Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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46th Annual Convention; Washington DC; 2020

Event Details

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Poster Session #301
Sunday, May 24, 2020
1:00 PM–3:00 PM
Walter E. Washington Convention Center, Level 2, Hall D
Chair: Amy Murrell (University of North Texas)
85.

Emotional Responding During Escape Extinction of Inappropriate Mealtime Behavior

Area: CBM; Domain: Applied Research
CHRISTOPHER ENGLER (University of Nebraska Medical Center's Munroe-Meyer Institute), Kathryn M. Peterson (University of Nebraska Medical Center's Munroe-Meyer Institute), Cathleen C. Piazza (Rutgers University)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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).

 
86. Gastrointestinal Issues and Problem Behavior: Using Conditional Probability to Determine Possible Relationships
Area: CBM; Domain: Service Delivery
MORGAN MARIE HALLGREN (Kennedy Krieger Institute), Meagan K. Gregory (Kennedy Krieger Institute), Anlara McKenzie (Kennedy Krieger Institute)
Discussant: Amy Murrell (University of North Texas)
Abstract: Constipation can be more common in individuals diagnosed with autism relative to their typically developing peers (Ibrahim, Voigt, Kautsic, Weaver, & Barbaresi, 2009). As such, caregivers sometimes report a suspected correlation between gastrointestinal (GI) distress and problem behavior. It is possible that some relationship exists, and that the individual has problem behavior occasioned by pain and maintained by automatic negative reinforcement. Conversely, it might be that the discomfort associated with GI distress serves as an establishing operation for problem behavior maintained by negative reinforcement more broadly (e.g., academic demands are only aversive when I am already constipated). When a relationship between GI distress and problem behavior is hypothesized, the first step should be to determine whether a there is a close temporal relationship between the two events. This can be done by calculating, and then comparing, conditional and background probabilities to determine whether a possible positive, neutral, or negative contingency between the events exists. If there is a relationship between problem behavior and bowel movements, treatment of problem behavior might begin by first encouraging the caregiver to address the GI issues with an appropriate physician. However, if it is determined that problem behavior is not related to bowel movements, the data can be used to help alleviate caregiver concerns and to encourage “buy-in” for caregivers to focus on treating the environmental causes of the problem behavior. The purpose of this poster is to discuss the process of collecting conditional and background probability data and subsequent treatment outcomes for two children with autism admitted to an inpatient hospital for the treatment of severe problem behavior. Key words: conditional probability, biological processes, treatment outcome measures
 
87.

The Use of a Levels System to Treat an Adolescent Exhibiting Food Refusal

Area: CBM; Domain: Applied Research
HAILEY RIPPLE (Kennedy Krieger Institute), Rita Druffner (Kennedy Krieger Institute), Hallie Smith (Kennedy Krieger Institute)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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.

 
88.

Preliminary Evaluation of a Trial-Based Functional Analysis of Inappropriate Mealtime Behavior

Area: CBM; Domain: Applied Research
ASHLEY ANDERSEN (University of Nebraska Medical Center, Munroe-Meyer Institute), Bethany Hansen (University of Nebraska Medical Center, Munroe-Meyer Institute ), Kathryn M. Peterson (Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services), Cathleen C. Piazza (Rutgers University)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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.

 
89.

Relative Preferences for Target and Non-Target Foods in Children With Pediatric Feeding Disorders

Area: CBM; Domain: Applied Research
JASON RAMSEY (University of Nebraska Medical Center), Lisa Guerrero (University of Nebraska Medical Center), Jonathan K Fernand (Aurora University), Jason R. Zeleny (Munroe-Meyer Institute, University of Nebraska Medical Center)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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.

