|Advancements in the Assessment and Treatment of Pediatric Feeding Disorders
|Saturday, May 23, 2020
|10:00 AM–11:50 AM
|Walter E. Washington Convention Center, Level 1, Salon A
|Area: CBM; Domain: Applied Research
|Chair: Valdeep Saini (Brock University)
|Discussant: Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington)
|CE Instructor: Caitlin A. Kirkwood, Ph.D.
Several reviews and meta-analyses have demonstrated the robust effects of behavioral treatments for feeding problems, including increasing oral intake, increasing diet variety, teaching feeding-related skills, and decreasing inappropriate mealtime behavior. This symposium will include four presentations related to recent advancements in the assessment and treatment of pediatric feeding disorders. The presentations are a product of research being conducted across different laboratories and clinical sites across North America. The first presentation will discuss indices of child happiness during treatment for pediatric feeding disorders. The second presentation will describe using structured visual inspection criteria with functional analyses of inappropriate mealtime behavior. The third presentation will compare a re-presentation and modified chin prompt technique to treat different topographies of liquid expulsion. The final presentation will display large-scale outcome data from an inter-disciplinary pediatric feeding disorders program. The symposium will conclude with a discussion and integration of how each of the presentations advance our current understanding of pediatric feeding disorders.
|Instruction Level: Intermediate
|Keyword(s): feeding disorders, food refusal, food selectivity, mealtime behavior
BCBAs, BCaBAs, clinical behavior analysts, clinicians working with children with pediatric feeding disorders
Indices of Child Happiness During Treatment for Pediatric Feeding Disorders
|LAURA E PHIPPS (Munroe-Meyer Institute, University of Nebraska Medical Center), Kathryn M. Peterson (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Rutgers University)
Caregivers may discount the clinical benefits of an effective intervention if it does not appear to lead to positive changes in their child’s affective behavior (Dillon & Carr, 2007). Some researchers suggest that when children appear to enjoy teaching procedures, caregivers may be more likely to seek out the treatment for their child and adhere to implementing the procedures (Green et al., 2005; Kazdin, 1980). Escape extinction, an empirically supported intervention for the treatment of pediatric feeding disorders, is often necessary to improve consumption of healthy, targeted foods for children with feeding disorders. However, escape extinction may occasionally be associated with undesirable side effects (e.g., bursts, increased emotional responding) (Bachmeyer, 2009; Woods & Borrerro, 2019). In the current study, we identified behavioral indices of happiness and unhappiness and collected data on those behaviors before and during escape and attention extinction in the treatment of pediatric feeding disorders. We have observed an increase in levels of happiness and a decrease in levels of unhappiness during escape extinction relative to baseline in one treatment evaluation thus far. We will discuss these findings and address future directions of the study in terms of intervening on child happiness or unhappiness during treatment.
|Using Structured Criteria for Ongoing Visual Interpretation of the Functional Analysis of Inappropriate Mealtime Behaviors
|EMILY MALUGEN (Munroe-Meyer Institute, University of Nebraska Medical Center), Lisa Guerrero (Munroe-Meyer Institute, University of Nebraska Medical Center), Christopher W Engler (Munroe-Meyer Institute, University of Nebraska Medical Center), Bethany Hansen (Munroe Meyer Institute, University of Nebraska Medical Center)
|Abstract: When treating pediatric feeding disorders, one of the first steps is conducting a functional analysis (FA) for inappropriate mealtime behaviors (IMB; Piazza et al., 2003). Traditionally, board certified behavior analysts (BCBAs) use visual inspection to analyze the results of an FA, despite criticism for its lack of standardized rules and subjectivity (Fisch, 1998). Previous research in visual interpretation of FAs found the use of structured criteria provides a method to increase agreement between reviewers (Hagopian, Fisher, Thompson, Owen-DeSchryver, 1997; Roane, Fisher, Kelley, Mevers, & Bouxsein, 2013). We collected FA graphs for 154 children and gave them to a panel of at least three BCBAs for traditional visual inspection. We then applied the modified visual-inspection criteria developed by Roane and colleagues (2013) to interpret FAs of IMB in a post-hoc analysis. Furthermore, we applied these criteria in an on-going visual inspection (OVI) fashion, as done by Saini, Fisher, and Retzlaff (2018). We compared the functions identified by all methods of analysis for agreement to evaluate the predictive validity of OVI. Results of this study indicate a high level of agreement between methods; however, future research is needed to further assess the utility, benefits, and drawbacks of each method of analysis.
|A Comparison of Re-presentation and Modified Chin Prompt to Treat Different Topographies of Liquid Expulsion
|VIVIAN F IBANEZ (Children’s Specialized Hospital, Rutgers University), Kerri P. Peters (University of Florida), Timothy R. Vollmer (University of Florida)
|Abstract: Children with feeding disorders might expel liquid when they lack the oral-motor skills, the motivation, or both, to retain a bolus and swallow. Additionally, the form in which children expel liquid might vary and influence the effectiveness of a treatment to reduce liquid expulsion. In the current investigation, we first identified topographies of liquid expulsion such as forceful and run out for each child. We then compared and evaluated the effects of two procedures, a modified chin prompt and re-presentation, on the liquid expulsion of three children with feeding disorders. For two participants, expulsion decreased to clinically meaningful levels with a modified chin prompt or re-presentation. However, for one participant, expulsion decreased to clinically meaningful levels only when we combined the modified chin prompt and re-presentation as part of a treatment package. We discuss possible mechanisms underlying the effects of a modified chin prompt and re-presentation in addition to areas for future research related to prescriptive treatment models.
Intensive Multidisciplinary Intervention for Patients With Feeding Tube Dependence: An Electronic Medical Record Review
|ADDAM J WAWRZONEK (The Marcus Autism Center), William G. Sharp (The Marcus Autism Center), Valerie M. Volkert (The Marcus Autism Center), Rashelle Berry (The Marcus Autism Center), Kathryn Holman Stubbs (The Marcus Autism Center), Carla Luevano (The Marcus Autism Center), Courtney McCracken (The Marcus Autism Center), Lawrence Scahill (The Marcus Autism Center)
The extant literature on pediatric feeding disorders indicates intensive, multidisciplinary treatment holds benefits for children with severe feeding difficulties, such as patients relying on enteral nutrition (e.g., gastrostomy tube). The most common methodology documenting outcomes for these programs are Nonrandomized Studies (NRS). Although NRS represents a valuable tool for providing insight to intervention, prior research utilizing NRS included potential bias concerning data abstraction. Additionally, there is a lack of standardization across studies regarding uniformity of outcome measures, and description of patient characteristics and treatment protocols. The purpose of the present study was to examine the clinical presentations, intervention characteristics, and treatment outcomes in a sample of children receiving intensive, multidisciplinary intervention for feeding tube dependence. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria to plan the study, guide data abstraction and structure the study’s methodology. We conducted a retrospective electronic medical review to gather outcome data for patients admitted to an intensive day treatment feeding program. The review included 81 individuals dependent on enteral nutrition. We will describe treatment setting and protocols and outcome measures including demographics, anthropometrics, meal-time behaviors, oral/enteral intake and caregiver satisfaction at admission, discharge and follow-up.