|Recent Advancements in the Use of Pretreatment Assessments and Antecedent Modifications in the Treatment of Feeding Disorders
|Sunday, May 28, 2023
|11:00 AM–12:50 PM
|Hyatt Regency, Centennial Ballroom E
|Area: CBM; Domain: Applied Research
|Chair: Ashley Andersen (Clinic 4 Kidz)
|Discussant: Vivian F Ibanez (University of Florida)
|CE Instructor: Vivian F Ibanez, Ph.D.
Recent shifts have urged clinicians and researchers to evaluate treatments for pediatric feeding disorders and avoidant/restrictive food intake disorders that increase appropriate feeding behaviors while minimizing treatment side effects. This symposium aims to disseminate novel research using antecedent-based treatments informed by pretreatment assessments. The first presentation describes a sensory assessment to identify target foods to introduce in treatment; researchers evaluated treatment including a systematic desensitization progression with netting in the absence of escape extinction. The next presentation displays an evaluation of treatment including differential reinforcement and establishing operation manipulations to increase self-feeding. The third presentation demonstrates the use of blending without escape extinction to increase consumption of pureed target foods after empirically identifying a preferred food to use as a blending agent. The final presentation describes a reinforcement and parametric analysis to determine what variables might reinforce appropriate feeding behavior, instead of a more traditional functional analysis; researchers developed treatments to increase acceptance and consumption based on the results of the assessments.
|Instruction Level: Intermediate
|Keyword(s): antecedent-based treatment, ARFID, assessments, feeding disorders
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, attendees will be able to (1) understand the utility of novel assessments for informing treatment of feeding disorders; (2) identify antecedent interventions to increase consumption while minimizing treatment side effects; and (3) describe treatment packages that can be efficacious at increasing consumption without escape extinction.
|Using a Sensory Assessment and Systematic Desensitization in the Treatment of Avoidant/Restrictive Food Intake Disorder
|VICTORIA MONZON (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz & Stanford University School of Medicine ), Ashley Andersen (Clinic 4 Kidz)
|Abstract: Children diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID) may display a variety of feeding difficulties, one being food selectivity. Food selectivity is defined as limited consumption of a variety of foods, in which foods may be rejected based on taste, texture, color, temperature, or presentation. Currently, there is a dearth of literature examining appropriate assessments that can help guide treatment for ARFID. The purpose of this study was to develop a sensory assessment to provide information on currently accepted foods. This assessment was used to identify foods to target in treatment based on varying similarity levels to the accepted foods. In addition, food preference assessments were conducted to first guide treatment and later to evaluate whether preference shifts occurred after treatment. Treatment involved a novel systematic desensitization progression using netting to expose two children diagnosed with ARFID to foods. Consumption increased for all three foods for both children in the absence of escape extinction. However, acquisition was longest for the food with 0% similarity, suggesting the need for a sensory assessment when treating AFRID. Furthermore, shifts in preferences were observed from pre- and post-food preference assessment. These data are discussed in relation to demand fading, food chaining, and exposure.
|An Evaluation of Differential Reinforcement and Establishing Operation Manipulations to Increase Self-Feeding
|NICOLE C DEMCHUK (Munroe-Meyer Institute, University of Nebraska Medical Center), Bethany Hansen (Munroe Meyer Institute ), Laura E Phipps (Munroe-Meyer Institute, University of Nebraska Medical Center), Amy K. Drayton (University of Nebraska Medical Center Munroe-Meyer Institute ), Rachel Knight (Munroe-Meyer Institute, University of Nebraska Medical Center), Lindsey Elson (Munroe-Meyer Institute, University of Nebraska Medical Center)
|Abstract: Self-feeding is a behavioral cusp vital to independence, growth, and development. Previous studies demonstrate that strategies like physical guidance are effective at increasing self-feeding for children with feeding disorders. However, these interventions may not be effective for all children, which could be due to their motivation for feeder attention, for escape from the self-feeding demand, or both. In the present study, we evaluated the effects of a treatment package that involved increasing the quality of feeder attention and access to tangibles to decrease the comparative value of escape from the self-feeding demand for two children with feeding disorders using a multiple baseline design. Despite demonstrating the skills to self-feed preferred foods and consume target foods when fed by a caregiver, neither child self-fed target foods independently. Following the introduction of differential reinforcement with the manipulation of establishing operations, both children demonstrated improvement in self-feeding individual bites of target foods. In addition, they successfully transitioned to self-feeding portions of target solids, and caregivers were trained to implement the protocol with high procedural integrity.
|Blending Without Escape Extinction to Increase Consumption of Pureed Target Foods
|NICOLE PERRINO (Florida Autism Center, University of Florida), Faith Kirkland (Florida Autism Center, a division of BlueSprig Pediatrics; University of South Florida), Vivian F Ibanez (University of Florida), Timothy R. Vollmer (University of Florida)
|Abstract: Investigators have used blending (i.e., mixing target foods with consistently consumed foods at various ratios) to increase consumption of target foods among children with feeding disorders. However, escape extinction is often necessary to support the efficacy of blending with pureed foods (King & Burch, 2020), and blending is generally considered after initial treatment has failed (e.g., Mueller et al., 2004). In the current case, a 5-year-old female diagnosed with Williams-Beuren syndrome, autism spectrum disorder, and avoidant/restrictive food intake disorder, the third author coordinated care with the child’s cardiologist to obtain medical clearance for day-treatment feeding therapy. Based on the cardiologist’s recommendations and because the child reliably accepted specific foods, we examined the effects of blending without escape extinction to increase consumption of pureed target foods during initial treatment. After we empirically identified a preferred food to use as a blending agent, results indicated that blending increased consumption for two foods, and we observed generalization for two other foods. We discuss the data in terms of the stimulus conditions under which blending might be effective and how to establish assessments that will predict the efficacy of blending during initial treatment.
Antecedent and Reinforcement-Based Interventions for Children with Avoidant/Restrictive Food Intake Disorder
|CASEY TOUTOUNGI (Caldwell University), Jaime Crowley-Zalaket (Children's Specialized Hospital), Christopher W Engler (Children's Specialized Hosptial), Kathryn Peterson (Rutgers University and Children's Specialized Hospital)
Children with ARFID often consume a limited variety of unhealthy foods and refuse to eat novel foods, liquids, and textures. Feeding difficulties can lead to nutrient-poor diets, which can cause impairments in cognitive and behavioral functioning, serious and irreversible effects on the brain, and severe health problems (Sullivan et al., 2002). Functional analysis is the gold standard assessment in ABA to identify the function of behavior that interferes with consumption, which can then inform treatment. Based on the results of these analyses, escape extinction is often warranted, and is currently the treatment with the most empirical support. Unfortunately, there are fewer studies evaluating the efficacy of antecedent- or reinforcement-based assessments and interventions for children with ARFID. In the current study, we conducted a reinforcement and parametric analysis to determine what environmental events or variables might reinforce appropriate feeding behavior, instead of a more traditional functional analysis for two children with ARFID. Based on the results of these assessments, we developed treatments to increase acceptance and consumption of target foods and liquids. These results have implications for use of alternative assessment and treatment methods that include choice-based components for the child.