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| Further Advancements in the Assessment and Treatment of Feeding Problems in Children |
| Monday, May 31, 2010 |
| 10:30 AM–11:50 AM |
| Texas Ballroom Salon C (Grand Hyatt) |
| Area: CBM/DDA; Domain: Applied Behavior Analysis |
| Chair: Meeta R. Patel (Clinic 4 Kidz) |
| CE Instructor: Adel Najdowski, Ph.D. |
| Abstract: Feeding problems are common in children with autism and other developmental disabilities; however, there is a paucity of research on the assessment and treatment of feeding problems. Previous research has shown that escape extinction has been an effective intervention. However, in some cases escape extinction alone is not effective. Furthermore, escape extinction may produce other side effects such as extinction bursts and/or emotional responding. Studies have also shown that escape extinction combined with differential reinforcement or noncontingent reinforcement may produce less emotional responding. Although escape extinction has been shown to be effective, it may be difficult for caregivers to implement such procedures. In addition, children who display skill deficits with regards to eating (e.g., poor lip closure, poor tongue movement, poor self-feeding skills etc.) may require other treatment components in combination with escape extinction. More research examining assessment tools and alternative treatments is warranted. Therefore, the purpose of this symposium is to present systematic data on both assessment and treatment of feeding problems in children. |
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| Using an Antecedent Assessment to Evaluate the Effects of a High- Probability Instructional Sequence and Food Fading in the Treatment of Feeding Problems in Children |
| NISSA WENDY GOLDBERG (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz), Michelle L. Waddell (Clinic 4 Kidz), Jennifer Leigh King (Clinic 4 Kidz), Aida Miles (Clinic 4 Kidz) |
| Abstract: Children with pediatric feeding disorders may display a variety of inappropriate behaviors to avoid eating. It has been hypothesized that these behaviors are maintained by negative reinforcement in the form of escape. Typically some form of escape extinction is necessary to increase acceptance and decrease inappropriate behaviors. However, escape extinction (EE) may produce side effects and in some cases EE alone in not a sufficient intervention. Many times antecedent based procedures such as a high-probability (high-p) instructional sequence and stimulus fading are warranted. High-p instructional sequence has shown to be effective in the treatment of feeding problems when topographically similar responses (e.g., presentation of highly preferred food/drink) were used prior to the target response (e.g., presentation of a nonpreferred food/drink) as opposed to using responses that were not associated with eating (e.g., putting a block in the bucket). The purpose of this study was to evaluate the effects of high-p instructional sequence and food fading by first using an antecedent assessment to empirically identify the most appropriate high-p response as well as to evaluate the starting point for treatment. Data from the antecedent assessment showed that each participant had a different high-p response. In addition the data indicated different starting points for treatment (e.g., milk on a spoon, apple juice on a spoon etc.). A multiple probe and multiple baseline across participants designs were used to evaluate high-p instructional sequence, fading and EE. Data from the treatment evaluation showed an increase in acceptance and decrease in inappropriate behaviors for both participants. One participant required the high-p instructional sequence with every food introduced; however, high-p instructional sequence was only required for the first food introduced for the second participant. In addition, no extinction bursts or emotional responding were observed. These data are discussed in relation to behavioral momentum, establishing operations, transfer of stimulus control, and stimulus generalization. |
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| Treating Food and Liquid Refusal in an Adolescent With Asperger’s Disorder |
| KEITH E. WILLIAMS (Penn State Hershey Medical Center), Michael P. Roth (The Pennsylvania State University, Harrisburg), Candace M. Paul (Penn State Hershey Medical Center) |
| Abstract: Food refusal is a complicated and problematic condition that has both medical and social implications. In the current study, a 16-year-old male with Asperger’s disorder, who was dependent on gastrostromy tube feedings for nine years, was treated with a behavioral intervention for both solid and liquid food refusal. The intervention consisted of several components included stimulus fading for both solids and liquids, a token economy for solids, and an escape prevention component for liquids. Prior to treatment the participant consumed three different foods and water. After treatment, the participant was consuming 78 foods and 13 beverages. At the end of 14 days of treatment, all of the participant’s intake was received orally, gastrostomy tube feedings were eliminated, and the patient had gained over one pound on oral feedings. The intervention was generalized to both home and school settings, and maintenance of treatment gains was reported by parents one month after the end of treatment. |
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| Use of Backward Chaining to Develop Self-Feeding Skills in Children With Developmental Disabilities |
| GEETIKA AGARWAL (Marcus Autism Center), David L. Jaquess (Marcus Autism Center), William G. Sharp (Marcus Autism Center) |
| Abstract: Backward chaining is a procedure that has been successfully used to assist individuals of various skill and developmental levels acquire a wide range of behaviors, including self-help skills, personal hygiene, and more complex sequences of behaviors, such as computer use. Few studies, however, have focused specifically on the use of backward chaining to encourage independent feeding skills, such as utensil use and/or self-feeding, in the treatment of pediatric feeding disorders. In the current study, data from a chart review for two children treated at an intensive day-treatment program for severe food refusal are presented. A non-self-feeder treatment package involving escape extinction was successful in increasing oral intake in both cases, but neither child demonstrated self-feeding skills or respond to less intensive prompting procedures to promote independent intake. A backward chaining protocol was successfully employed for both children to increase self-feeding using a spoon. Results from the study are discussed in relation to treatment development and generalization of findings to other children with pediatric feeding disorders. |
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| Use of Swallow Facilitation and a Chaser to Decrease Packing in Children With Feeding Disorders |
| CHARIS L. FARRELL (Munroe-Meyer Institute, University of Nebraska Medical Center), Valerie M. Volkert (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center), Rebecca A. Groff (Munroe-Meyer Institute, University of Nebraska Medical Center), Jana Frese (Munroe-Meyer Institute, University of Nebraska Medical Center), Carrie E. Combs (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: Previous research has demonstrated that escape extinction in conjunction with reinforcement- based procedures often is effective in increasing acceptance and decreasing inappropriate mealtime behavior (e.g., head turns, disruptions) in children diagnosed with feeding disorders (Piazza, Patel, Gulotta, Sevin, & Layer, 2003; Reed et. al., 2004). However, additional procedures may be needed when the child packs (pockets) accepted food (Sevin, Gulotta, Sierp, Rosica, & Miller, 2002). The purpose of the current investigation was to evaluate the effects of swallow facilitation (i.e., using a flipped spoon or a Nuk brush) and/or a chaser alone and in combination as treatment for the packing of 2 children diagnosed with a feeding disorder. Neither swallow facilitation nor the chaser alone produced clinically significant decreases in packing. By contrast, the combination of swallow facilitation and a chaser produced clinically significant decreases in packing for both children. |
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