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| “Soup to Nuts”: Parent Variables that Affect Treatment and Outcomes for Children with Food Refusal |
| Sunday, May 30, 2004 |
| 10:30 AM–11:50 AM |
| Conference Room 3 |
| Area: CBM; Domain: Applied Research |
| Chair: Charles S. Gulotta (Kennedy Krieger Institute) |
| Abstract: . |
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| Food Selectivity in Autism: Behavioral or Family Influence? |
| KIMBERLY A. SCHRECK (Pennsylvania State University, Hershey Medical Center), Keith E. Williams (Pennsylvania State University, Hershey Medical Center) |
| Abstract: Clinicians and researchers have commonly assumed that behavioral feeding problems are co-morbid with autism, and thus, have successfully developed Applied Behavior Analysis treatments to eliminate the behaviors. This presentation will examine the types of foods typically eaten by children with autism, patterns of family food acceptance, and will consider the relationship of eating behavior to the severity of the diagnostic characteristics of autism. |
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| Caregiver Treatment Integrity and the Influence on Maintenance of Child Appropriate Behavior |
| STEPHANIE D. BETHKE (Marcus Institute), Cathleen C. Piazza (Marcus and Kennedy Krieger Institutes), Meeta R. Patel (Clinic 4 Kidz) |
| Abstract: Few studies have examined the effects of training caregivers to treat pediatric feeding problems. Notable exceptions include studies by Werle et al. (1993), Anderson and McMillan (2001), and Mueller et al. (in press), which suggested that caregivers could be trained to implement pediatric feeding protocols. However, the relation of caregiver treatment integrity to child appropriate and inappropriate behavior during meals is less clear. That is, Werle et al. showed that changes in caregiver behaviors corresponded with increases in appropriate child behaviors during meals. By contrast, there was no relation between levels of caregiver treatment integrity and child behavior during meals in the study by Mueller et al. Therefore, the purpose of the current investigation was to examine the relation between caregiver treatment integrity and child behavior more fully. Caregivers were taught individual skills (e.g., correct use of instructions, prompts, and consequences) to use during meals and the extent to which the caregiver used the skill was assessed. In addition, child behavior was evaluated throughout the baseline and training phases. Results will be discussed in terms of the conditions under which caregivers’ treatment integrity and child behavior correspond. |
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| Training Caregivers to Implement Escape Extinction Using Different Methods |
| ELLEN J. MCCARTNEY (West Virginia University), Cynthia M. Anderson (West Virginia University), Nicole Vermillion (West Virginia University) |
| Abstract: Escape extinction has been demonstrated to be an effective treatment for children exhibiting food refusal. To date, most studies have been conducted in in-patient treatment settings by trained clinicians. Few studies have evaluated the extent to which caregivers are able to implement efficacious interventions for their food selective child in their home. McCartney and Anderson (in press) examined whether caregivers could be trained on an outpatient basis to implement escape extinction in their home with their food selective child. The purpose of the present study was to evaluate this systematic strategy for training caregivers to implement escape extinction using different methods. In the present investigation a multiple-baseline across three target foods will be used. First, trained therapists will implement escape extinction in the clinic with the child. Once the child is consuming 5 bites of each target food the child's caregiver will be trained to implement the intervention in the clinic setting. Again, once the child is consuming 5 bites of each target food, the caregiver will implement the intervention in the home. Follow-up meals will be conducted to monitor the maintenance of gains made from direct intervention and the consumption of new foods that were not previously consumed. |
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| An Intervention for Enhancing Treatment Gains Post Discharge |
| JENNIFER E. DAWSON (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), James H. Boscoe (Kennedy Krieger Institute), Barbara J. Shao (Kennedy Krieger Institute), Ping Wang (Kennedy Krieger Institute) |
| Abstract: One of the greatest challenges for clinicians treating problem behaviors is maintenance of treatment gains post discharge. It can be particularly difficult to sustain contact with families who live great distances from the clinical unit, making on-site follow-up and counsel impracticable. The purpose of this study is to compare child and parentn performance, as well as compliance with treatment recommendations, for two differing methods of long distance follow-up. Following the completion of an inpatient admission for the assessment and treatment of food refusal, twenty children and their respective families were observed during meals following discharge at 1, 3, and 6-month intervals. Results implicate the necessity for clinicians working with food refusal to focus on developing effective follow-up procedures which solicit family involvement prior to discharge, and include home video tapes of meals and scheduled phone contact. Difficulties of collecting observational data post discharge are discussed. Interobserver agreement was obtained for more than 40% of meal observations and total agreement was always greater than 90%. Integrity measures of parental protocol implementation were also calculated for all subjects. |
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