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Association for Behavior Analysis International

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44th Annual Convention; San Diego, CA; 2018

Event Details

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Symposium #32
CE Offered: BACB
Considerations Regarding the Assessment and Treatment of Pediatric Feeding Disorders
Saturday, May 26, 2018
10:00 AM–11:50 AM
Manchester Grand Hyatt, Coronado Ballroom AB
Area: CBM; Domain: Applied Research
CE Instructor: Valerie M. Volkert, M.A.
Chair: Caitlin A. Kirkwood (University of Nebraska Medical Center's Munroe-Meyer Institute)
Discussant: Valerie M. Volkert (Marcus Autism Center and Emory School of Medicine)
Abstract: Children are diagnosed with a feeding disorder when they do not eat an adequate quantity or variety of foods, sustain an appropriate weight, or grow (Palmer & Horn, 1978; Piazza & Carroll-Hernandez, 2004). Feeding disorders are reported to occur in 2% to 35% of typically developing children and 33% to 80% of children with developmental disabilities (Bachmeyer, 2009; Burklow, et al., 1998; Palmer & Horn, 1987). Applied behavior analytic interventions have proven effective in the treatment of pediatric feeding disorders (Bachmeyer, 2009). A multi-component intervention combining differential positive reinforcement and escape extinction has the most empirical support (Volkert & Piazza, 2012). However, escape extinction is not always feasible, and using extinction as a treatment for inappropriate mealtime behavior can be associated with extinction bursts, emotional responding, and extinction-induced aggression (Lerman, Iwata, & Wallace, 1999; Volkert & Piazza, 2012). The current symposium reviews the prevalence of extinction bursts and examines the use of antecedent-based approaches to treat inappropriate mealtime behavior with and without escape extinction. Finally, the current symposium reviews the findings of a trial-based functional analysis of inappropriate mealtime behavior and function-based treatments compared to a traditional functional analysis of inappropriate mealtime behavior (Piazza et al., 2003).
Instruction Level: Intermediate
Keyword(s): antecedent-based approaches, escape extinction, feeding disorders, functional analysis
Target Audience: Researchers and clinicians interested in learning more about the assessment and treatment of pediatric feeding disorders.
Learning Objectives: 1) The listener will be able to identify when a child is at risk for a feeding disorder. 2) The listener will be able to identify and explain the application of antecedent-based approaches to feeding disorders. 3) The listener will be able to identify behaviors often associated with extinction bursts during the treatment of inappropriate mealtime behavior.
 
Effects of a High-Probability Instructional Sequence and Response-Independent Reinforcer Delivery on Pediatric Food Refusal
SYDNEY BALL (University of North Carolina Wilimington), Melanie H. Bachmeyer (University of North Carolina Wilmington), Ashleigh Leuck (University of North Carolina Wilmington), Casey Ogburn (University of North Carolina Wilmington), Elizabeth Gonzalez (University of North Carolina Wilmington)
Abstract: Previous investigators have shown that a high-probability (high-p) instructional sequence may be effective without escape extinction (EE) or result in beneficial effects when combined with EE to treat the feeding problems of some children (e.g., Patel et al., 2006; Patel, Reed, Piazza, Mueller, & Bachmeyer, 2007). Bullock and Normand (2006) showed that compliance increased for 2 children using either a high-p instructional sequence or a fixed-time (FT) schedule of positive reinforcement. We used a combined multielement and reversal design to compare the effects of a high-p instructional sequence and response-independent delivery of positive reinforcers to treat the food refusal of 2 children. Compliance with low-probability demands (bite presentations) increased using either the high-p instructional sequence or an FT schedule of positive reinforcement for both children. Compliance with low-p demands was higher and inappropriate mealtime behavior was lower in both conditions compared to EE alone with the child for whom EE was necessary. These findings suggest that the response requirement arranged in the high-p instructional sequence may not be necessary to increase compliance with the low-p demands. Two independent observers collected data during at least 33% of sessions and agreement was above 80%. We will discuss conceptual and clinical implications of these findings.
 
