Association for Behavior Analysis International

Pediatric feeding disorders (PFD) commonly associated with developmental disorders have adverse effects on health, development, and social skills. The leading empirically supported approach to treating PFD is behavioral intervention. Researchers have made much progress in this area over the last 10 years. In this symposium, researchers will present the results of literature syntheses on two topics in the assessment and treatment of PFD. Each speaker will share summary data, provide practice guidelines, and suggest future avenues of research, all with a focus on the assessment and treatment of PFD in the evidence-based practice of ABA. The first speaker will discuss research on interventions for feeding problems in individuals with intellectual and developmental disabilities across the lifespan. The second speaker will discuss research on the use of nonremoval of the cup to treat liquid refusal in PFD. Attendees will leave the symposium with guidelines for using ABA to treat PFD in children with autism.

Behavior analysts, speech and language pathologists, occupational therapists

Pediatric feeding disorders have adverse effects on health, social skills, and development. These disorders are highly prevalent in individuals with intellectual and developmental disabilities and emerge in early childhood. Left untreated, they can persist into adulthood putting individuals at increased risk for health conditions and dependence on others. Multiple current syntheses have shown that behavioral interventions are highly empirically supported and effective. However, no prior reviews examined research on behavioral interventions for feeding disorders across the lifespan. We addressed this gap in the literature by conducting a multistep electronic search of behavioral interventions for feeding disorders in individuals with intellectual, developmental, and learning disabilities between 2008 and 2018. Among the many findings generated from this comprehensive synthesis, we found (a) that the most empirically supported interventions were differential reinforcement of alternative behavior, nonremoval procedures, representation, rules, and demand fading; and (b) most participants in the reviewed studies were preschool age children (i.e., 3-6 yr), followed by school age children (i.e., 6-12 yr), and toddlers (i.e., 1-3 yr). Almost no studies included infants or adults, suggesting much more research is needed to examine the social validity and effectiveness of behavioral intervention as support for feeding problems in those populations.

Liquid refusal sometimes co-occurs with pediatric feeding disorders. Potential adverse effects of liquid refusal include dehydration, malnutrition, failure to thrive, and constipation. This synthesis discusses the use of the nonremoval of cup and related procedures such as manual guidance and stimulus control transfer procedures for treating liquid refusal. We conducted a multistep electronic database search to identify behavioral intervention studies that evaluated the effects of the nonremoval of the cup procedure on liquid refusal. Seven studies met inclusion criteria. We used these studies to characterize liquid refusal (i.e., critical and variable features), and describe how the use of the nonremoval of cup procedure to treat this problem has evolved. After synthesizing the participant and study characteristics of these studies, we provide practice guidelines for using nonremoval of the cup to treat liquid refusal in the context of the evidence-based practice of applied behavior analysis. We conclude with a discussion of future research.