|Translational and Clinical Research on Relapse and Pediatric Feeding Disorders|
|Monday, May 28, 2018|
|3:00 PM–4:50 PM |
|Manchester Grand Hyatt, Coronado Ballroom AB|
|Area: CBM/AUT; Domain: Applied Research|
|Chair: Vivian F Ibanez (Munroe-Meyer Institute, University of Nebraska Medical Center)|
|Discussant: Michael E. Kelley (The Scott Center for Autism Treatment, Florida Institute of Technology)|
|CE Instructor: Vivian F Ibanez, M.A.|
Previous literature supports the use of a functional analysis to identify reinforcers maintaining inappropriate mealtime behavior and to indicate necessary treatment components for children with feeding disorders (Bachmeyer et al., 2009; Piazza et al., 2003). However, additional research is necessary to further refine function-based assessment that will result in the development of enhanced function-based interventions. The majority of research has shown that children's inappropriate mealtime behavior is maintained by negative reinforcement in the form of escape from bites or drinks (Volkert & Piazza, 2012). Therefore, escape extinction is often warranted. However, less is known about the generalization and maintenance of these effects over time. Basic and translational research presents an opportunity to understand the variables that influence long-term outcomes of behavioral interventions. Saini and colleagues will present a meta-analysis of functional analysis procedures and outcomes in pediatric feeding disorders. Kirkwood and colleagues will present results of a comparison of a function-based treatment to a nonindicated treatment of inappropriate mealtime behavior. Ibañez and colleagues will present a translational evaluation of renewal of inappropriate mealtime behavior. Finally, Wathen and colleagues will present the results of multiple-context training to mitigate resurgence in children diagnosed with autism spectrum disorder.
|Instruction Level: Intermediate|
|Keyword(s): feeding disorders, functional analysis, translational research|
|Target Audience: |
Researchers and clinicians who are interested in learning about the assessment and treatment of pediatric feeding disorders and those who wish to gain an understanding of resurgence and renewal.
|Learning Objectives: 1. Participants will gain information regarding functional analysis methodology in the area of pediatric feeding disorders. 2. Participants will be able to identify future directions for research involving children with autism spectrum disorder and feeding disorders. 3. Participants will be able to describe how translational examinations of renewal and resurgence provide a method to evaluate techniques to enhance the generality and durability of behavioral interventions.|
A Meta-Analysis of Functional Analysis Procedures and Outcomes in Pediatric Feeding Disorders
|HENRY S. ROANE (Upstate Medical University), Valdeep Saini (Upstate Medical University), Heather Kadey (The Kelberman Center; State University of New York Upstate Medical University), Joshua Jessel (Queens College), Julia Iannaccone (Queens College), Charlene Agnew (Queens College), Katherine Paszek (Syracuse University)|
Functional analysis methodology was refined and adapted for children who engaged in refusal behavior during mealtime situations over a decade ago. In Study 1, we evaluated 86 functional analyses of inappropriate mealtime behavior across a variety of dimensions. We highlight procedural differences across studies that could affect functional analysis outcomes and describe the state of the literature on functional analysis in pediatric feeding disorders. In Study 2, we conducted effect-size analyses to determine whether treatments based on a prior functional analysis led to more robust and efficacious treatment effects (i.e., reductions in inappropriate mealtime behavior) than those not based on the results of a functional analysis. We discuss the implications of our results with respect to (a) the assessment and treatment of pediatric feeding disorders, (b) functional analysis methodology as applied to inappropriate behavior that occurs during the mealtime context, and (c) areas of future investigation that could potentially resolve existing gaps in the literature.