 
90. Increasing Parent Compliance With In-Session Practice by Altering Child's Criteria for Reinforcement to Include Accuracy of Parental Implementation
Area: CBM; Domain: Service Delivery
NICOLE HIGGINS (Kennedy Krieger Institute, Johns Hopkins Medical School)
Discussant: Amy Murrell (University of North Texas)
Abstract: Behavior problems are prominent in children with developmental delays. Common concerns often include, but are not limited to, noncompliance, hyperactivity, inattention, and disruptive or unsafe behaviors. Parent training is a common behavioral intervention for parents of children with problem behaviors in which clinicians teach parents to accurately define, assess, and implement behavior management techniques based on concepts of behavior modification. While previous research has shown parent training to be effective, challenges related to accurate implementation of treatment recommendations may still arise in clinical practice. The present case study aims to explore increasing parent compliance within session practice by altering child’s reinforcement (e.g., treasure box) to include accurate parent implementation of treatment recommendations. The target skill identified is parent ability to deliver effective demands. To date, the study includes one parent-child dyad receiving treatment to address tantrums, noncompliance, and elopement. At baseline, parent delivery of effective instructions was not observed. Accurate implementation of intervention by the parent was not observed following education, modeling, and parent practice despite corrective feedback provided. Immediately following altering the child’s reinforcement for session dependent on parent’s accurate implementation of recommendation, percentage of correct implementation of effective demands increased and generalization effects were observed.
 
91.

Increasing Self-Feeding and Self-Drinking Using a Backward Chaining Procedure

Area: CBM; Domain: Applied Research
ALEXANDRIA BROWN (University of North Carolina Wilmington & Center for Pediatric Behavioral Health ), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington), Connor Sheehan (Center for Pediatric Behavioral Health & University of North Carolina Wilmington), Tiffany Kronenwetter (University of North Carolina Wilmington), Melanie H. Bachmeyer-Lee (University of North Carolina Wilmington)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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.

 
92.

A Comparison of a Food Chaining Approach to an Applied Behavior Analytic Approach in the Treatment of Food Selectivity in Children With Autism Spectrum Disorder

Area: CBM; Domain: Applied Research
CONNOR SHEEHAN (Center for Pediatric Behavioral Health), Melanie H. Bachmeyer-Lee (University of North Carolina Wilmington), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington), Emily G. Doane (University of North Carolina Wilmington)
Discussant: Amy Murrell (University of North Texas)
Abstract:

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.

 
93.

Training Staff in Effective Performance Feedback to Coach Foster Parents' Use of Behavioral Health Strategies

Area: CBM; Domain: Service Delivery
Mike Moleski (Devereux Foundation), Richard Allen (Devereux Foundation; Philadelphia College of Osteopathic Medicine), ELIZABETH SMITH (Devereux Foundation)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract:

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.

 
94.

Interdisciplinary Intervention Towards Avoidant and Restrictive Food Intake Disorder: A Review of 16 Inpatient Cases

Area: CBM; Domain: Service Delivery
AARON D. LESSER (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Michelle Melicosta (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Emily Seals Mathis (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract:

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.

 
95. A Comparison of Trial-Based and Pair-Wise Functional Analyses in the Assessment of Pediatric Feeding Disorders
Area: CBM; Domain: Applied Research
TAYLOR KRISTINA MOSELEY (University of North Carolina Wilmington), Melanie H. Bachmeyer-Lee (University of North Carolina Wilmington), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington), Connor Sheehan (Center for Pediatric Behavioral Health), Tiffany Kronenwetter (University of North Carolina Wilmington), Richelle Elizabeth Hurtado (University of North Carolina Wilmington), Yohan Krumov (University of North Carolina Wilmington), Jourdan Bayne (University of North Carolina Wilmington)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract: Functional analyses identify the environmental variables maintaining problem behavior and thus aid in the development of the most specific, effective, and efficient interventions (Hanley, Iwata, & McCord, 2003). Despite the usefulness of functional analyses in determining the function of problem behaviors, some concerns have been identified, including the amount of time required (Iwata and Dozier, 2008). The trial-based functional analysis is a methodological variation which consists of comparing the occurrence of the target behavior during briefer individual trials of test and control conditions, resulting in reduced assessment time (Iwata & Dozier, 2008). To our knowledge, no published study to date has examined the efficacy of the trial-based functional analysis methodology to identify environmental consequences maintaining inappropriate mealtime behavior. We conducted trial-based and pair-wise functional analyses in the assessment of inappropriate mealtime behavior exhibited by 4 children with feeding disorders to examine correspondence between the two assessments. Results indicated that both analyses identified the same functions for 3 of 4 children. Increasing the number of trials during the trial-based functional analysis resulted in the identification of functions consistent with the pair-wise functional analysis for the fourth child. Interobserver agreement was collected for at least 33% of sessions and was above 80%.
 
