|
| #405 Poster Session – CBM |
| Monday, May 31, 2004 |
| 5:30 PM–7:00 PM |
| Exhibit Hall D (Hynes) |
|
| 37. Combining Stimulus Fading Procedure and Escape Extinction as Treatment for a Child with Total Food Refusal |
| Area: CBM; Domain: Applied Research |
| JOSLYN CYNKUS (Marcus Autism Center), Meeta R. Patel (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Nicole M. Trosclair-Lasserre (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center) |
| Abstract: Prior studies have demonstrated the effectiveness of escape extinction as treatment for pediatric feeding disorders (e.g. Cooper et al., 1999). Although escape extinction is associated with increased acceptance, the procedure may be associated with negative side effects such as extinction bursts and increased emotional responding (Piazza et al, in press; Reed et al, in press.). The current investigation evaluated whether stimulus fading plus escape extinction (Fading + EE) was associated with fewer negative side effects relative to escape extinction alone (EE) using a combination reversal (ABAB) and multi-element design. The participant was a typically developing 14-month-old boy. During baseline (A) two conditions were alternated in which a spoon with food was presented once every 30-s either at (touching) or 25.4 cm from the child’s lips. Inappropriate mealtime behavior resulted in a 20-s escape. In the subsequent phase (B), two treatments were alternated, Fading + EE and EE. Independent observers achieved over 95% agreement for 38% of sessions. Results indicated that Fading + EE was associated with lower levels of inappropriate behavior relative to EE alone. However, the terminal treatment criterion was reached more rapidly with EE alone. Results are discussed in terms of efficiency-based treatment selection versus negative side effects. |
| |
|
| 38. A Preliminary Analysis of a Fluency-based Feeding Intervention |
| Area: CBM; Domain: Applied Research |
| KENNETH MACALEESE (University of Nevada, Reno), Amy Kenzer (University of Nevada, Reno), Nicholas M. Berens (University of Nevada, Reno) |
| Abstract: The majority of research studies examining treatments for feeding disorders focus on approaches designed to get a child to begin eating or to eat independently. The present study describes an intervention that was implemented following a strategy which taught the child to eat independently. The participant in this study could eat independently but ate so slowly that it disrupted her routines at home. The described intervention was added to increase the rate of food consumption. At the conclusion of twenty-seven, fifteen minute treatments, the child could eat twenty-two bites in fifteen minutes on a VR-2 schedule of reinforcement (IOA for all sessions=90%). While treatment was terminated before an appropriate rate of independent eating was achieved, the current analysis may provide an initial glimpse into an additional feeding strategy where eating more quickly is the focus. |
| |
|
| 39. Social Curriculum Activities to Improve Social Communication Skills of Children with Autism |
| Area: CBM; Domain: Applied Research |
| SANG BOK LEE (Daegu University, South Korea), Eun Jung Seo (Brain Korea 21 Task Force Project), Min Dong Kim (Daegu University, South Korea), Eun Jin Lee (Daegu University, South Korea), Mi Gyung An (Daegu University, South Korea) |
| Abstract: The study had two purposes to evaluate the effectiveness of social curriculum activity(SCA) programs. First, it was to see if the SCA program could increase contextually appropriate social communication skills for two 8-year boys with high functioning autism in inclusive settings. Second, it was to see if the SCA program could decrease their inappropriate social interactions with peers in the inclusive settings. The study developed SCA to improve social communication skills of the children with autism, such as asking a help, expressing appreciation, and complimenting. A social curriculum booklet as an instructional tool in the study was consisted of five steps of the SCA: setting up social rules, demonstrating examples from video movies, creating scripts, role playing, and practice in real life situations. Each participant was given the whole social curriculum booklet for the intervention. The results of the study showed that 0%-8.3% stable levels of correct responses of the social communication skills in the baseline conditions were dramatically accelerated up to 80-100% levels for all participants after the introduction of the SCA. In addition, their inappropriate social interactions with peers in the inclusive settings were decreased 0-10% level. Furthermore, the reliability of dependent variables was 95.3%, so the SCA was reliable for the improvement of the behaviors. |
| |
|
| 40. On the Relation Between Response Effort and Food Texture in a Child with Feeding Problems |
| Area: CBM; Domain: Applied Research |
| AMANDA BOSCH (Marcus Autism Center), Meeta R. Patel (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center) |
