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| Advancements in Training Individuals to Conduct Treatment for Feeding Difficulties |
| Sunday, May 25, 2025 |
| 5:00 PM–6:50 PM |
| Marriott Marquis, M4 Level, Archives |
| Area: DDA; Domain: Applied Research |
| Chair: Denise Pichardo (Kennedy Krieger Institute) |
| Discussant: Melanie H. Bachmeyer-Lee (Center for Pediatric Behavioral Health) |
| CE Instructor: Melanie H. Bachmeyer-Lee, Ph.D. |
| Abstract: Interventions focused on the principles of applied behavior analysis are highly effective at addressing pediatric feeding difficulties and teaching caregivers to implement those behavioral strategies. Involving caregivers is critically important to achieve generality and maintenance over time. Studies in this symposium will highlight the use of empirically identified strategies to teach caregivers and staff to implement behavioral feeding interventions and explore a decision-making model for working with children with feeding difficulties. Presenters will discuss (a) how to address challenges associated with generalizing feeding interventions to the home setting while minimizing treatment degradation, (b) behavioral skills training (BST) while exploring the direct effects of immediate versus delayed feedback and video modeling when training caregivers, (c) preferences for feedback on acquiring mastery of treatment protocols frequently conducted during behavior analytic services and, (d) using a decision-making model to treat feeding problems. Ultimately, these presentations will address the importance of caregiver training once an effective treatment has been identified as it relates to pediatric feeding disorders and ways to enhance training procedures for caregivers and staff. Important directions for practical and impactful behavior-analytic treatment decisions and caregiver training will be discussed. |
| Instruction Level: Basic |
| Keyword(s): caregiver training, feedback, feeding difficulties, treatment adherence |
| Target Audience: N/A |
Learning Objectives: 1. Discuss the existing research on caregiver training procedures and pediatric feeding disorders
2. Identify ways to improve caregiver integrity when implementing ABA based meal recommendations
3. Discuss the importance of assessing feedback preference when training individuals to implement feeding protocols |
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Evaluation of Mealtime Barriers During Caregiver-Implemented Feeding Interventions |
| SARAH D. HANEY MCDEVITT (Kennedy Krieger Institute), Alison Kozlowski (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Carrie S. W. Borrero (Kennedy Krieger Institute), Denise Pichardo (Kennedy Krieger Institute) |
| Abstract: Previous research has shown that behavioral skills training is effective for training caregivers of children with feeding disorders to implement ABA-based feeding interventions with high integrity (Alaimo et al., 2017; Bachmeyer et al., 2020). Less is known about how caregiver treatment integrity generalizes outside of the clinical setting. Caregivers may have challenges with generalizing their skills to the home as the training context (e.g., clinic) may not include stimuli necessary for caregiver skill generalization. The purpose of the current study was to evaluate ways to improve caregiver integrity in the presence of mealtime barriers relevant to their home mealtime setting (e.g., eating while implementing treatment, attending to siblings during meals). We trained three caregivers of children admitted to an intensive feeding program to implement ABA-based feeding interventions in the absence and presence of caregiver-identified mealtime barriers relevant to their home mealtime setting. Treatment integrity decreased for two of three caregivers in the presence of the mealtime barriers but increased to high levels following additional feedback. One caregiver required no additional training when the mealtime barrier was introduced. We discuss these results in terms of considerations for improving generalization of caregiver treatment integrity outside of the clinical setting. |
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| An Evaluation of Selected and Non-Selected Feedback Packages on Performance |
| RUAIRI DEVEREUX (Western Michigan University), Nicole C Demchuk (Munroe-Meyer Institute, University of Nebraska Medical Center), Bethany Hansen (University of Nebraska Medical Center’s Munroe Meyer Institute) |
| Abstract: Researchers have broadly applied performance feedback within Organizational Behavior Management. However, the specifics regarding the most effective type of feedback still require careful investigation. The current study evaluated how assessing preferences for a selected feedback package containing different forms of source, timing, and content would affect performance on acquiring mastery of treatment protocols frequently conducted during behavior analytic services. The experimenters trained participants on three clinical protocols and provided their preferred feedback package. For the preferred feedback package, participants selected the source, timing, and content of feedback. Participants also received training with a non-selected feedback package on a fourth clinical protocol. Both participants demonstrated improvement post-baseline after exposure to their preferred feedback package. One participant also demonstrated improvement post-baseline after exposure to the non-selected feedback package. Social acceptability results indicated a preference for the selected feedback package over the non-selected feedback package. Results suggest that supervisors should continue to assess feedback preferences that are organizationally feasible. |
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Using a Decision-Making Model to Treat Feeding Problems in Children With Poor Oral Intake |
| JESSICA NOELLE ABONITALLA PASCUAL (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz; Stanford University School of Medicine), Ashley Andersen-Weber (Clinic 4 Kidz) |
| Abstract: Children who display feeding problems may engage in inappropriate mealtime behaviors to avoid eating. It has been hypothesized that these behaviors are often maintained by negative reinforcement in the form of escape. Therefore, escape extinction has been a viable treatment that has been shown to be effective. However, with escape extinction comes side effects. Therefore, the purpose of this study was to develop a decision-making model to treat feeding problems by first conducting an antecedent assessment that would help determine a starting point for an antecedent based treatment. Thereafter, if the antecedent-based treatment was not effective, the model progresses to different levels of escape extinction, starting with the least intrusive procedure first. Two patients, one who was 100% tube dependent at the start of treatment and one who was 100% liquid dependent, participated in the study. Different treatments for each child were developed based on the results of the antecedent assessment. Acceptance increased and inappropriate mealtime behaviors decreased for both patients. Furthermore, we were able to decrease dependence on tube and bottle feedings because of their individual assessment and treatment plan and avoid more intrusive escape extinction procedures. These data are discussed in relation to antecedent-based intervention and trauma-informed care |
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| An Evaluation of Video Modeling and Feedback Types for Caregivers Learning How to Implement Pediatric Feeding Protocols |
| NICOLE PERRINO (University of Florida, Florida Autism Center), Ronald J. Clark (University of Florida), Angie Van Arsdale (University of Florida), Vivian F Ibanez (University of Florida), Timothy R. Vollmer (University of Florida) |
| Abstract: Caregiver training is an integral part of behavior analytic feeding intervention as they ultimately become the main source of support for the long-term maintenance of their child’s outcomes with feeding. Fortunately, behavioral skills training (BST) has substantial empirical support as a method to teach caregivers how to feed their child according to a specific protocol (Mueller et al., 2003). While multi-component treatment packages have been effective (Seiverling et al., 2013), components like the use of videos have been less explored (Clark et al., 2020). In addition, we know that feedback is an effective component of BST for increasing caregiver performance. However, currently, the direct effects of immediate and delayed feedback on caregiver performance are mixed (Aclan & Taylor, 2017; Bachmeyer-Lee et al., 2020). Therefore, the purpose of this study was to use video modeling, and when necessary, compare the relative effectiveness of immediate and delayed feedback when teaching caregivers pediatric feeding protocols. |
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