Association for Behavior Analysis International

A significant problem in children with pediatric feeding disorders is packing (i.e., pocketing or holding accepted food in the mouth), which could result in unsuccessful treatment. Prior research has identified effective treatments to decrease packing. However, none have systematically evaluated a model to use assessments to identify conditions under which consumption occurs, to inform treatment selection to decrease packing. In the present study, a multielement design was used to identify conditions under which mouth cleans occurred, and the results were used to empirically inform treatment selection to decrease packing for one child of typical development. Results of the assessment indicated that packing was related to food texture and compliance, suggesting that presenting preferred foods at a regular texture and decreasing the texture of non-preferred foods would decrease levels of packing. When treatment (i.e., decreased texture of non-preferred foods) was implemented, levels of packs decreased and all foods were consumed. During the reversal to baseline, however, levels of packs remained at 0%, suggesting that mouth cleans may have generalized following exposure to the nonpreferred food. These preliminary results suggest this model may be useful in empirically selecting treatment packages for children who pack bites.

Mere exposure to novel foods is often not sufficient to increase acceptance of those foods for young children with a pediatric feeding disorder. Rearranging the mealtime environment or contingencies is usually necessary to increase acceptance of novel foods. Demand fading, in which the number of bites increases across mealtimes following acceptance, is one way to increase the amount of foods a child will consume. While demand fading involves gradually increasing the number of bites, this procedure in isolation may not be sufficient as the requirement increases. In this case study, we combined demand fading and an avoidance contingency such that the child avoided a meal with a target food contingent upon completion of the bite requirement. If the child did not consume the required number of bites, another meal with the same bite requirement occurred. The results suggested that with demand fading alone, we were able to introduce two new foods, but the child did not consume enough bites to meet mastery criterion. When the avoidance contingency was implemented, we introduced a total of eight foods, and the child met mastery criterion for five of those foods.

Most commonly, pica is classified as automatically maintained in individuals with developmental or intellectual disabilities (Ashworth, Hirdes, & Martin, 2009). It is less commonly documented in typically developing individuals. Behavioral approaches are considered well-established treatments (Hagopian, Rooker, & Rolider, 2011), but many interventions for pica represented in typically developing populations include medical approaches such as vitamin and micronutrient supplements (e.g., Chishold & Martin, 1981). The purpose of this case study was to present a behavioral approach to assessment and treatment of pica that was identified in a girl with no psychiatric diagnoses and for whom pica was maintained by social attention. The participant was Kelsey, a 3-year-old African American girl. A multiple baseline across settings design was used to demonstrate the effects of a differential reinforcement of other behavior (DRO) with a token economy and extinction procedures on rates of Kelsey's pica behavior. Increasing rates of pica were observed in baseline followed by immediate reductions at the initiation of treatment. Low rates of problem behavior were maintained as the DRO schedule was faded in all settings. In addition, treatment was generalized from therapists to three caregivers, who demonstrated high implementation integrity. Limitations, future directions, and implications will be discussed.

Escape extinction, which typically involves blocking behavior that produces escape from demands, is often a necessary treatment component for severe feeding problems. Although escape extinction is a common treatment for feeding problems and is well-documented in published research, response blocking procedures have received very little attention. The present study aimed to review published literature for descriptions of blocking procedures and determine if these descriptions were sufficient for the purposes of procedural replication. We conducted a systematic electronic search of the feeding literature using relevant search terms and combinations (e.g., "escape extinction + block," "feeding + block"). All published English-language manuscripts from peer-reviewed journals that mentioned or described escape extinction with response blocking as a component of treatment were included in the present review. An initial search identified 10 articles meeting these criteria. Of these, five studies described the response blocking procedures used, one was sufficiently detailed for the purposes of replication, one mentioned therapist or caregiver training, and none reported measures of procedural integrity. Future research should identify when response blocking is appropriate and necessary, who should block escape-maintained behaviors during the implementation of escape extinction (i.e., the feeder or a second person), and what these procedures entail.

