Association for Behavior Analysis International

Children are diagnosed with a feeding disorder when they do not eat an adequate quantity or variety of foods, sustain an appropriate weight, or grow (Palmer & Horn, 1978; Piazza & Carroll-Hernandez, 2004). Applied behavior analytic interventions have proven effective in the treatment of pediatric feeding disorders (Volkert & Piazza, 2012). Preference for flavors develop in a variety of ways in typical eating individuals (Capaldi, 1996), however, if and how preference occurs for individuals with feeding disorders is less known. The current symposium includes two studies that evaluated preference for nonpreferred foods and examined shifts in preference before, during, and after applied behavior analytic intervention in children with feeding disorders. An additional study used preferred foods during treatment involving a high-probability sequence with and without escape extinction to increase consumption of healthy, nonpreferred foods. The effectiveness of applied behavior analytic interventions to treat feedings problems may be influenced by treatment integrity. The final study examines various components of behavior skills training in isolation and in combination to increase correct implementation of feeding protocols.

Board Certified Behavior Analysts

Picky eating is defined as the consumption of a limited number of foods from each food group (Food Selectivity, 2018). There are various challenges associated with picky eating including a restricted diet and challenging mealtime behavior (Bandini et al., 2010; Penrod, Gardella, & Fernand, 2012). We were interested in identifying whether there were any shifts in preference for nonpreferred foods following treatment. Therefore, prior to and following treatment (i.e., differential reinforcement of alternative behavior with and without nonremoval of the spoon) with eight children, we conducted paired stimulus preference assessments (Fisher et al., 1992) with high-preferred and nonpreferred foods to determine whether there were shifts in preference or if there were selections of previously nonpreferred foods. Results demonstrated that five children selected and consumed at least one previously nonpreferred food and three children selected and consumed at least one previously nonpreferred food at a higher level than at least one preferred food.

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 can develop in some children. For example, if a child were to experience pain, discomfort, or excessive emesis shortly following mealtimes, he or she may be more likely to avoid certain foods, flavors, textures, or mealtime altogether in the future. However, little is known about the development of food preferences for children with feeding disorders. The goal of our investigation primarily focused on identifying whether intervention for the feeding disorder resulted in preference changes for foods as a function of exposure. In the current investigation, we replicated an earlier study (Zeleny et al., 2019) with additional participants and evaluated whether 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 during clinical treatment. We observed a shift in preference following exposure to exposed foods throughout the preference assessments, suggesting that preferences for foods may have changed due to exposure during treatment.

The high-probability (high-p) instructional sequence is a non-intrusive procedure that involves the presentation of a series of high-p requests followed by 1 low-probability request. To date, only 9 studies have examined its effectiveness to treat food selectivity in children, and results of these studies have been mixed. In the current study, we used a multielement design to compare the effectiveness and efficiency of 2 iterations of the high-p sequence to increase the consumption of healthy food in picky eaters. One iteration of the high-p instructional sequence consisted of the researcher presenting 3 bites of a preferred food on a spoon to the child and the other consisted of the researcher presenting 3 bites of an empty spoon to the child. Preliminary results show that nonremoval of the spoon may be necessary to increase consumption for some children. We will discuss the results within the context of treatment implications, limitations, and suggestions for future research.

Pediatric feeding problems are present in approximately 50% of the general population and 90% of children with autism spectrum disorder. Much research has been conducted to evaluate behavioral interventions aimed at addressing these problems. In research and clinical protocols, it’s reported that trained staff implement the treatments. However, it’s unclear how much of the variability observed in the results of behavioral interventions for feeding is a result of differences in the therapist's ability to implement the treatment reliably. This study evaluated different training packages containing all of or some of the following components: written instructions, verbal instructions, video modeling, rehearsal, feedback, and task clarification. Three groups were evaluated across staff members and two groups were evaluated across caregivers. It is expected that the use of these treatment components will increase protocol adherences across novel staff and caregivers with varying levels of acquisition conditional to the group they are exposed to.