Association for Behavior Analysis International

Escape extinction is a well-established treatment for increasing acceptance and decreasing inappropriate mealtime behavior of children with feeding disorders (Volkert & Piazza, 2012), but some researchers have characterized escape extinction as intrusive because of potential negative side effects. One potential negative side effect is an increase in emotional responding (Lerman & Iwata, 1996). Woods and Borrero (2019) found that extinction-induced negative vocalizations occurred in three of 10 data sets (30%). In the current study, we assessed whether negative vocalizations occurred during extinction of inappropriate mealtime behavior for children diagnosed with a pediatric feeding disorder. We analyzed data of 79 children with food refusal, liquid refusal, or both, resulting in 121 data sets (67 and 54 data sets for solid and liquid intake, respectively). We observed an initial increase in negative vocalizations following extinction implementation in 70% of the data sets. However, we also observed that negative vocalizations decreased to zero within an average of six treatment sessions or after approximately 70 min of exposure to extinction. We discuss these findings as they relate to caregiver preference for escape extinction over other interventions as well as treatments that could be added to escape extinction to reduce negative vocalizations (e.g., noncontingent attention).

A levels system is typically comprised of differential reinforcement, a response cost, and punishment (Hagopian, 2002). Specifically, levels systems involve the manipulation of a participant’s access to/ restriction of reinforcement based upon a specific behavioral criterion. While levels systems have been used to intervene on various problem behaviors (Grace, Thompson, & Fisher, 1996; Hagopian et al., 1996) and to increase independence and self-feeding during meals (Gonzalez, Taylor, Borrero, & Sangkavasi, 2013), current literature has not yet documented their use in treating food refusal - specifically with the goal of increasing volume and overall meal completion. The current study examined the effectiveness of a levels system to treat food refusal in a 12-year-old female with a mild intellectual disability, fetal alcohol syndrome, attention-deficit/hyperactivity disorder, and a history of being significantly underweight (body mass index below the 1st percentile). Results indicated that a levels system was successful in increasing the volume of food consumed at each meal and decreasing refusal during the meal. Specifically, by the end of treatment the participant was consuming an age appropriate volume and variety of food at each meal within an appropriate mealtime duration.

Researchers have developed an extended functional analysis methodology to determine the function of inappropriate mealtime behavior (Najdowski et al., 2003; Piazza et al., 2003). Often, researchers find that inappropriate mealtime behavior is maintained by escape from bites or drinks, which may lead clinicians to forgo the analysis to move to treatment more quickly (Saini, Kadey et al., 2019). However, clinicians should demonstrate a clinical need for the use of treatments through the results of assessments, especially when reinforcers are withheld and side effects are expected. The development of a more efficient assessment methodology to determine the function of inappropriate mealtime behavior is warranted. Recently, researchers have recommended the use of trial-based functional analysis to test for individual functions efficiently (Saini, Fisher et al., 2019). Therefore, the purpose of this study is to evaluate a trial-based functional analysis procedure, adapted for the mealtime context, to efficiently determine the function of inappropriate mealtime behavior. Preliminary results suggest that a presentation assessment-informed trial-based functional analysis shows promise for efficiently identifying the maintaining variables for inappropriate mealtime behavior.

Research has demonstrated that children with autism spectrum disorder (ASD) have a higher prevalence of food selectivity when compared with neurotypical children (Sharp et al. 2013). Children with severe food selectivity undergo behavioral feeding therapy to increase their consumption of foods; however, we have limited understanding regarding children’s preferences for foods that are targeted in therapy. In this study, we evaluated relative preferences for foods that underwent treatment and foods that never required treatment. The participants of this study were children with ASD and severe food selectivity that were participating in behavioral feeding therapy. We conducted preference assessments with eight target foods and eight high-preferred (HP), non-target foods to assess their relative preferences in the format that Conine and Vollmer (2019) assessed relative preferences for edibles and leisure items. Results found that several target foods displaced HP foods in a mixed foods preference assessment, indicating that once a child is reliably consuming new foods, the child’s preferences for foods in their diet shifts. For future consideration, we would like to conduct more replications of the current study to verify our results. Additionally, we would like to conduct reinforcer assessments with target foods to see if these function as reinforcers.

Typically developing eaters use a spoon by 14 months of age and begin drinking from an open cup independently by 36 months (Carruth & Skinner, 2002). However, past research has indicated that children with feeding disorders often do not begin self-feeding (self-drinking) in the absence of intervention (Peterson, Volkert, & Zeleny, 2015). Although studies have shown that consequence-based interventions are effective at increasing self-feeding (self-drinking; e.g., Luiselli, 1998; Volkert, Piazza, & Ray-Price, 2016), the literature assessing self-feeding (self-drinking) with antecedent interventions is limited. To our knowledge, only one study has evaluated backward chaining as an antecedent intervention for self-drinking (Hagopian, Farrel, & Amari, 1996). In backward chaining, a complex task is broken down into steps. All steps in the behavior chain are initially completed by the therapist, except for the final step. Once the child masters the final step, each subsequent step is taught until the child completes each step, and thus, the whole task, independently. We evaluated self-feeding and self-drinking in a 4-year-old child with a feeding disorder using a backward chaining procedure with differential reinforcement. Results suggest that backward chaining was effective in increasing self-feeding and self-drinking for one child.