Researchers have conducted most feeding interventions in clinic settings with highly trained therapists who feed and train caregivers to implement the feeding interventions (e.g., Wilkins, Piazza, Groff, & Vaz, 2011). Research in this area has shown that caregivers can implement feeding interventions in clinic and natural (e.g., home; Tarbox, Schiff, & Najdowski, 2010; Seiverling, Williams, Sturmey, & Hart, 2012) settings with high integrity (Mueller, M. M., et al., 2003). However, there is limited research on caregivers as the initial and ongoing change agents during a child's feeding intervention. Understanding the effects of caregivers as feeders is important because inappropriate mealtime behavior typically occurs when the caregiver feeds the child (Borrero et al., 2010). In the current investigation, we compared the outcomes of therapist- versus caregiver-fed function-based feeding intervention with a 4-year-old girl diagnosed with a feeding disorder. Results showed that the child's caregiver implemented a function-based baseline and intervention with high integrity. In addition, during therapist-fed sessions, inappropriate mealtime behavior did not return to initial baseline rates, despite increasing the response effort relative to the initial baseline and caregiver-fed baseline. We discuss implications the current findings have on function-based interventions and caregiver training.

Extant research suggests behavioral economic assessments of delay discounting (DD) and demand curve analysis may be useful for understanding behavioral processes related to obesity in adults. These assessments often use hypothetical tasks to assess DD and demand. Although sugar-sweetened beverages (SSB) are known to significantly contribute to obesity, no studies to date have examined demand for SSB via hypothetical purchase task (HPT) in relation to obesity. The current study sought to develop a novel HPT to assess demand for SSB and examine its relation to obesity (via body mass index; BMI) and DD. DD for money was assessed using the 5-trial adjusting delay task (Koffarnus & Bickel, 2014). These tasks were administered to over 200 participants in an online platform. The HPT of SSB resulted in orderly responding well-described by Hursh and Silberberg's (2008) exponential demand equation (average r2 = 0.89). Relations between BMI and delay discounting (natural log of k), demand intensity (Q0), demand elasticity (alpha), and essential value (EV) were examined. Additionally, relations between ln(k) and these demand parameters were examined. Results indicated that BMI was significantly related to Q0 and EV, but not to ln(k) or alpha. Ln(k) was significantly related to Q0 and alpha, but not EV. Results are discussed regarding implications for obesity assessment and treatment.

As many as 82% of children with Autism Spectrum Disorders (ASD) experience numerous chronic sleep disturbances and parents report that some sleep disturbances evolve from their own attempts to address other long-standing sleep problems, such as engaging in undesired co-sleeping to reduce night awakenings. Undesired co-sleeping can be a part of the initial bedtime routine or a response to difficulty falling back asleep and disruptive behaviors (i.e., tantrums, refusal to sleep in own bed, or escaping from the bed and bedroom) following night awakenings. Bedtime Fading with Response Cost (BFRC) is a promising intervention that targets a multitude of sleep problems concurrently, however, undesired co-sleeping has yet to be the primary sleep variable in studies evaluating BFRC with children on the autism spectrum. This study evaluated the effectiveness of parent-delivered BFRC in achieving parent-defined sleep goals (e.g., reduction of undesired co-sleeping) for their children with ASD in the home environment. A non-concurrent multiple baseline design across three participants was used. Results indicate that parent-implemented BFRC was effective in achieving parent-defined sleep goals, such as the reduction of unwanted co-sleeping, frequent night awakenings, dependent sleep onset, and related sleep-disturbances. Follow-up data demonstrate that gains were maintained. Parents reported high satisfaction with BFRC and sleep outcomes for their children. This study extends both the clinical practice and science of parent-defined treatment goals and parent-implemented behavioral interventions as treatment options for children with ASD and co-occurring sleep disturbances.

