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.


47th Annual Convention; Online; 2021

All times listed are Eastern time (GMT-4 at the time of the convention in May).

Event Details

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Symposium #281
CE Offered: BACB
Advancements in the Assessment and Treatment of Pediatric Feeding Disorders: Novel Applications of Evidence-Based Practices
Sunday, May 30, 2021
3:00 PM–4:50 PM
Area: DDA/CBM; Domain: Applied Research
Chair: Hallie Smith (Mississippi State University )
Discussant: Alison Kozlowski (Kennedy Krieger Institute)
CE Instructor: Alison Kozlowski, Ph.D.

There is no shortage of literature demonstrating the effectiveness of various procedures (e.g., nonremoval of the spoon, differential reinforcement, physical guidance, etc.) addressing a variety of mealtime problem behaviors. There are however, gaps in the feeding disorders literature when it comes to the assessment of specific mealtime problem behaviors as well as the utility of less-intrusive behavioral procedures (i.e., protocols that do not include nonremoval of the spoon). This symposium will include four presentations of novel applications of evidence-based behavior analytic practices to address various topographies of food refusal. The first presentation will discuss the development and utility of an assessment designed to efficiently identify an effective physical guidance procedure to incorporate into treatment. The second presentation will discuss the use of a levels system, without the use of nonremoval procedures, to increase consumption. The third and fourth presentations will evaluate the use of a token economy to decrease packing and increase variety, respectively. The symposium will conclude with a discussion on how these novel applications of well-known behavioral strategies add to the body of literature on the assessment and treatment of pediatric feeding disorders.

Instruction Level: Intermediate
Keyword(s): feeding disorder, levels system, packing, token economy
Target Audience:

The target audience for this presentation are BCBA's or other practitioners who provide clinical services, supervision, and/or conduct research on the assessment and treatment of pediatric feeding disorders. Audience members should have some pre-requisite knowledge of the assessment and treatment of pediatric feeding disorders.

Learning Objectives: At the conclusion of the presentation, participants will be able to use alternative evidence-based treatment approaches to treat food refusal and selectivity that do not include nonremoval of the spoon. They will also be able to identify the benefits of using a rapid assessment process to facilitate treatment selection prior to evaluation. Finally, participants will have a better understanding of how to individualize evidence-based procedures to best fit the client, their topography of food refusal, and their overall presentation.

Increasing Food Consumption in an Underweight Adolescent: A Tiered-Reinforcement Approach

MARGARET BERNHEIM POWELL (Mississippi State University), Heather Whipple (Kennedy Krieger Institute), Brian T. Dudley (Kennedy Krieger Institute)

Feeding difficulties occur in somewhere between 33 and 80% of children with developmental disabilities and can cause a number of health, developmental, and social concerns. The current study examined a 11-year-old boy with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder who was referred to an intensive outpatient pediatric feeding disorders program for significant food selectivity, limited volume intake, underweight classification, and inappropriate mealtime behavior (IMB). Treatment was implemented in the form of a levels system and a token economy, and a changing criterion design was utilized. Results indicated that with the implementation of the rewards system, the participant was able to consume 10+ new foods at an age-appropriate volume, as well as decrease IMB, increase volume intake, and gain weight to classify as a healthy weight. Additionally, caregivers rated treatment as highly acceptable. These results are significant in that escape extinction, which has been frequently studied and substantiated in the prominent feeding literature, was not necessary in the current study; instead, the implementation of a rewards system, which have been less studied in the feeding literature, was effective independently. Future implications will be discussed.


Using a Token Economy to Decrease Packing Within an Outpatient Setting

HEATHER WHIPPLE (Kennedy Krieger Institute), Margaret Bernheim Powell (Mississippi State University), Hailey Ormand (Kennedy Krieger Institute)

Children with feeding disorders may exhibit a wide range of problem behaviors, including packing (i.e., holding food in the mouth for a prolonged period of time). There are several treatment strategies in the literature to address packing, including texture manipulations, redistribution, offering a chaser, and reinforcement-based contingencies; however, these strategies may be difficult to implement and are not always effective. There is significant research regarding the use of token economies with individuals with autism spectrum disorder (ASD) and other developmental disabilities to increase prosocial and adaptive behaviors as well as decrease challenging behaviors. Limited research has been conducted on the use of token systems within feeding, particularly to address packing. Researchers in the current study conducted an evaluation of a token system to decrease packing and latency to swallow bites. The study included a 9-year-old female diagnosed with ASD and food selectivity in an outpatient setting via telehealth. Latency to swallow was high during home baseline session. The addition of a token system and visual cues led to reductions in latency to swallow. These results were maintained during 1-month follow-up.


The Use of an Individualized Levels System to Increase Consumption for an Adolescent With Food Refusal

HAILEY RIPPLE (Mississippi State University), Hallie Smith (Mississippi State University ), Heather Whipple (Kennedy Krieger Institute), Rita Druffner (Kennedy Krieger Institute; University of Maryland, Baltimore County )

A levels system is an intervention consisting of various evidence-based behavioral strategies that are implemented in a way that requires the individual to achieve a specific criterion of a target behavior, while decreasing problem behavior (Bauer et al., 1986; Hagopian et al., 2003). Specifically, the individual is provided access to reinforcers for meeting the behavioral criterion, and access to reinforcers is restricted for engagement in problem behavior. Historically, levels systems have been used to address severe problem behavior (Hagopian et al., 2003; O’Connor et al., 2003; Randall et al., 2018); however, there has been limited application of levels systems to address inappropriate mealtime behavior (Gonzalez et al., 2013). The purpose of the current study was to evaluate the use of an individualized levels system to increase consumption of solids and liquids in a 12-year-old adolescent with a history of food refusal.


Rapid Assessment of Physical Prompts for the Treatment of Pediatric Food Refusal

SAMANTHA HARDESTY (Kennedy Krieger Institute), Hallie Smith (Mississippi State University ), Sadie Ingram (Little Leaves )

When nonremoval of the spoon and reinforcement-based strategies are ineffective at increasing acceptance, physical guidance or prompting procedures are considered. Physical prompts are effective at increasing acceptance in the treatment of pediatric food refusal (Borrero et al., 2013; Rubio et al., 2015). Typically, prompts are introduced sequentially, utilizing the least restrictive procedures first. However, it might be more efficient to evaluate all physical prompt options within the context of the assessment process. In the current study, a rapid assessment of physical prompts (RAPP) was completed in a multi-element design with 3 participants who were admitted to an intensive day treatment program for the assessment and treatment of food selectivity and refusal. Participants ranged from 2-5 years old and all had a history of food refusal. Data were collected on acceptance, inappropriate mealtime behavior (IMB), and negative vocalizations. Parents also completed a treatment acceptability survey. The physical prompt procedure identified as most effective (highest levels of acceptance, lowest levels of IMB) in the RAPP, and most acceptable to parents, was introduced into the treatment evaluation. Results suggest that the RAPP is an efficient and effective way to assess physical prompts prior to the initiation of treatment.




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