|Behavioral Interventions Without Escape Extinction in the Treatment of Food Selectivity|
|Saturday, May 25, 2019|
|12:00 PM–12:50 PM |
|Swissôtel, Event Center Second Floor, Vevey 1/2|
|Area: CBM/AUT; Domain: Translational|
|Chair: Bryant C. Silbaugh (The University of Texas at San Antonio, Department of Interdisciplinary Learning and Teaching )|
|CE Instructor: Bryant C. Silbaugh, Ph.D.|
Most pediatric feeding problems are maintained by negative reinforcement in the form of bite or meal termination. Nevertheless, escape extinction-based interventions have undesirable side effects (e.g., extinction-burst) which have motivated researchers to further develop and evaluate interventions that do not rely on escape extinction. The studies herein examined the evidence for the effects of the high-probability instructional sequence on feeding in children, and evaluated the effects of a full, hierarchically organized instructional sequence on generalized food consumption in a typically developing boy with food selectivity. In a final clinical case study, clinicians evaluated the effects of differential reinforcement of acceptance using high preferred foods on acceptance, gagging, and expulsion in both restricted- and free-operant arrangements for a boy with developmental delays. The evidence base for the high-probability instructional sequence suggests the intervention can improve feeding, but the authors call for further research to clarify when and for whom the intervention is effective. Delivering an instructional sequence in which the final step was consumption of a nonpreferred food, consumption of nonpreferred foods increased and the researchers observed generalization. In the clinical case study, differential reinforcement of acceptance with high preferred foods increased self-fed acceptance of nonpreferred foods and this improvement coincided with reductions in gagging and expulsion. These data will be discussed in the context of apparent trends in research on behavioral interventions for feeding problems over the last decade.
|Instruction Level: Intermediate|
|Keyword(s): Feeding disorders, Food selectivity, High-probability sequence|
|Target Audience: |
Researchers and practitioners focused on feeding interventions
|Learning Objectives: (1) identify three behavioral interventions for food selectivity that do not involve escape extinction. (2) describe how differential reinforcement can be applied to increase acceptance in a free-operant arrangement without escape extinction. (3) discuss the evidence for the effects of the high-probability sequence on feeding in children with feeding disorders.|
A Synthesis of Research on the Effects of the High-Probability Instructional Sequence in Children With Feeding Disorders
|Gabriela Calderon (The University of Texas at San Antonio), BRYANT SILBAUGH (The University of Texas at San Antonio, Department of Interdisciplinary Learning and Teaching )|
The high-probability (high-p) instructional sequence is an intervention commonly used to increase compliance. It involves delivering a series of requests with a high probability of compliance prior to the delivery of a request with a low probability of compliance. Researchers have evaluated whether the high-p sequence can increase compliance with low probability (low-p) mealtime demands to consume nonpreferred foods in children with pediatric feeding disorders, for example, by delivering multiple high-p mealtime demands to consume a preferred food prior to the delivery of a low-p mealtime demand (e.g., to consume a bite of a nonpreferred food). The effects of the high-p sequence have varied across studies, and a systematic synthesis of the literature to guide practice and further research is lacking. We conducted a systematic multistep search and identified seven studies that met inclusion criteria. We then extracted data on participant and study characteristics and compared the literature to the 2014 Council for Exceptional Children (CEC): Standards for Evidence-Based Practices in Special Education. Preliminary results suggest that (a) the high-probability instructional sequence can improve compliance with low-p mealtime demands in young children with feeding disorders but more research is needed to clarify when and for whom the intervention is likely to be effective, (b) additional research should examine the effects of the high-p on feeding in older children or adults with disabilities as more intrusive procedure such as escape extinction-based procedures become inappropriate, and (c) the evidence does not meet the CEC’s standards for an evidence-based practice.
|Effects of a Full Instructional Sequence on Generalized Food Consumption|
|VARSOVIA HERNANDEZ ESLAVA ESLAVA (Universidad Veracruzana), Jonathan K Fernand (Aurora University)|
|Abstract: The purpose of the current study was to examine the effects of delivering a full- instructional sequence on generalized consumption of nonpreferred foods with similar properties to treatment foods. The participant was a 5-year-old, typically-developing child with a history of food selectivity. The participant was asked to complete each step of an instructional sequence in which the final step was consumption of a nonpreferred food. Praise was delivered after compliance to complete each step and a preferred food was delivered after compliance with the final step. The full- instructional sequence was effective in increasing consumption of nonpreferred foods and generalization was observed to nontarget foods with similar properties. The importance of evaluating reinforcer-based procedures to treat food selectivity will be discussed.|
A Case Study in the Differential Reinforcement of Acceptance in a Boy With Developmental Delays and Food Selectivity During Restricted- And Free-Operant Arrangements
|MARIANA DE LOS SANTOS (Bloom Childrens Center), Bryant C. Silbaugh (The University of Texas at San Antonio, Department of Interdisciplinary Learning and Teaching )|
Differential reinforcement of alternative behavior (DRA) with high-preferred food can improve feeding problems in children with autism and food selectivity. However, clinical case studies of the effects of DRA in the absence of escape extinction-based procedures such as the nonremoval of the spoon are limited, especially for free-operant feeding arrangements. The current clinical case study evaluated the effects of a Fixed-Ratio 1 schedule of DRA on acceptance of nonpreferred foods in a boy with developmental delays and food selectivity in clinic and home settings. We conducted the first treatment evaluation in a restricted operant arrangement targeting feeder-fed bites. We then incorporated mastered foods from the restricted operant arrangement into an evaluation of DRA for self-feeding in a free-operant arrangement. The results suggest that (a) DRA using high-preferred foods increased self-feeding of nonpreferred foods in a free-operant arrangement without escape extinction, (b) the effects generalized across foods, and (c) increased self-fed acceptance coincided with a reduction in expulsion and gagging.