| Abstract: Selectivity by food texture is one problem displayed by children with feeding disorders (Munk & Repp, 1994). In the current investigation, we treated a child who consumed lower textured foods, but packed (held food in his mouth) and expelled higher textured foods. We hypothesized that higher textured foods were associated with increased effort because these foods require (a) more physical work (e.g., chewing) and (b) more advanced oral motor skills and control than pureed foods. The purpose of the current study was to evaluate response effort in relation to food texture by measuring one child’s chewing and associated oral-motor responses (packing and expelling) across three textures: high (chopped), medium (wet ground), and low (pureed). Two independent observers achieved over 97% agreement on over 28% of these sessions. Results were consistent with a response effort hypothesis in that rates of chewing, packing, and expelling varied systematically and orderly according to the texture presented (e.g., rates of chewing increased as texture increased, but consumption decreased due to increased packing and expulsions). The relevance of these data to treatment and future research will be discussed. |
| |
|
| 41. Home Sweet Home? The Maintenance of Treatment Gains up to Two Years Following an Intensive Feeding Admission |
| Area: CBM; Domain: Applied Research |
| KUNISE K. STROH (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), James H. Boscoe (Kennedy Krieger Institute), Ping Wang (Kennedy Krieger Institute) |
| Abstract: The Kennedy Krieger Pediatric Feeding Disorders Program (KKI) has demonstrated the effectiveness of behavioral interventions (e.g., non-removal, stimulus fading) to treat children with severe feeding difficulties during an intensive feeding admission. Whether children maintain the treatment gains subsequent to discharge and continue to make progress outside of the clinical setting (e.g., home, school) has yet to be investigated. To determine the long-term effect of treatment procedures and its impact on the children and their caregivers, follow-up assessments were conducted at 1, 3, 6, 12, 18, and 24 months after discharge from KKI. Outcome measures included the KKI Follow-up Questionnaire (including questions about caregiver report of child behavior/satisfaction), the Children’s Eating Behavior Inventory, the Child Behavior Checklist, and the Parenting Stress Index. This poster will examine the results of the assessment and discuss issues associated with conducting long-term follow-up (e.g., return rate). |
| |
|
| 42. Management of Behavior Outside of Mealtime: An Evaluation of a General Behavior Management Program Provided to Caregivers During Their Child’s Admission to an Intensive Feeding Unit |
| Area: CBM; Domain: Applied Research |
| SUZANNE M. FUNK (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Ping Wang (Kennedy Krieger Institute) |
| Abstract: Caregivers of children attending the KKI intensive feeding program often report that their children exhibit problem behavior (e.g., noncompliance, disruption, etc.) outside of mealtime. The present study evaluated the effectiveness of a behavior management program designed to provide caregivers with strategies to manage non-feeding problem behaviors. Over the course of an eight-week feeding admission, caregivers attended four training modules that included short presentations, video examples, group activities, content quizzes, and feedback. To determine the effect of the program on child behavior, behavior ratings scales (e.g., Child Behavior Checklist) were administered to caregivers pre- and post-admission. To examine if caregivers increased their use of effective behavior strategies after training, direct observations of caregiver-child interactions before and after the training program were conducted in analog settings (outside mealtimes). Caregiver feedback about the program will be presented and future modifications of the program will be discussed. |
| |
|
| 43. An Evaluation of Two Procedures for Treating Packing Associated with Food Selectivity |
| Area: CBM; Domain: Applied Research |
| KISHA HOPE (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Cathleen C. Piazza (Kennedy Krieger Institute) |
| Abstract: Packing (pocketing and holding accepted food in the mouth) is a common occurrence among children with food selectivity and refusal; however, specific treatments for packing exhibited by these are limited. One suggested treatment for packing is the use of “chasers” (e.g., high preferred liquids or foods) following target bites. Chasers may effectively reduce packing behavior because they are of a preferred type or they are of a texture that is more readily swallowed (e.g., puree or liquids) by the individual. In the current investigation, we evaluated the relative effectiveness of high- (hp) versus low-preferred chasers, while maintaining a constant, easy to swallow texture. The participant was a young girl who exhibited packing associated with food selectivity by type. Independent observers achieved over 90% agreement for approximately 20% of sessions within an outpatient setting. A combined multielement and reversal design was used. Results showed that both chaser treatments were equally effective for reducing packing behavior; both also were associated with higher percentages of oral intake and decreased meal duration. Results are discussed in terms of chaser selection and potential mechanisms for chaser efficacy. |
