Association for Behavior Analysis International

Individuals diagnosed with developmental and intellectual disabilities can experience a number of challenging behaviors (i.e., restricted food intake, rapid ingestion of food, tow walking, aggression, self-injury) which may result in physical health and safety concerns (American Psychiatric Association, 2013; Valentino, LeBlanc, & Raetz, 2018). Symposium attendees will experience practical applications for individuals diagnosed with developmental and intellectual disabilities who exhibit various challenging behaviors. More specifically, the rapid consumption of food will be evaluated under the application of an electronic cueing device. While the additional bite presentation method, under-loaded spoon is used to examine increasing food consumption and decreasing challenging behavior. Considerations for assessing and treating toe walking includes the introduction of shoe inserts. Additionally, preliminary data will be disseminated from a reoccurring COVID vaccine clinic for individuals who exhibit severe and significant challenging behavior.

Intermediate

Children who exhibit feeding difficulties, such as avoidant and restricted food intake disorder (ARFID), often fail to consume an adequate volume or variety of foods, resulting in not meeting their daily nutritional or energy needs (American Psychiatric Association, 2013). Applied-behavior-analytic treatment components to address inappropriate mealtime behavior and encourage acceptance of the bite most commonly include escape extinction, differential reinforcement of alternative behavior (DRA), and stimulus fading (Ledford et al., 2018; Saini et al., 2019; Sharp et al., 2017; Volkert & Piazza, 2012). Once the food enters the mouth, additional problematic behaviors may occur, possibly due to skill or motivational deficits that will result in decreased oral intake, such as expulsion and packing (holding food in the mouth without swallowing; Sevin et al., 2002). Previous research has evaluated the impact of alternative bite presentation methods including flipped spoon and Nuk brush in comparison to upright spoon on expulsion and packing (Ibañez et al., 2021; Milnes et al., 2019). This consecutive controlled case series assesses the clinical application of an additional bite presentation method, under-loaded spoon, to increase food consumption and decrease problematic behavior which interfere with mouth clean for children with ARFID.

The rapid consumption of food is a prevalent concern amongst individuals with intellectual disabilities (Favell, McGimsey, & Jones, 1980; Lennox, Miltenberger, & Donnelly, 1987). Rapid ingestion of food can create significant health and safety issues including choking, aspiration, food regurgitation, and vomiting (Anglesea, Hoch, & Taylor, 2008; Echeverria & Miltenberger, 2012; Page, Griffith & Penrod, 2017; Valentino, LeBlanc & Raetz, 2018). Furthermore, staff resources are heavily used to prevent these health and safety issues. The use of an electronic cueing device has been used in recent studies and has been effective in reducing the rate of eating in adults and children to normative levels (Echeverria & Miltenberger, 2013; Page et al.,2017; Valentino et al., 2018). This study will examine the effects of a cueing device on the rate of eating in adults with intellectual disabilities across three target foods. Furthermore, this study will also investigate the effects of the cueing device on rate of eating when the proximity of direct care staff is faded.

Toe walking is relatively common among children with Autism Spectrum Disorder and if untreated, can contribute to a number of physical problems. Previous research has suggested that toe walking may vary by walking surface. Some (e.g., rough) surfaces may inhibit toe walking, whereas other surfaces may encourage it. In the current study, we first conducted a functional analysis screening to verify that toe walking exhibited by two young children with autism was maintained by automatic reinforcement. Next, we assessed toe walking on a variety of surfaces, including tile, artificial grass, and grip tape. Finally, we placed inserts of the surface associated with the lowest level of toe walking into each participants’ shoes. The inserts were effective to nearly eliminate toe walking by one participant and reduce toe walking to low levels for the second participant. To decrease the second participant’s toe walking further, we added a hand-on-shoulder procedure, which was also effective. We discuss the results in terms of the putative mechanisms responsible for the reduction.

Children with autism and developmental disabilities are at high risk for contracting and being hospitalized for COVID-19. Although there are several vaccines available for public distribution, children with autism and developmental disabilities often engage in severe challenging behavior (e.g., aggression, destruction, self-injury) preventing their successful completion of such invasive medical procedure and increasing their and others’ risk of harm in the process. We developed a recurring vaccine clinic to provide those engaging in severe challenging behavior and their families an outlet to receive the COVID-19 vaccine safely and efficiently. The clinic has a 100% vaccination rate for patients thus far. Caregivers also reported highly satisfactory experiences and that the clinic increased their accessibility to the vaccine.