|Evaluation of Antecedent-Based Manipulations in Applied Behavior-Analytic Feeding Interventions|
|Saturday, May 25, 2019|
|10:00 AM–11:50 AM |
|Swissôtel, Event Center Second Floor, Vevey 1/2|
|Area: CBM; Domain: Applied Research|
|Chair: Bethany Hansen (Munroe Meyer Institute )|
|Discussant: Melanie H. Bachmeyer (University of North Carolina Wilmington)|
|CE Instructor: Bethany Hansen, Ph.D.|
|Abstract: Feeding disorders can range in severity and can negatively impact a child’s nutrition and growth (Piazza, & Carroll-Hernandez, 2004). Various factors (e.g., complex medical histories, oral motor deficits) can contribute to the development and maintenance of feeding difficulties. ABA-based interventions have the most empirical support for the assessment and treatment of pediatric feeding disorders (Volkert & Piazza, 2012). These ABA-based interventions include antecedent manipulations, such as demand fading (Dolezal, 2006) and utensil manipulation (Wilkin et al., 2014), and consequence-based strategies, such as escape extinction (Bachmeyer et al., 2009). The purpose of the current symposium is to present four studies which investigate a variety of antecedent manipulations as treatment for feeding disorders. The first will compare the effects of three utensil manipulations (i.e., upright-spoon, Nuk, flipped-spoon) and evaluated their effects on oral-motor skills. The second will investigate whether an alternative bite placement can compensate for oral motor deficits and will review effective interventions for increasing lip closure during feeding. The third will evaluate demand fading across several dimensions (i.e., bite placement, bolus size, bite quantity) with and without escape extinction. The fourth will examine whether food preferences change over the course of intervention and discuss implications as possible antecedent manipulations.|
|Instruction Level: Intermediate|
|Keyword(s): antecedent manipulation, escape extinction, feeding, oral motor|
|Target Audience: Clinicians
|Learning Objectives: 1. Attendees will be able to identify at least 3 different dimensions that demand fading can occur across.
2. Attendees will be able to discuss at least one treatment aimed to improve lip closure.
3. Attendees will be able to identify at least 3 utensil manipulations that can be used as antecedent strategies.|
Further Evaluation of Utensil Manipulation During Initial Treatment of Pediatric Feeding Disorders
|VIVIAN F IBANEZ (University of Florida), Kerri P. Peters (University of Florida), Jovanie St. Paul (University of Florida; Florida Autism Center), Timothy R. Vollmer (University of Florida)|
Children with feeding disorders may pack or expel food when they lack the oral-motor skills, the motivation, or both to swallow. Utensil manipulation such as presenting bites on the tongue with a Nuk or flipped spoon is a treatment that researchers generally implement after these behaviors emerge. One exception is Wilkins et al., (2014) because they implemented utensil manipulation during initial treatment of pediatric feeding disorders. In the current study, we extended previous utensil-manipulation studies by comparing the effects of (a) upright-spoon presentation; (b) Nuk presentation; and (c) flipped-spoon presentation on 2 product measures of swallowing, 15- and 30-s mouth clean, and expulsion during the initial treatment of feeding disorders with 5 children. We also monitored lip closure during upright-spoon presentation and following bite deposit in all conditions to evaluate whether utensil manipulation corresponded with improvements in this oral-motor skill. Nuk presentation produced the highest levels of 15-s mouth clean and the lowest rates of expels relative to upright-spoon presentation and flipped-spoon presentation across children. We discuss the data in terms of potential reasons why utensil manipulation improved feeding behavior and how measures of oral-motor skills might predict the necessity of utensil manipulation during initial treatment.
