|Assessment Modifications and Antecedent Interventions in the Treatment of Pediatric Feeding Disorders
|Sunday, May 29, 2022
|11:00 AM–12:50 PM
|Meeting Level 1; Room 152
|Area: EAB/AUT; Domain: Applied Research
|Chair: Nicole C Demchuk (UNMC Munroe-Meyer Institute)
|Discussant: Valerie M. Volkert (Marcus Autism Center and Emory School of Medicine)
|CE Instructor: Valerie M. Volkert, Ph.D.
Recent research in the assessment and treatment of pediatric feeding disorders (PFDs) has focused on increasing efficiency, decreasing opportunities for prolonged maintenance of inappropriate mealtime behavior (IMB), and promoting the likelihood for generalization outside of highly controlled clinic settings. The present symposium aims to disseminate novel research in assessment modifications, as well as treatment through the implementation of antecedent interventions. The first presentation will show the potential utility for brief functional analyses in the assessment of PFDs for increasing efficiency and decreasing the time to onset of treatment. The following presentation will introduce a means for systematically identifying optimal bolus size in the treatment of PFDs—a measure currently chosen arbitrarily in most treatment programs. The third presentation will evaluate an individualized treatment plan consisting of antecedent interventions, a reinforcement system, and escape prevention; as well as assessment of choice throughout the intervention to determine how clinicians may best program for generalization and enhance treatment through preference. The final presentation will display a replication of a choice-based intervention, in combination with stimuli to program for generalization to a home setting in the treatment of change-resistant feeding behavior.
|Instruction Level: Intermediate
|Keyword(s): antecedent interventions, feeding disorders, functional analysis, generalization
Attendees should be Master's or Ph.D. level students and individuals currently holding or seeking a BCBA or BCaBA credential.
|Learning Objectives: At the conclusion of the presentation, (1) Attendees will be able to understand the utility of novel assessments for increasing efficiency in the treatment of pediatric feeding disorders; (2) Attendees will be able to identify antecedent interventions to reduce rates of inappropriate mealtime behavior; (3) Attendees will be able to state methods for improving generalization outcomes in the treatment of pediatric feeding disorders.
|Comparison of Brief and Extended Functional Analyses of Inappropriate Mealtime Behavior in Pediatric Feeding Disorders
|CONNOR SHEEHAN (Center for Pediatric Behavioral Health), Melanie H. Bachmeyer-Lee (Center for Pediatric Behavioral Health), Caitlin A. Kirkwood (Center for Pediatric Behavioral Health)
|Abstract: Functional analyses are the predominant assessment used to identify environmental variables maintaining inappropriate mealtime behavior in children with feeding disorders (Bachmeyer et al., 2009; Piazza et al., 2003). Despite the utility of functional analyses in determining function, concerns regarding the time required to conduct the assessment have been raised (Iwata & Dozier, 2008). Prolonged assessments can extend the time spent reinforcing problem behavior and delay the onset of treatment. A brief functional analysis is a methodological variation that compares the occurrence of the target behavior during shorter periods of test and control conditions, resulting in reduced assessment time (Northrup et al. 1991). We conducted brief and extended functional analyses of inappropriate mealtime behavior with 9 children with feeding difficulties, and results indicated high levels of correspondence (89%) between the two analyses. With 3 participants, we implemented function-based treatments based on the results of the functional analyses, and results indicated that treatments matched to each identified function resulted in clinically acceptable changes in acceptance and inappropriate mealtime behavior. We discuss implications for using a brief functional analysis to develop the most specific, effective, and efficient interventions for children with feeding difficulties.
|An Individualized Treatment Package to Increase Food Consumption and Promote Generalization
|ASHLEY ANDERSEN (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz, Stanford University School of Medicine)
|Abstract: Children with avoidant/restrictive food intake disorder may consume an insufficient variety of foods which can lead to medical complications. Interventions to increase consumption of a variety of foods may include differential reinforcement, demand fading, and escape prevention (i.e., escape extinction). However, interventions to increase food consumption may not have a plan for generalizing consumption to unstructured meals or take into account the child’s preferences. In this study, we evaluated the effects of a treatment package including demand fading with escape prevention accompanied by a self-monitoring and reinforcement system on consumption of three foods. We assessed the child’s preferences across foods the child frequently consumed, foods the child previously consumed, and novel foods. The treatment package was individualized and developed as part of a larger system to promote generalization to unstructured meals. We found target step compliance increased rapidly during treatment and was faded successfully to consumption of the target foods without evoking inappropriate mealtime behaviors or negative vocalizations. Although consumption of novel foods increased, preference did not shift across treatment. The impact of initial foods selected for intervention, how clinicians can be flexible to account for child preferences, and the development of systems to promote generalization will be discussed.
|What Would Goldilocks Choose? Determining the “Just Right” Bolus Size in Treatment of Feeding Disorders
|LAURA E PHIPPS (University of Nebraska Medical Center, Munroe-Meyer Institute,), Bethany Hansen (Munroe Meyer Institute )
|Abstract: Nonremoval of the spoon (Piazza et al., 2015) may be necessary to rapidly increase acceptance and decrease inappropriate mealtime behavior for children with avoidant/restrictive food intake disorder (Volkert & Piazza, 2012). However, with nonremoval of the spoon comes the potential for temporary increases in rates of inappropriate mealtime behavior that could warrant additional components (i.e., blocking, safe seating, increased need for staff). Bolus fading, an antecedent intervention, theoretically decreases the feeding demand (Hodges et al., 2020), such that a child may engage in lower rates of inappropriate mealtime behavior when combined with nonremoval of the spoon. Anecdotally, the initial bolus size presented in baseline is often age-typical or selected arbitrarily across providers. In the current presentation, we review an assessment used to determine the ideal initial bolus size for children with avoidant/restrictive food intake disorder receiving treatment in an intensive day treatment program. Then, we will review how the results of the bolus size assessment informed treatment using an ABAB design with terminal probes. We will discuss if results indicate a benefit to starting with an individualized bolus size when nonremoval of the spoon is an indicated treatment.
Recent Advancements in the Treatment of Change-Resistant Feeding Behavior
|BRITTANY JEAN MARTINO (Childrens Specialized Hospital), Kathryn Peterson (Children's Specialized Hospital, Rutgers University), Vivian Ibanez (University of Florida), Lisa Guerrero (Little Leaves), Christopher Engler (Children's Specialized Hosptial), Jaime Crowley-Zalaket (Children's Specialized Hospital), Cathleen Piazza (Children's Specialized Hospital, Rutgers University)
Resistance to change is a core symptom of autism spectrum disorder (ASD) characterized by extreme emotional outbursts in response to small environmental changes (Turner, 1999). Food selectivity is a change-resistant behavior that occurs frequently in children with ASD, characterized by insistence on eating the same few foods, in the same, specific conditions. Change-resistant feeding behavior leads to nutrient-poor diets, which can cause impairments in cognitive and behavioral functioning, serious and irreversible effects on the brain, and increases the risk for severe health problems (Sullivan et al., 2002). Crowley et al. (2020) determined that differential reinforcement and nonremoval of the spoon, implemented within a concurrent-operants arrangement, were effective at reducing change-resistant feeding behavior with young children with ASD. In the current study, we replicated Crowley et al. by evaluating a similar choice-based intervention to reduce the change-resistant feeding behavior of a child with ASD and scurvy, by increasing the number of alternative foods and programming stimuli to generalize responding to the home setting. Results showed that treatment effects generalized from the clinic with a therapist to the home with the caregiver. These results have implications for examining methods that produce faster consumption of a wider variety of healthy foods at home.