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| Evaluating Stimulus Fading Procedures as a Treatment in Pediatric Feeding Disorders |
| Sunday, May 25, 2025 |
| 12:00 PM–12:50 PM |
| Convention Center, Street Level, 143 A-C |
| Area: CBM; Domain: Applied Research |
| Chair: Ilissa Frye (University of Nebraska Medical Center's Munroe-Meyer Institute) |
| Discussant: Kathryn M. Peterson (Emory University and Children's Healthcare of Atlanta) |
| CE Instructor: Kathryn M. Peterson, Ph.D. |
| Abstract: Children diagnosed with feeding disorders and avoidant/restrictive food intake disorders have a critical need for intervention, resulting in clinicians and researchers exploring innovative areas of behavioral treatments. One commonly used technique for behavior acquisition involves stimulus fading, which has been utilized as an approach across many areas of behavior analysis, and research has been steadily growing regarding the effectiveness of this method within the context of pediatric feeding (Peterson et al., 2024). Due to the inherent complexity of feeding disorders, many researchers have explored a variety of modifications to this procedure to target fading of different utensils (e.g., spoon-to-cup, syringe-to-cup, etc.) or increasing consumption of solids or liquids (Groff et al., 2011, 2014). The purpose of the current symposium will be to explore two different practices of stimulus fading in the treatment of pediatric feeding disorders. The first presentation will report on the findings of a bolus assessment and treatment package designed to prepare a child for a video fluoroscopic swallow study (VFSS). The second presentation will discuss a retrospective consecutive controlled case series review of spoon-to-cup fading procedures to identify the profiles of children who responded to the stimulus fading procedure. |
| Instruction Level: Intermediate |
| Keyword(s): Assessment, Demand Fading, Feeding, Stimulus Fading |
| Target Audience: Individuals interested in learning more about the treatment of pediatric feeding disorders. For BCBAs, BCaBAs, RBTs, and any other practitioners. |
Learning Objectives: 1. Attendees will be able to identify the potential components of the treatment packages used to increase acceptance of solids and liquids in children diagnosed with feeding disorders.
2. Attendees will learn about the profiles of children who may benefit from fading procedures in the treatment of feeding disorders.
3. Attendees will be able to describe two different practices of stimulus fading in the treatment of pediatric feeding disorders. |
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| Determining Appropriate Bolus Size for Bolus Fading Treatment to Prepare for Video Fluoroscopic Swallow Study |
| ASHLEY ANDERSEN-WEBER (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz & Stanford University School of Medicine) |
| Abstract: Prematurity is common in children with feeding problems, frequently leading to tube dependence, and these children are often at increased risk of aspiration. Determining swallow safety in these children can be challenging due to interfering mealtime behaviors and limited oral feeding experience. The purpose of this study was to evaluate a treatment package that prepared a child for a video fluoroscopic swallow study (VFSS) by increasing consumption and reducing inappropriate mealtime behaviors while minimizing the risk of aspiration. We conducted an antecedent assessment of differing bolus sizes to determine a starting point for a bolus fading treatment designed to increase food consumption. The assessment was undifferentiated suggesting that treatment should begin with an empty spoon. With the introduction of the bolus fading, nonremoval of the spoon, and noncontingent reinforcement treatment package, acceptance and mouth clean increased and inappropriate mealtime behavior decreased to low levels across increasing bolus sizes. Appropriate eating generalized to thin liquids and the swallow study environment, allowing swallow safety to be assessed. |
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| A Consecutive Controlled Case Series of Spoon-to-Cup Fading |
| MEARA X. H. MCMAHON (Marcus Autism Center and Emory School of Medicine), Anna Karen Castro-Alcocer (30324), Ashlynn Payton (Marcus Autism Center), Gabriel Yanez (Marcus Autism Center, Emory University School of Medicine) |
| Abstract: Restricted/repetitive behavior exhibited by autistic children may manifest as inflexibility with food and drink presentation. Some children continue drinking from a bottle or sippy cup when it is no longer age-appropriate and demonstrate sensitivity to change with the drink receptacle even when presented with a preferred drink. Prolonged bottle dependence has the potential to lead to dental disease, difficulties with swallowing, and carries a negative stigma for both caregivers and the child. Spoon-to-cup fading is a form of stimulus fading that involves slowly fading an accepted stimulus (spoon) out and fading in the target stimulus (cup). Preliminary research shows that spoon-to-cup fading can increase liquid intake from an open cup for children with feeding difficulties. Researchers conducted a retrospective consecutive controlled case series review to further identify profiles of children who respond to spoon-to-cup fading. Rapid acceptance of liquid increased, and inappropriate mealtime behavior decreased for all three children during spoon-to-cup fading. Shaping with graduated exposure and spoon/cup interspersal were attempted and deemed ineffective at increasing liquid consumption for these children. Implications for long-term health and trauma-informed care will be discussed. |
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