| |
|
| 44. The Effectiveness of Behavioral Momentum and Extinction Procedures in Reducing Food Refusal in an At-Risk Child |
| Area: CBM; Domain: Applied Research |
| STEPHANIE L. MILES (University of Nebraska Medical Center), Torri Smith Tejral (University of Nebraska Medical Center) |
| Abstract: Inadequate food intake has been cited as resulting in 20% of all childhood dietary insufficiencies (Palmer & Horn, 1978). Several treatment studies have shown that escape extinction is effective for treating food refusal (Hoch, Babbitt, Coe, Krell, & Hackbert, 1994; Ahearn, Kerwin, Eicher, Shantz, & Swearingin, 1996; and Patel, Piazza, Martinez, Volkert, & Santan, 2002) Behavioral Momentum procedures have also been shown to increase more compliant behaviors (Belfiore, Lee, Scheeler, and Klein, 2002). Therefore, this particular study, evaulated the effectiveness of both behavioral momentum and extinction procedures with a three-year old foster child who was born at-risk for developmental delays and presented with significant food refusal. Over the course of several weekly sessions, behavioral momentum and extinction procedures were implemented to decrease food refusal, and to increase more compliant behaviors during mealtimes. Results showed a significant increase in the variety of foods accepted and an increase in the amount of previously non-preferred foods accepted. In addition, his foster mother was able to generalize the strategies to the home setting, and a significant increase in appropriate behavior was seen there as well. |
| |
|
| 45. Outcomes for an Intensive Day Treatment Program forChildren with Pediatric Feeding Disorders |
| Area: CBM; Domain: Applied Research |
| ANGELA PRUETT (Marcus Autism Center), Meeta R. Patel (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Amanda Oberdorff (Marcus Autism Center), Stacy A. Layer (Marcus Autism Center), Jackie Otto (Marcus Autism Center), Michele Walker (Marcus Autism Center) |
| Abstract: Pediatric feeding disorders occur in approximately 22-23% of typically developing children and up to 80% of children diagnosed with developmental disabilities. There are currently few interdisciplinary programs designed for the purpose of treating pediatric feeding disorders. Further, few large scale studies have been conducted on the outcomes produced by such programs. The current proposal will present treatment outcomes for seventy-three patients with pediatric feeding disorders who were seen at the Marcus Institute from October 1999 through July 2003. A summary of specific outcome measures will be provided, including data related to specific treatment goals (e.g., total increases in oral consumption, decreases in inappropriate mealtime behaviors, caregiver treatment integrity), patient demographics, and other relevant clinical gains. These data will be discussed in terms of the efficacy of our interdisciplinary approach and the need for systematic longitudinal treatment research in the area feeding disorders. |
| |
|
| 46. I'll Eat It, but I Don't Like it: Food Preference in Children with Severe Food Refusal |
| Area: CBM; Domain: Applied Research |
| BRIAN T. DUDLEY (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), James H. Boscoe (Kennedy Krieger Institute) |
| Abstract: Research has demonstrated the effectiveness of behavioral interventions to increase intake and decrease food refusal during an intensive treatment program. The current study examined the development of food preferences in children with severe food refusal before and after treatment is implemented (Masler, 2003). To determine preference forced-choice edible preference assessments were conducted at admission and at several stages of treatment (e.g., during baseline, introduction of treatment, texture manipulations). Preliminary results demonstrated that some children did not indicate clear preferences. An analysis of meal data (e.g., gags, coughs, and inappropriate behavior) demonstrated that some children might not exhibit preference during the forced-choice assessment, but respond differently to foods during meals. Implications for assessing food preferences in children with severe food refusal and the impact of behavioral interventions (e.g., non-removal) on demonstrations of preference will be discussed. |
| |
|
| 47. Assessing Environmental Variables Effecting Latency to Swallow |
| Area: CBM; Domain: Applied Research |
| PING WANG (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Jennifer E. Dawson (Kennedy Krieger Institute) |
