Association for Behavior Analysis International

It is not uncommon for individuals with developmental disabilities to present challenging food-related behaviors that can lead to social isolation and may pose long-term health risks. For example, the excessive consumption of calories following food stealing poses health risks such as obesity and diabetes. By contrast, vomiting responses under operant control that frequently occur can include malnutrition, weight loss, dehydration, and tooth decay (Lang et. al., 2011). During this symposium, each talk will provide insight on effective interventions identified in previous literature and then applied in practice to address clinically significant food-related problem behaviors. The first presenter will discuss challenges associated with addressing the food stealing of a child diagnosed with Prader-Willi Syndrome and will highlight a function-based approach to intervention that incorporated differential reinforcement and schedule leaning. The second presenter will describe an iterative approach to intervention for projective vomiting when functional analysis results were inconclusive. Effective intervention ultimately consisted of a reprimand and positive practice and generalized across multiple staff throughout the school setting.

Given unrestricted access to food, individuals with Prader-Willi Syndrome (PWS) may consume as much as three times more calories than that of individuals matched on age and body mass index. When food is unavailable, it is not uncommon for individuals with PWS to engage in problematic food seeking behavior such as food-stealing or pica. Because food-related challenging behavior is not uncommon for individuals with PWS and can lead to obesity and other long-term health complications, intervention is often warranted. However, efforts to decrease these behaviors, such as isolation during meals and strict monitoring of food consumption, can be socially stigmatizing. Ideally, effective intervention would decrease problematic food-seeking behavior without isolating the child or restricting access to socially important events; such as eating dinner at the dinner table with family members. Our participant was a 7-year-old girl with PWS that engaged in mealtime food-stealing behavior that precluded her participation in traditional familial mealtime routines. We conducted a latency-based functional analysis of food stealing in a clinic setting and then implemented an intervention that included a token board, function-based differential reinforcement of other behavior (DRO), and schedule thinning. The intervention generalized to the home setting across food preferences, therapists, and family members.

Vomiting is a common symptom of many illnesses and disorders. Typically vomiting requires minimal intervention and is resolved once the offending agent has been resolved (Scorza et al., 2007). However, chronic vomiting can be associated with a variety of conditions. In order to get a better understanding of vomiting a thorough evaluation should be conducted. Through the evaluation, signs and symptoms should be identified along with the underlying etiology of nausea and vomiting (Scorza et al., 2007) Vomiting may lead to an increase in medical complications/concerns and social isolation. Azarin & Wezolowski (1975) utilized positive practice and self-correction to address habitual vomiting in two individuals and saw a reduction in vomiting across both participants. A similar treatment was developed to treat projectile vomiting in a 16 year old male. Ten minute trials were conducted across the day and percent of opportunities for each trial was collected. A multiple baseline across staff members was used to demonstrate experimental control. The treatment was effective in decreasing the overall frequency of vomiting. In addition, most of the vomiting that continued to occur occurred in the practiced location (i.e. toilet).