A Comparison of a Function-Based Treatment to a Nonindicated Treatment in the Treatment of Inappropriate Mealtime Behavior
|CAITLIN A. KIRKWOOD (University of Nebraska Medical Center's Munroe-Meyer Institute), Cathleen C. Piazza (University of Nebraska Medical Center's Munroe-Meyer Institute), Kathryn M. Peterson (University of Nebraska Medical Center's Munroe-Meyer Institute), Vivian F Ibanez (University of Nebraska Medical Center's Munroe-Meyer Institute)|
Previous literature supports the use of a functional analysis to identify reinforcers maintaining inappropriate mealtime behavior and to indicate the necessary treatment components for children diagnosed with feeding disorders (Bachmeyer et al., 2009; Piazza et al., 2003). However, within the field of behavior analysis, clinicians often train caregivers on treatment components that may not be function-based or indicated. Training caregivers on nonindicated treatments may be unnecessary and can result in additional time and effort for both caregivers and clinicians. In the current study, we assessed the potential effects (e.g., no decrease in inappropriate mealtime behavior, low levels of acceptance, and poor treatment integrity) of including an additional, nonindicated treatment component (i.e., attention extinction) and compared it to a function-based, indicated treatment with two children whose functional analysis of inappropriate mealtime behavior indicated only an escape function. So far, results indicated that inappropriate mealtime behavior decreased, acceptance increased, and treatment integrity increased across both the indicated and nonindicated treatments for both children. Implications of implementing nonindicated treatment components are discussed further.
|A Translational Evaluation of Renewal of Inappropriate Mealtime Behavior|
|VIVIAN F IBANEZ (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center), Kathryn M. Peterson (University of Nebraska Medical Center's Munroe-Meyer Institute)|
|Abstract: Basic and translational researchers have shown that context influences generalization and maintenance of intervention outcomes (Podlesnik & Kelley, 2015). Specifically, results demonstrated that transitioning away from an intervention setting could result in a return of undesirable behavior, a phenomenon referred to as renewal. We determined it would be critical to conduct a translational evaluation of renewal during feeding interventions because feeding occurs in many different contexts across a child’s day (e.g., home, school). Contextual changes do not impact feeding routines for children who are typical eaters, given that eating is likely an automatically reinforced behavior. We do not know, however, whether children with feeding disorders will respond similarly to contextual changes. Therefore, we tested for renewal using an ABA arrangement during feeding interventions with three children. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child’s caregiver as feeder, B was function-based extinction in a standard clinic setting with therapist as feeder, and a return to the A phase was function-based extinction in a simulated home setting with caregiver as feeder. For all children, returning to Context A resulted in a return of inappropriate mealtime behavior despite extinction remaining in effect.|
Assessing Multiple-Context Training to Mitigate Resurgence in Children Diagnosed With Autism Spectrum Disorder
|STEPHANIE WATHEN (The Scott Center for Autism Treatment, Florida Institute of Technology), Ronald Clark (The Scott Center for Autism Treatment, Florida Institute of Technology), Melinda Galbato (The Scott Center for Autism Treatment, Florida Institute of Technology), Cassie Maureen Vergason (Florida Institute of Technology), Weizhi Wu (Florida Institute of Technology), Christopher A. Podlesnik (The Scott Center for Autism Treatment, Florida Institute of Technology; The University of Auckland)|
Resurgence is a form of treatment relapse observed when a previously extinguished response returns following the discontinuation or reduction in rate of reinforcement of a more recently reinforced response. This study used a translational approach to examine multiple-context training as a potential method to mitigate resurgence in three children with ASD. In Phase 1, we reinforced target responding with edibles on a variable-ratio schedule in Context A. In Phase 2, we reinforced alternative responding on a continuous schedule and discontinued reinforcement for the target response across either Context B only or Context B, C and D. In Phase 3, we returned Context A while discontinuing reinforcement for the alternative response and continuing to withhold reinforcement for the target response. Each participant experienced all three phases twice: Once with one context in Phase 2 and once with three contexts in Phase 2. We compared resurgence of target responding in Phase 3 following one context or multiple contexts in Phase 2. Multiple-context training did not significantly mitigate resurgence of the target response observed in the third phase. The current study and other translational examinations of treatment relapse provide a method to evaluate techniques to enhance the generality and durability of behavioral interventions.