Applied behavior-analytic (ABA) interventions are the most empirically supported approach to the assessment and treatment of pediatric feeding disorders (Volkert & Piazza, 2012). Despite the effectiveness of behavior-analytic interventions, interventions with limited empirical support are often the first-line treatments for feeding difficulties (Peterson, Piazza, & Volkert, 2017). Food chaining is a sensory-integration approach often recommended by occupational and speech and language therapists that introduces new foods into a child’s diet by building off the child’s past successful eating history. The current study used a nonconcurrent multiple-baseline design to compare a food chaining approach to an ABA approach, that consistent of noncontingent attention and escape extinction, for the treatment of food selectivity for 3 children with feeding disorders. We observed an increase in acceptance of target foods and a decrease in inappropriate mealtime behavior only after exposure to the ABA treatment. Results are consistent with previous research supporting the use of behavior-analytic interventions over sensory-based interventions in the treatment of pediatric feeding disorders (Addison et al., 2012; Peterson, Piazza, & Volkert, 2017). We discuss implications for creating and implementing empirically supported treatments for children with feeding difficulties.

There are approximately 400,000 youth in foster care every year in the U.S., many of these children experiencing a myriad of traumatic, negative experiences. Together Facing the Challenge (TFTC) is an evidence-based model that includes both practice-based elements of Treatment Foster Care and components of the Multidimensional Treatment Foster Care model. A core component of the TFTC model involves direct care staff providing ongoing coaching and support to foster parents. A meta-analysis conducted of parent training programs found that parents who were provided an opportunity to practice skills and receive feedback benefited significantly better. The current Devereux foster care project has focused on training direct-service staff to provide evidence-based performance feedback to foster parents in the home setting. A multiple-probe design across three staff is being implemented to evaluate the effectiveness of a training package that includes an online module followed by performance feedback on recorded sessions while coaching foster parents. Performance feedback is being implemented using the 7-step protocol as part of the Supportive Behavioral Supervision model. Results regarding the effectiveness of the training package for foster care staff will be reviewed as well as limitations and future applications of behaviorally-based staff training in child welfare settings.

Avoidant and Restrictive Food Intake Disorder (ARFID) is described as a diagnostic category for individuals with feeding difficulties that cannot sustain adequate nutritional status and does not manifest from a distorted body image (Diagnostic and Statistical Manual of Mental Disorders-5th Edition, 2013). Individuals with this presentation may require intensive medical and behavioral therapy to increase oral consumption and address comorbidities that have developed from events preceding this diagnosis (e.g., illness, choking). There is a burgeoning amount of empirical data that focuses on this population and describes treatment approaches and their respective outcomes. We completed a chart review of all inpatient admissions from an interdisciplinary pediatric feedings disorders program from 2015-2019 and identified 16 patients that met inclusion criteria. The results of the review showed that 88% of patients experienced an acute event that preceded feeding difficulties, all patients met at least 80% of their admission treatment goals, and 92% of patients that completed their admission consumed 100% of their nutritional needs orally.

One of the largest pediatric hospitals in the country introduced the principles of applied behavior analysis (ABA) into its treatment and care of patients. Principals of ABA in partnership with medical principals and procedures has contributed to successful treatment of target behaviors in the medical hospital environment. This partnership has allowed for functional assessments to be conducted outside of the typical settings and populations in which ABA is implemented. This study will review successful functional analyses and treatment for targeted behaviors in pediatric patients who are in a medical hospital. Applied behavior analysis within this setting has been met with many challenges. This poster will briefly note the staffing model, training individuals on the principals of applied behavior analysis and understanding the culture of risk aversion within the environment of a medical hospital. This poster will review patient cases in which functional analyses and data informed behavioral interventions successfully decreased target behavior, highlighting the benefits of integrating ABA into the care of patients admitted to an inpatient medical setting. A discussion of these cases will also include areas of growth when introducing ABA into a new environment of individuals who are primarily trained in medical procedures and principles.

Currently, 40-70% of infants born prematurely or with significant medical conditions have a severe feeding disorder, and studies have shown that 70% of children who refused to eat during infancy will continue to experience feeding problems at the age of four years. Infants quickly learn to associate formula, breast milk, and bottles with pain and danger because of the way that infants are fed in most neonatal intensive care units. This project will describe how the application of principles from classical and operant conditioning can be applied to address feeding issues during infancy. We will also present data demonstrating that behavioral treatment during infancy can prevent severe feeding disorders that require costly and intensive treatment later in childhood.