|An Examination of Food Preferences Before and After Treatment for a Pediatric Feeding Disorder|
|JASON R. ZELENY (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center), Valerie M. Volkert (Marcus Autism Center; Emory School of Medicine), Vivian F Ibanez (University of Florida), Jaime Crowley (Munroe-Meyer Institute, University of Nebraska Medical Center), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington)|
|Abstract: Exposure to noxious stimuli in the context of eating results in avoidance behavior in nonhuman animals (Garcia & Kellog, 1966), which may be the same mechanism by which feeding disorders develop in children. However, little is known about the food preferences of children with a feeding disorder and medical diagnoses. Therefore, we set out to identify whether intervention for the feeding disorder results in changes in preferences for foods as a function of exposure. In the current investigation, we evaluated whether the food preferences of children with feeding disorders changed over the course of intervention. We conducted repeated free- and random-choice preference assessments with foods to which we either exposed or did not expose children with a feeding disorder and medical diagnoses during clinical treatment. Responding was relatively equivalent for exposure and nonexposure foods throughout the preference assessments, suggesting that preferences for foods did not change due to exposure during treatment.|
Demand Fading Across Dimensions With and Without Escape Extinction in the Treatment of Pediatric Feeding Disorders
|CHEYENNE DANIEL (University of North Carolina Wilmington; Center for Pediatric Behavioral Health), Melanie H. Bachmeyer (University of North Carolina Wilmington), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health; University of North Carolina Wilmington), Connor Sheehan (University of North Carolina Wilmington; Center for Pediatric Behavioral Health), Erika Winnie (University of North Carolina Wilmington; Center for Pediatric Behavioral Health
Previous literature supports the use of demand fading in conjunction with differential reinforcement of alternative behavior to increase food consumption and mitigate potential emotional responding often observed in escape extinction of inappropriate mealtime behavior (Dolezal, 2006). However, demand fading can occur across many dimensions (e.g., bite placement, bolus size, bite quantity; Kerwin Ahearn, Eicher, & Burd, 1995; Knox, Rue, Wildenger, Lamb, & Luiselli, 2012; Penrod, Gardella, & Fernand, 2012). It is unclear which dimension is the most effective and efficient to fade along to increase consumption and decrease inappropriate mealtime behavior. We used a combined multielement and reversal design to assess the effects of demand fading across bite placement and bolus size plus differential reinforcement of alternative behavior, with and without escape extinction, on compliance and inappropriate mealtime behavior. So far, results indicated that compliance increased across both demand fading dimensions only after we added escape extinction. Initial rates of inappropriate mealtime behavior were lower across both demand fading dimensions with escape extinction compared to escape extinction alone, suggesting that demand fading can help attenuate some potential side effects of escape extinction. Implications of incorporating demand fading into escape extinction are discussed.
Increasing Lip Closure and Decreasing Biting on the Spoon in a Child With Autism and 100% Gastrostomy Tube Dependency
|HOLLY M NEY (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz)|
The clinical significance of lip closure as it relates to pediatric feeding disorders has not yet been empirically evaluated. From an oral motor perspective, in typically developing infants, lip closure helps to keep food within the mouth, and the skill becomes more efficient as the child develops (Carruth & Skinner, 2002). Unfortunately, this behavior does not always emerge in children with feeding disorders, as they do not follow an age-typical eating progression. This may result in an “open mouth posture” when depositing food. It is unclear whether this behavior is actually an avoidance response or a result of limited oral motor skills. For children with limited oral motor capabilities, this may also result in higher levels of expulsion and/or packing (Wilkins et al., 2014; Sharp, Harker, & Jaquess, 2010). Previous researchers have demonstrated that antecedent manipulations such as an alternative bite placement on the middle of the tongue may compensate for these deficits (Girolami, Boscoe, & Roscoe, 2007). However, bite placement alone does not necessarily address the issue of poor lip closure. Therefore, increasing lip closure may be an alternative antecedent manipulation that may also compensate for a lack of oral motor capabilities. In the current study, we successfully increased lip closure and decreased biting on the spoon in a 6-year old boy with a feeding disorder using physical guidance and fading. As a result of this manipulation, we were able to increase oral intake and decrease tube feedings.