96. Treatment of Sudden Onset Avoidant and Restrictive Food Intake Disorder: A Medical and Behavioral Model
Area: CBM; Domain: Service Delivery
ELIZABETH A. MASLER (Kennedy Krieger Institute), Aaron D. Lesser (Kennedy Krieger Institute, Johns Hopkins University School of Medicine), DeLicia Boyd (Kennedy Krieger Institute), Clark Elliott (Kennedy Krieger Institute)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract: Treatment of feeding problems free of a distorted body image has been well-documented in the behavior analytic literature. Categorically, this is diagnosed as avoidant and restrictive food intake disorder (ARFID) which encompasses a variety of behavioral presentations (Diagnostic and Statistical Manual of Mental Disorders-5th Edition, 2013). Often, these are longstanding feeding problems which may include food selectivity and refusal and may be attributed to characteristics of an individual’s developmental diagnosis (e.g., autism). However, there is a subset of patients within this diagnostic category that experience an acute onset of these symptoms that may originate from a sudden illness or traumatic event, secondary to a co-morbid psychiatric diagnosis. For either presentation, inadequate oral intake may require supplemental feeding methods to prevent excessive weight loss (e.g., tube feed, high-caloric drink). This case study examined the combined medical and behavioral treatment for a 10-year-old girl admitted to an inpatient feeding program. At admission, she refused all oral feeding and was 100% dependent on tube feeds after the sudden onset of ARFID secondary to salmonella poisoning. Behavioral treatment included variations in choice, demand fading, and environmental manipulation. The outcome of the study resulted in 100% oral consumption and elimination of tube feeds.
 
97.

Introducing Applied Behavior Analysis to a Pediatric Medical Hospital

Area: CBM; Domain: Applied Research
LAURA PIZZA (Children's Hospital of Philadelphia)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract:

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.

 
98.

The Use of Behavioral Principles to Address Infant Feeding Problems

Area: CBM; Domain: Service Delivery
Amy Drayton (University of Michigan Medical School), RACHEL KNIGHT (University of Michigan Medical School), Melissa Andersen (University of Michigan Medical School)
Discussant: Elizabeth Meshes (TCS-LA)
Abstract:

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.

 
99. Rumination Syndrome: Review of Historical Trends and Ethical Considerations
Area: CBM; Domain: Theory
KRISTYN PETERSON (The Chicago School of Professional Psychology), Julie A. Brandt (The Chicago School of Professional Psychology )
Discussant: Elizabeth Meshes (TCS-LA)
Abstract: Rumination syndrome, where an individual regurgitates recently ingested food and then typically reingests it, presents many unique challenges for treatment. Rumination syndrome has deleterious medical side effects, including cardiovascular problems, dental concerns, endocrine dysfunction, and up to death. This indicates a large need for effective treatment. Characteristics of rumination syndrome, including incidence, comorbidities, and medical features are reviewed. Historical and current research in the behavioral intervention on rumination syndrome are examined, including occurrence in non-human analogs. Historical trends illuminate the use of intrusive punishment procedures, including taste aversion and contingent electric shock procedures. Additional historical trends include the use of Freudian explanations to drive treatment and the lack of provision of objective data. More recent research has trended toward the development and use of assessment procedures to identify when rumination is more likely to occur to inform the use of antecedent interventions, primarily in the form of manipulating aspects of food and liquid delivery, which have shown minimal to moderate success. Ethical concerns related to treatments for rumination are considered. Discussion, and finally, suggestions for future research and intervention development are presented.
 
 

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