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| Advancements in the Treatment of Pediatric Feeding Disorders |
| Monday, May 25, 2015 |
| 9:00 AM–10:50 AM |
| Texas Ballroom Salon C (Grand Hyatt) |
| Area: CBM/DDA; Domain: Applied Research |
| Chair: Danielle N. Dolezal (Seattle Children's Hospital and The Autism Center) |
| Discussant: Sean D. Casey (The Iowa Department of Education) |
| CE Instructor: Danielle N. Dolezal, Ph.D. |
| Abstract: Children diagnosed with pediatric feeding disorders present with a variety of difficulties such as food refusal, difficulties advancing texture, and restrictive diets. In the treatment of these disorders, a number of consequent procedures have been shown to be effective. Given the heterogeneity of the population, further advancements in targeted procedures to improve outcomes are necessary. This symposium will present data that exemplify innovative treatments that improve outcomes for these children. The first investigation evaluates a skill training protocol to increase oral-motor skills and improve the consumption in one child. In the second investigation, the authors evaluated the influence of response effort, quality of reinforcement, and the interaction of these two dimensions on advancing texture in a small child. Study 3 examined the utility of telehealth in training parents to implement interventions to treat food selectivity. Results suggested this may be a suitable method for training parents to expand their childrens diets. The final investigation evaluated the impact of positive reinforcement in the treatment of feeding disorders and began to identify for whom the inclusion of this treatment component was beneficial. These studies will be discussed in terms of variables that influence the development of empirically derived treatments for pediatric feeding disorders. |
| Keyword(s): feeding difficulties, reinforcement quality, response effort, telehealth |
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| The Effects of Skills Training on Consumption and Preference in Children with Pediatric Feeding Disorders |
| ASHLEE MATRIGALI (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz) |
| Abstract: Children with feeding problems display a variety of inappropriate behaviors to avoid eating. Avoidance behaviors are often related to negative experiences that have been paired with eating (i.e., gagging, choking, and vomiting). However, some children, especially those who do not consume food orally but instead via feeding tube for prolonged periods of time, may not develop the adequate oral motor skills to manage different textures or types of food. These skill deficits may increase the aversive properties of eating. To address these skill deficits it is common to implement a skill training protocol to train the necessary oral motor skills. Therefore, the purpose of this study was to evaluate the effectiveness of a training protocol to increase consumption of fruits. In addition, we evaluated the effects of the training protocol on preference. A preference assessment was conducted pre and post training to evaluate preference shifts. Independent consumption increased for the first fruit after training occurred for that food. Interestingly, generalization occurred for the other two fruits and training was not necessary. The results from the post-skills training preference assessment indicated an increase in preference for all fruits presented. These data are discussed in relation to negative reinforcement and establishing operations. |
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| Outpatient Evaluation of the Effects of Response Effort and Quality of Reinforcement on Increasing Bite Acceptance of Food |
| BROOKE M. HOLLAND (The University of Iowa), David P. Wacker (The University of Iowa), Linda J. Cooper-Brown (The University of Iowa), Ashley Willms (The University of Iowa), Kelly M. Schieltz (The University Of Iowa) |
| Abstract: The purpose of this study was to evaluate the influence of response effort, quality of reinforcement, and the possible interaction of these two dimensions on food consumption. The participant, Neil, was a 35-month-old male who had a history of feeding difficulties. Response effort was defined as the combined and regulated oral-motor manipulations required to consume different types and textures of food. Quality of reinforcement was defined as the type of presentation of a particular food. Bites accepted were the dependent variable. Interobserver agreement was assessed across 42.4% of feeding sessions with an average IOA of 97.8%.The evaluation was conducted within two phases: Phase I, conducted within a reversal design, and Phase II, conducted within a changing criterion design. . Phase I results demonstrated quality and effort influenced bites accepted. Specifically, Neil accepted bites of the blended foods (medium effort) via spoon and graham cracker self-fed (higher quality with high effort), but he did not accept bites of fork-mashed foods (high effort). Phase II results demonstrated that the stimulus fading plan of gradually increasing the blended texture to a fork-mashed texture was successful in increasing bites accepted of the high effort food. |
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| Examining the Utility of Telehealth in Training Parents to Implement Interventions to Treat Food Selectivity |
| Abby Greif (Florida Institute of Technology and The Scott Cent), ALISON M. BETZ (Florida Institute of Technology) |
| Abstract: We trained 4 parents of children with food selectivity to implement treatment procedures during mealtime. Prior to training all children engaged in disruptive behaviors such as vocal protests, aggression, and refusal behaviors (e.g. covering mouth and head turns) when presented with a nonpreferred or novel food. A Behavior Skills Training model was used to train parents to implement a treatment package consisting of 3-step prompting, differential reinforcement, and escape extinction. During training parents were first provided with a description of the protocol via didactic training and role playing with the researchers (in vivo) and had an opportunity to ask questions. The researchers then provided immediate feedback during mealtimes via telehealth. Results showed increases in parents’ appropriate implementation of mealtime procedures as well as increases in appropriate child behaviors. Further, high levels of parent integrity maintained following the removal of immediate feedback. Overall, results suggest telehealth may be a suitable method for training parents to implement interventions to treat food selectivity. |
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| On the Effects of Differential and Noncontingent Reinforcement in the Treatment of Feeding Disorders |
| AARON D. LESSER (Munroe-Meyer Institute, University of Nebraska Medical Center), Suzanne M. Milnes (Munroe-Meyer Institute, University of Nebraska Medical Center), Jennifer M. Kozisek (Munroe-Meyer Institute, University of Nebraska), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: Clinicians commonly use positive reinforcement in conjunction with escape extinction (EE) in the treatment of feeding disorders. Some evidence suggests EE is effective to increase acceptance with or without positive reinforcement; however, the addition of positive reinforcement to EE may result in lower levels of inappropriate mealtime behavior (IMB) and/or negative vocalizations for some children (Piazza, Patel, Gulotta, Sevin, & Layer, 2003; Reed et al., 2004). The purpose of the current investigation was to further evaluate the impact of positive reinforcement in the treatment of feeding disorders and begin to identify for whom the addition of positive reinforcement is beneficial. We conducted an assessment comparing differential (DRA), noncontingent (NCR), and no reinforcement on the acceptance, IMB, and negative vocalizations of 31 children with feeding disorders. We observed no difference for acceptance across all conditions for all children and lower IMB and/or negative vocalizations in NCR for 29% of children. We later evaluated NCR or DRA with and without EE on the same behaviors. If we observed no benefit to NCR or DRA across all behaviors during the earlier assessment, we again observed no benefit when NCR or DRA was combined with EE. Additional findings and implications will be discussed. |
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