F IBANEZ (Munroe-Meyer Institute, University of Nebraska Medical Center), Kathryn M. Peterson (University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center)
Children with autism spectrum disorder (ASD) often display feeding problems, and food selectivity, defined as consumption of a limited variety of foods (Schreck, Williams, & Smith, 2004), is the most commonly reported feeding problem. Results of studies have shown that treatments based on applied behavior analysis (ABA) are effective as treatment for feeding disorders in the general pediatric population (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003; Volkert & Piazza, 2012). Although ABA treatments have empirical support for feeding problems, and ABA also has empirical support for the treatment of the core symptoms of ASD, there are no ABA randomized clinical trials with a well-defined cohort of children with ASD and food selectivity. We conducted a randomized clinical trial of ABA treatment of food selectivity in children with ASD relative to a wait-list control group. We randomly assigned 3 children to ABA and 3 children to a wait-list group and compared the effects of treatment in a multiple baseline design across novel, healthy groupings of foods. Results demonstrated that ABA treatment increased acceptance of all food groupings for all six children who participated in the study.
|Comparison of Descriptive and Functional Analyses in the Treatment of Pediatric Feeding Disorders
|JESSICA ASHLEY KEANE (UNCW), Melanie H. Bachmeyer (University of North Carolina Wilmington), Catherine Elizabeth Graham (University of North Carolina Wilmington), Jessica Woolson (University of North Carolina Wilmington), Hannah Edwardson (University of North Carolina Wilmington), Sydney Ball (University of North Carolina Wilmington), Natalie Jones (University of North Carolina Wilmington)
|Abstract: Previous research on the correspondence between hypotheses derived from descriptive and functional analyses has shown mixed findings (e.g., Lalli et al., 1993; Lerman & Iwata, 1993; Thompson & Iwata, 2007). Further, studies comparing the relative effects of treatments matched to each hypothesis when results of these analyses do not correspond are scarce. To our knowledge, no studies to date have conducted a systematic comparison of descriptive and functional analyses outcomes in the treatment of pediatric feeding problems. Therefore, we compared the results of a descriptive analysis and caregiver- and therapist-conducted functional analyses of the inappropriate mealtime behavior of three children with feeding disorders. Then, using a reversal design, we compared treatments matched to the results of each analysis. Results of the descriptive and functional analyses did not correspond for any of the children. Results of the subsequent treatment evaluations showed that treatments matched to the functional analysis were more effective for all children. Interobserver agreement was collected on at least 33% of sessions. Agreement was above 80% for each child. Clinical implications of these findings will be discussed.
|An Evaluation of Alternative Bite Presentations in the Treatment of Feeding Difficulties
|HAILEY ORMAND (Marcus Autism Center), Valerie M. Volkert (Marcus Autism Center), William G. Sharp (The Marcus Autism Center)
|Abstract: Interventions utilizing nonremoval procedures and reinforcement have yielded positive outcomes, including increased acceptance and decreased inappropriate mealtime behavior, in the treatment of feeding difficulties (e.g., Patel, Piazza, Martinez, Volkert, & Santana, 2002; Piazza, Patel, Gulotta, Sevin, & Layer, 2003; Reed et al., 2004). However, challenging behaviors (i.e., expels, packs) often persist even after a bite is accepted. Alternative bite presentations, such as depositing bites with a flipped spoon or Nuk, are antecedent manipulations that have been shown to reduce these behaviors for children who are unsuccessful with bites presented on an upright spoon (e.g., Sharp, Harker, & Jaquess, 2010). The current study expands on past research examining alternative bite presentations by providing a review of pediatric cases from an intensive day-treatment feeding program to determine the frequency with which these presentations are utilized clinically. We will present descriptive information about the assessment and/or treatment protocols implemented with these individuals and summarize observed outcomes by topography. Finally, the implications of alternative bite presentations in the treatment of pediatric feeding disorders will be considered.
Using Response Blocking to Distinguish Between Motivational and Skill Deficits in Pediatric Feeding Disorders
|ALEC BERNSTEIN (University of Kansas), Danielle L. Gureghian (Garden Academy), Henry S. Roane (Upstate Medical University), Courtney Moore (University of Kansas), Pamela L. Neidert (University of Kansas)
Children typically gain the skills to appropriately feed themselves by the age of two years (Carruth et al., 2004). Those whose skills are delayed have statistically been shown to consume less nutrients (Carruth et al., 2004) and are at risk for both developmental and growth delays (Manikam & Perman, 2000; O?Brien et al., 1991). Though previous research has assessed a multitude of treatments for feeding delays and disorders (Cooper et al., 1995; Manikam & Perman, 2000; Piazza & Carroll-Hernandez, 2004), little research has evaluated whether such delays are maintained by motivational or skill deficits. The current study describes the treatment of age-inappropriate self-feeding skills for four children with developmental disabilities. Response blocking was used to determine whether the absence of appropriate self-feeding was a motivational or skill deficit. Results of response blocking for one child suggest a motivational deficit, whereas results for the other three children suggest a skill deficit. Results will be discussed in terms of response blocking as an assessment procedure as well as backward chaining as a procedure for increasing self-feeding skills.