| Abstract: Swallowing foods is one of the ultimate goals when treating food refusal. In order for a child to eat efficiently he or she needs to be able to swallow in a timely manner. Several variables that effect how quickly a child swallows include texture, spoon size, preference/food groups and reinforcement. The current study examined the relative effects of these variables on the latency to swallow (i.e., the duration measure for each bite from the time a bite is taken till the time the bite is swallowed). All the cases used in the study were referred to an intensive (6-8 week) feeding program for the assessment and treatment of food refusal. Although acceptance was quickly established for all participants’ long rates of latency to swallow were observed when certain independent variables (i.e., texture, spoon size, food group, and reinforcement) were introduced. Some variables were found to be directly related to the increased latency to swallow. Results are discussed in terms of the role of motivation and response effort when designing treatment for food refusal. |
| |
|
| 48. Use of Multiple Measures to Determine the Effectiveness of an Intensive Feeding Program Admission |
| Area: CBM; Domain: Applied Research |
| ELIZABETH A. MASLER (Kennedy Krieger Institute), Ashley J. Greer (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute) |
| Abstract: The Kennedy Krieger Institute's intensive feeding program assesses and treats children with severe problem behavior during mealtime. To determine the effectiveness of the program, a number of outcome measures are collected before and after admission to the unit. Outcome measures administered/collected include the Parenting Stress Index, Children’s Behavior Eating Inventory, Parent Satisfaction Questionnaire, % of Parent goals met, and reduction of problem behavior during meals. This study examined the relationship between these measures in terms of their predictive value of children’s progress in the program. The poster will also discuss implications for future program evaluation and follow-up. |
| |
|
| 49. Outcome Evaluation of Short-term Intervention for Children with Severe Behavioral Disorders |
| Area: CBM; Domain: Applied Research |
| SAMUEL MADDOX (Marcus Autism Center), Nathan Call (Marcus Autism Center), Henry S. Roane (Marcus Autism Center) |
| Abstract: The Short Protocol Clinic at the Marcus Behavior Center conducts behavioral assessments and interventions for children with disabilities and their families over a period of no more than ten, two-hour sessions. Sessions are conducted over a period of two to four weeks with over 40 patients served in a 6-month period. Assessments generally include functional analyses to determine variables that maintain the target behaviors. Based on assessment results treatments are evaluated to reduce or eliminate the target behaviors and/or increase alternative behaviors. Parents or other care providers receive training in implementing recommendations. In addition, home visits are conducted with some patients to evaluate/promote treatment generalization. Data will be presented on patient demographics, (including frequency of different topographies of problem behavior), assessment outcomes (including percentage of patients displaying specific behavioral functions), percent reduction in problem behaviors post-treatment, generalization, and social validity of the procedures and treatment recommendations. |
| |
|
| 50. Treatment of Chronic Aphasia with Errorless Learning Procedures and Operant Conditioning |
| Area: CBM; Domain: Applied Research |
| Z. GABRIELA SIGURDARDOTTIR (University of Iceland), Magnus Sighvatsson Blondahl (University of Iceland) |
| Abstract: Three males and one female with chronic broca’s aphasia as a result of stroke, ages 52-62, received treatment based on errorless learning procedures and operant conditioning for seven months. Treatment effects were evaluated with a multiple-baseline design across behaviors with each participant. The performances that were treated varied across participants but were two or three of the following in each case: naming people, naming objects, making sentences, sequencing stimuli (e.g., months), letter discrimination, and unassisted recall (e.g., naming favorite cakes). Treatment variables were clearly defined and systematically used in standard ways across participants and tasks with flexibility for adaptation to individual outcomes using clearly defined criteria for fading prompts in or out. Prompts were faded out as performances improved. Mean inter-scorer agreement for dependent variables was 90-100 percent, > 95% for 10 out of 11 variables. Mean inter-scorer agreement for experimenter’s use of correct prompt was 87-100 percent, > 95% in 8/11 cases. The performances of all participants improved significantly in all tasks, they all reached 100% correct performance without any prompts from the experimenter in at least one task. Generalization measures across stimuli and settings demonstrated that their improved performances generalized to novel stimuli and novel settings. |
| |
| |