Association for Behavior Analysis International

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.

BCBAs, BCaBAs, clinical behavior analysts, clinicians working with children with pediatric feeding disorders

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.

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.