Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


41st Annual Convention; San Antonio, TX; 2015

Event Details

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Symposium #208
CE Offered: BACB
Advancements in the Assessment and Treatment of Pediatric Feeding Disorders
Sunday, May 24, 2015
2:00 PM–3:50 PM
Texas Ballroom Salon B (Grand Hyatt)
Area: CBM; Domain: Applied Research
Chair: Melanie H. Bachmeyer (University of North Carolina Wilmington)
Discussant: Meeta R. Patel (Clinic 4 Kidz)
CE Instructor: Melanie H. Bachmeyer, Ph.D.

Interventions based in applied behavior analysis have been shown to be effective in the treatment of pediatric feeding problems. However, well-established interventions are limited to escape extinction and differential positive reinforcement to reduce inappropriate mealtime behavior and increase acceptance, and physical guidance to increase self feeding (Volkert & Piazza, 2012). Thus, additional research is needed to identify efficacious interventions to treat other topographies of feeding problems, such as packing. In addition, further research is necessary to determine effective assessment methods to predict the most necessary, effective, and efficient interventions to treat the wide range of feeding problems. Dieter and colleagues from Kennedy Krieger Institute will present on descriptive and lag-sequential analyses to assess emesis. Kirkwood and colleagues from UNC Wilmington will present results of a comparison of two different experimental analysis methods to identify the function of food/liquid refusal. Wall and colleagues from the Marcus Autism Center will present on a decision matrix to guide selection of interventions to establish liquid intake. Finally, Ibanez and colleagues from the Munroe Meyer Institute will present the results of a comparison of two methods to treat packing.

Keyword(s): feeding disorders, feeding problems, food refusal

Descriptive and Lag-Sequential Analyses of Emesis Related to Pediatric Feeding Disorders

DENISE DIETER (Kennedy Krieger Institute), Carrie S. W. Borrero (Kennedy Krieger Institute), Vivian Ibanez (Kennedy Krieger Institute)

Descriptive analyses have been used to observe food refusal directly under naturally occurring conditions. Although a history of emesis and health concerns related to emesis (e.g., reflux, food allergies) may be associated with food refusal, emesis has not been the focus of previous descriptive analyses. Emesis is not an ideal response to evaluate using functional analyses due to potential health risks, and may be more suited for evaluation as it naturally occurs. Thus, the purpose of the current study was to evaluate emesis, gagging, and coughing, for 10 children, via descriptive analyses by conducting conditional probability analyses to evaluate the most common caregiver responses following these responses. Descriptive data were also used to conduct lag-sequential analyses to examine the relationship between emesis, gagging, and coughing. Conditional probabilities for caregiver responses following emesis, gagging, and coughing were compared to the unconditional probabilities of each event. Results showed that tangible access, attention, and escape occurred frequently followed emesis. Lag-sequential analyses identified gagging or coughing as potential precursors to emesis for 60% of participants. The patterns observed may reveal the uniqueness of emesis as a target response due to its biological nature and these implications are discussed.

A Comparison of Two Methods of a Functional Analysis of Inappropriate Mealtime Behavior
CAITLIN A. KIRKWOOD (University of North Carolina Wilmington), Melanie H. Bachmeyer (University of North Carolina Wilmington), Amanda Criscito (University of North Carolina Wilmington), Courtney Mauzy (University of North Carolina Wilmington), Billie J. Klein (University of North Carolina Wilmington), Diane Berth (University of North Carolina Wilmington)
Abstract: Functional analyses have been used to quantify precisely the functions of problem behavior and develop the most effective and efficient treatments (Iwata, Dorsey, Slifer, Bauman, & Richman 1994). Two procedural variations for conducting functional analyses of inappropriate mealtime behavior (Najdowski et al. 2008; Piazza, Fisher, et al. 2003) have been established in the literature. We assessed the food refusal of a three children diagnosed with feeding disorders by comparing the two methods. Interobserver agreement was conducted on at least 33% of sessions. Agreement was above 80% for each child. One method identified a single function and the second method identified multiple functions for the first child, both methods identified a single function for the second child, and both methods identified multiple functions for the third child. We then examined the relative effects of interventions matched to results from each method. The intervention matched to multiple functions resulted in lower rates of inappropriate mealtime behavior and higher levels of acceptance. Results suggest that the method that identified only one function produced false negative findings. Potential operant explanations for the differential functional analysis outcomes will be discussed.

Establishing Liquid Intake in Pediatric Feeding Disorders: A Decision Matrix to Guide Treatment Selection and Evaluation

MEGHAN WALL (Marcus Autism Center and Emory University), Roseanne S Lesack (Marcus Autism Center), William G. Sharp (The Marcus Autism Center)

Behavioral intervention is the only treatment for severe feeding disorders with well-documented empirical support. To date, the majority of this research focuses on establishing food consumption with comparably fewer examples of methods to increase intake of liquids. Establishing adequate consumption of liquids represents a key aspect of intervention planning, necessary to assure optimal health outcomes (e.g., adequate hydration) and a prerequisite for weaning a child from tube feedings. Past reports describing the use of behavioral intervention to establish liquid intake include non-removal of the cup, spoon-to-cup fading, and stimulus fading of drink bolus. However, few replications of these treatments are available and no guidelines exist to aide clinicians in selecting and evaluating these treatments. The current study describes an assessment and decision-making model for selecting treatment elements to increase liquid intake in pediatric feeding disorders. This model involves the combination of antecedent manipulations with extinction procedures to promote highly specific treatment packages that balance addressing the operant function of liquid refusal with maintaining the least restrictive environment. Results suggest this systematic approach to intervention may serve as a valuable tool for clinicians, with all participants experiencing a significant increase in liquid intake.

Treating Packing: A Comparison of Nuk Re-distribution and Nuk Presentation
VIVIAN IBANEZ (Kennedy Krieger Institute), Suzanne M. Milnes (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center), Jennifer M. Kozisek (Munroe-Meyer Institute, University of Nebraska)
Abstract: Packing (holding food in the mouth without swallowing) may occur if a child lacks the oral motor skills and/or motivation to swallow. Previous interventions for the treatment of packing have included altering presentation method (i.e., presenting bites with a Nuk brush or flipped spoon; Sharp, Harker, & Jaquess, 2010) or re-distribution (i.e., collecting packed food from the child’s mouth and replacing it on the child’s tongue; Gulotta, Piazza, Patel, & Layer, 2005). These studies showed that both procedures increased mouth clean; however, it is not clear whether one procedure is more effective than the other. The purpose of the current investigation was to compare the effects of re-distribution using a Nuk relative to presenting bites using a Nuk on packing and mouth clean for 2 children with a feeding disorder. One child packed thickened liquids and pureed food and another child packed pureed food only. We used a reversal and multielement design to evaluate the procedures with thickened liquids and a multielement design to evaluate the procedures with solids. For both children, using the Nuk to present bites was more effective, resulting in decreased packing and clinically meaningful levels of mouth clean. We observed similar results for thickened liquids.



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