Prevalence of Extinction Bursts During Treatment of Inappropriate Mealtime Behavior
CHRISTOPHER W ENGLER (Munroe-Meyer Institute, University of Nebraska Medical Center), Suzanne M. Milnes (Munroe-Meyer Institute, University of Nebraska Medical Center), Vivian F Ibanez (Munroe-Meyer Institute, University of Nebraska Medical Center), Kathryn M. Peterson (Munroe-Meyer Institute, University of Nebraska Medical Center)
Abstract: Extinction bursts are commonly identified as a side effect of extinction when treating problem behavior (Cooper, Heron, & Heward, 2007). Lerman and Iwata (1995) found that 27 of 113 data sets (24%) in studies that included extinction as treatment for problem behavior displayed an extinction burst. In a subsequent analysis, Lerman, Iwata, and Wallace (1999) found that 39% of 41 data sets in studies that included extinction as treatment for self-injurious behavior found an extinction burst. Even though extinction is a well-established treatment for food refusal (Volkert & Piazza, 2012), no studies to date have examined the prevalence of extinction bursts during the treatment of inappropriate mealtime behavior (IMB) for children with feeding disorders. The current study evaluated the presence of extinction bursts during treatment of IMB, using the criteria delineated by Lerman and Iwata, with 88 children with food refusal, liquid refusal, or both. Results of 133 data sets (74 and 59 datasets for solid and liquid intake, respectively) indicated the overall prevalence of extinction bursts was 12%. We will discuss these findings and the results of additional analyses, including limitations and implications.
 
An Evaluation of Stimulus Fading in the Treatment of Food Selectivity in Children with Autism Spectrum Disorder
ELIZABETH GONZALEZ (University of North Carolina Wilmington), Ashleigh Leuck (University of North Carolina Wilmington), Kyndra Lawson (University of North Carolina Wilmington), Sarah Teague (University of North Carolina Wilmington)
Abstract: Food selectivity is a common problem in children with autism spectrum disorder (ASD; Schreck & Williams, 2006). Escape extinction (EE) is an effective and often necessary intervention, but it is associated with negative side effects, such as extinction bursts, emotional responding, and extinction-induced aggression (Lerman, Iwata, & Wallace, 1999; Volkert & Piazza, 2012). Therefore, additional research identifying antecedent treatments that may be effective alone or attenuate the side effects of EE are warranted. We used a combined multielement and reversal (ABAB) design to evaluate the effects of stimulus fading with simultaneous presentation of preferred and nonpreferred foods to treat the food selectivity of a child with ASD. Initially, inappropriate mealtime behavior decreased and acceptance and mouth clean (a product measure of swallowing) increased using fading without EE. However, it was necessary to combine EE with stimulus fading to maintain high levels of acceptance and mouth clean. Consumption of nonpreferred foods alone did not increase until after stimulus fading. Additionally, inappropriate mealtime behavior, negative vocalizations, and expulsions remained low throughout stimulus fading. Two independent observers collected data during at least 33% of sessions and agreement was at or above 80%. We will discuss the conceptual and clinical implications of these findings.
 
An Initial Evaluation of Trial-Based Functional Analyses of Inappropriate Mealtime Behavior
ABBY HODGES (Baylor University), Stephanie Gerow (Baylor University), Tonya Nichole Davis (Baylor University), Supriya Radhakrishnan (Baylor University), Kristin O'Guinn (Baylor University)
Abstract: In order to address feeding problems such as food refusal and selectivity, is important to consider the variables maintaining inappropriate mealtime behavior (IMB). The purpose of the present study was to evaluate the trial-based functional analysis of IMB and assess correspondence of the results with the traditional functional analysis. The participants were two boys, ages 3 to 5 years old, diagnosed with developmental disabilities. A trial-based functional analysis and traditional functional analysis of IMB were conducted with each participant, with the order of functional analyses counterbalanced across participants. The trial-based functional analysis resulted in differentially higher levels of IMB in one or more test conditions, indicating a social function of problem behavior for both participants. In addition, the results of the trial-based and traditional functional analysis corresponded for both participants. The subsequent function-based intervention resulted in a decrease in IMB and an increase in appropriate feeding behaviors for both participants, providing additional evidence that the trial-based functional analysis resulted in the accurate identification of the function of IMB for both participants. The results of this study provide initial support for the use of trial-based functional analysis to assess the function of IMB.
 

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