One of the most common pediatric sleep issues is an extrinsic dyssomnia, which includes difficulty initiating sleep. This often leads to behavioral difficulties at bedtime. There is compelling evidence which suggests behavioral interventions are effective for improving behaviors at bedtime (e.g., Kuhn, 2014). An example of this includes the Excuse Me Drill (EMD; Kuhn, 2011). The EMD is a procedure that uses positive parental attention during bedtime to reinforce a child's sleep compatible behaviors, while ignoring disruptive behavior (i.e., differential reinforcement of alternative behavior). Although EMD has received anecdotal support, no published empirical data supporting its effectiveness exists. Participants in this study included three typically developing children: a two-year-old Caucasian female, a six-year-old Caucasian female; and a seven-year-old Caucasian female. A seven-year old Caucasian male with autism was the final participant. A non-concurrent multiple baseline across design across participants was utilized to examine the relative effectives of the EMD for increasing independent sleep onset and decreasing disruptive behaviors at bedtime. Results indicated that the EMD was effective in increasing independent sleep onset, while decreasing disruptive behaviors for all participants. The current study is the first to empirically support the use of the EMD to improve independent sleep onset.

Many students suffer with the sleep problems, such as sleep disruption and excessive sleepiness, which has a negative effect on their study performance and everyday life. As previous studies indicate that irregular sleep pattern, napping and daytime activity can lead to daytime sleepiness, how to cope with sleepiness can be related to sleepiness continuing. The aim of this study is to investigate the relationship between undergraduate students’ coping skills and daytime sleepiness they experience. Eighty undergraduate student who take a psychology classes will be participated. Participants will be classified as morningness-eveningness, using Horne and Ostberg questionnaire to consider the circadian rhythm preference. In phase 1, coping strategies which can be used when they sleep will be explored via semi-structured interview, including napping/activity, adjusting sleep schedule, promoting health that found in a pilot study. Type of napping will be explored in detail based on the reason of napping. In phase 2, participants will be divided into groups and will apply the strategies that is found to be effective in phase 1 for 3 weeks. Participant will be educated about strategies and report everyday progress during the intervention. Quantity of nap and nighttime sleep will be assessed, based on interview (phase 1) and their sleep diary (phase 2). Also the sleep quality and daytime sleepiness will be measured using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) in both phases. Present study will provide information on the effectiveness of coping skills that can be applied to whom suffer from excessive sleepiness during the day in a non-clinical settings.

Children with a history of renal disease and a kidney transplant are medically required to consume larger volumes of liquid compared to typical same-age peers. When a child takes prolonged durations to consume liquids, it makes it difficult to consume the required volume of liquid by mouth which in turn requires dependency on tube feedings to obtain nutritional and fluid needs. Furthermore, consuming liquid for the majority of waking hours leaves less time for other aspects such as solids and oral motor skill development. The purpose of this study was to decrease the duration of liquid consumption by implementing a behavioral treatment package including a token economy and choice paradigm without the use of escape extinction for a 6-year-old boy diagnosed with pediatric feeding disorder and has a history of end-stage renal disease. A changing criterion design with baseline probes was used to evaluate the treatment protocol. Results found that using a choice paradigm and token economy without the use of escape extinction was effective at decreasing the duration of liquid consumption and increasing overall liquid consumption by mouth as well as avoiding the effects of extinction bursts. Since duration of liquid consumption decreased there was more time for solid intake and oral motor skill development. These data are discussed in relation to the importance of meal duration as a dependent variable and how it relates to overall health.

The investigation of variables related to healthy and unhealthy food intake is important given statistical data showing that a large part of the world population is overweight. To address this question, the present study aimed to investigate the effect of different types of rules on healthy and unhealthy food intake, with ten children. Five of them had normal Body Mass Index (BMI) and five were overweight/obese. In each session, nine small pieces both of healthy and unhealthy food were displayed for each child, in the absence of the experimenter. After a baseline, each child was given a minimum rule (he/she could eat only one piece of unhealthy food). In the next phase, the same child received information about healthy eating and the same rule was presented, and in the next phase, questions about food and health were asked before the rule was presented again. At the end of each session, participants reported to the experimenter the food ingested. In general, the rule showed more effectiveness for the children with normal BMI. The rule was effective for reducing unhealthy food intake for five children at all phases in which it was presented. For three other children, it was effective only at the beginning of the exposure to the rule, whereas it was not effective for two other children.

Unmanaged acute or chronic medical conditions (such as diabetes, asthma, or seizure disorder), sensory loss, discomfort, and pain (e.g., from migraines or acute infections) affect behavior. Many individuals with neurocognitive or neurodevelopmental disorders have comorbid conditions that may disrupt behavior and exacerbate behavioral presentations. These conditions may have to be considered during treatment planning. Because medical providers tend to rely on self-report, there is a high risk that these conditions remain undetected and untreated when self-descriptive verbal skills are insufficient. Using adult cognitive loss as an example, this presentation will provide an overview of comorbidities and their impact from a behavior-analytic lens. Emphasizing the importance of integrative treatment planning, we will discuss how behavior analysts can contribute to monitoring comorbid conditions, indirectly intervene upon them, make appropriate referrals, and advocate with care partners to ensure that clients receive appropriate medical management. Special attention will be given to the prevention of psychotropic prescribing cascades.

Serious mental illness (SMI) is a term used to describe diagnoses that indicate repeated episodic loss of contingent control that affects the interpretation of everyday events. Such a loss of contingent control can accompany diagnoses of schizophrenia, post-traumatic stress disorder, major depression, and bipolar disorder. As the first-line treatment, individuals with SMI receive prescriptions of psychotropics without an end date; however, as adults with SMI age, they may develop difficulties remembering, thinking, and problem-solving. At present, there are no guidelines for managing the behavior of older adults with SMI and cognitive loss. Indeed, in terms of etiology, it is frequently unclear whether confusion and disorientation are part and parcel with the preexisting SMI diagnosis or due to a neurodegenerative condition. Such a determination would be important as many psychotropics are listed as inappropriate prescriptions for older adults in general and, when cognitive loss is present, the Food and Drug Administration warns of an increased risk of stroke and death related to antipsychotics. This presentation will review the literature regarding interventions for older adults with SMI and cognitive loss. We will discuss the role of behavior analysts in ensuring clients receive the highest quality of care.

Eating is a behavior essential to all humans. While the topography of ingestion is similar across individuals, many factors influence eating behavior and problems in eating are common. An estimated 90% of children with autism have difficulties eating; in the general adult population, eating disorders such as anorexia or bulimia have a lifetime prevalence of 1-3.5%; and approximately 22.8% of older adults present with malnutrition. Thus, it is vital to gain an understanding of the physiological, psychosocial, and environmental factors that influence eating behavior across the lifespan and across clinical presentations. This paper will provide an overview of the factors that impact eating and how they may operate as motivating and maintaining operations. In addition to psychosocial processes, sensory loss, alterations in metabolism, and frequent adverse medication effects will be considered. Finally, suggestions for referrals to appropriate providers will be offered. This presentation will provide education with broad relevance to clinical and applied behavior analysis.

Cognitive difficulties are common: In addition to children and adults with neurodevelopmental disabilities, many adults lose their ability to remember, reason, or problem-solve due to a range of neurological conditions, such as traumatic brain injury or Alzheimer's disease. As most people rely on family care partners for assistance, parents and other family care partners must receive skill training to manage behavior in the home and consistently implement behavioral interventions that may have been recommended or prescribed by providers. Among barriers to implementation of interventions by care partners in the home are lack of knowledge and perceived helplessness, competing contingencies, a lack of financial resources to receive coaching, social isolation, lack of coherent sources of information, and difficulties understanding aspects of the interventions. These factors may impede the availability, accessibility, and acceptability of care partner training and thereby effective caregiving. Although steps have been taken at the community level, government care coordination, and health insurance policies to improve family care partner access to trainings, barriers must be addressed directly to ensure that care partners receive adequate support throughout the care process. This presentation will detail barriers to training and possible solutions.