|Assessment and Treatment of Pediatric Feeding Disorders|
|Saturday, May 25, 2019|
|11:00 AM–12:50 PM |
|Hyatt Regency West, Ballroom Level, Regency Ballroom A|
|Area: AUT/DDA; Domain: Applied Research|
|Chair: Kelley L. Harrison (Trumpet Behavioral Health)|
|Discussant: Caitlin A. Kirkwood (Center for Pediatric Behavioral Health, University of North Carolina Wilmington)|
|CE Instructor: Kelley L. Harrison, Ph.D.|
Pediatric feeding disorders range in severity from mild selectivity to complete refusal. If left untreated, pediatric feeding disorders can result in serious health ramifications including malnutrition, growth delays, and developmental delays. In this symposium, we will describe treatments for disordered feeding that involve differential reinforcement, simultaneous presentation plus nonremoval of the spoon (NRS), synthesized reinforcement, and a variation of the finger prompt. Harrison and colleagues will present a study on the evaluation of how to best select an effective reinforcer for the treatment of food selectivity. McHugh and colleagues will present a study comparing a commonly used occupational therapy treatment (food chaining) to an empirically supported behavioral treatment (simultaneous presentation plus NRS) for the treatment of food selectivity in children with autism spectrum disorder. Gover and colleagues will present an extension of the use of shaping with synthesized reinforcers and partial extinction in treatment of pediatric food selectivity. Rubio and colleagues will present a study evaluating the efficacy and acceptability of a variation of the finger prompt to food refusal in children with feeding disorders.
|Instruction Level: Intermediate|
|Keyword(s): feeding disorders|
|Target Audience: |
Researchers and practitioners.
|Learning Objectives: 1) Attendees will be able to describe reinforcer assessment strategies to identify a reinforcer most likely to increase acceptance of nonpreferred foods in treatment 2) Attendees will be able to identify and explain effective antecedent- and consequent-based interventions for feeding disorders 3) Attendees will be able to describe an assessment and treatment process to treat pediatric feeding disorders 4) Attendees will be able to identify future directions for research on pediatric feeding disorders|
Evaluation of a Pre-Assessment to Identify Most Effective Reinforcer for Treatment of Food Selectivity
|Jessica Juanico (Trumpet Behavioral Health), KELLEY HARRISON (Trumpet Behavioral Health)|
Differential reinforcement of alternative behavior is a widely used procedure to increase consumption of nonpreferred foods in children with food selectivity (e.g., Allison et al., 2012; Anderson & McMillan, 2001; Kern & Marder, 1996; Najdowski, Wallace, Doney, & Ghezzi, 2003). However, the types of reinforcing stimuli used varies across studies, including edibles, tangibles, attention, or a combination of edibles, tangibles, and attention. The purpose of the current study was to evaluate the use of a progressive ratio reinforcer assessment to identify a reinforcer that will most effectively increase the acceptance of nonpreferred foods. First, we conducted a progressive ratio reinforcer assessment using an arbitrary task. Then, we evaluated the effects of differential reinforcement using an edible, a tangible, a type of attention, or a combination of the stimuli as the reinforcer. We compared the effects of each reinforcer to the outcome of the progressive ratio reinforcer assessment to determine if this assessment accurately predicts the most effective reinforcer to be used during treatment for individuals with food selectivity. Preliminary results suggest the progressive ratio reinforcer assessment predicted the most effective reinforcer to be used during differential reinforcement with food selectivity for one participant.
A Comparison of Modified Food Chaining and Simultaneous Presentation Plus Nonremoval of the Spoon to Treat Food Selectivity in Children With Autism Spectrum Disorder
|CATHERINE MCHUGH (Brock University), Kimberley L. M. Zonneveld (Brock University)|
Feeding disorders can range from mild (e.g., food selectivity by taste or texture) to severe (e.g., total food refusal). If left untreated, feeding disorders can result in serious health ramifications, including malnutrition, growth delays, and developmental delays. Recent studies comparing commonly used occupational therapy (OT) treatments and empirically supported applied behavior analysis (ABA) treatments found that the ABA treatments were effective for all participants while the OT treatments were ineffective for all participants. We used a multielement design to compare a modified version of commonly used OT treatment, Food Chaining, and an empirically validated ABA treatment, simultaneous presentation plus nonremoval of the spoon, to treat the food selectivity of 2 children with autism spectrum disorder (ASD). For both participants, consumption of the target foods only increased during the ABA-treatment condition. We subsequently faded the size of the preferred food within the simultaneous-presentation arrangement, moved to a sequential-presentation arrangement, and then thinned the schedule of reinforcement. We will discuss the results within the context of treatment implications, limitations, and suggestions for future research.
Extensions of Shaping With Synthesized Reinforcers and Partial Extinction in Treatment of Pediatric Food Selectivity
|HOLLY GOVER (Western New England University ), Gregory P. Hanley (Western New England University), Robin K. Landa (Western New England University)|
Gover, Hanley, Marcus, Ruppel, and Landa (in prep) described an assessment and treatment process addressing the food selectivity of five children with and without developmental disabilities. The process involved (a) indirectly and directly assessing food preference and problem behavior associated with mealtimes and (b) incorporating assessment results into a treatment process that relied on differential and synthesized reinforcement of successive approximates to eating. This paper extends that research by evaluating the process across novel populations including a group of three typically developing siblings using a group contingency and a young boy with autism who engaged in total food refusal and relied on a g-tube. Implications for practitioners and areas for future research will be discussed.
|Efficacy and Acceptability of a Finger Prompt Variation for the Treatment of Pediatric Food Refusal|
|EMILY KATE RUBIO (Georgia State University), Valerie M. Volkert (Marcus Autism Center and Emory University School of Medicine), William G. Sharp (Marcus Autism Center and Emory University School of Medicine)|
|Abstract: Children with feeding disorders do not consume enough food or liquid to meet their nutritional needs resulting in placement of feeding tubes in severe cases (Kerwin, 1999; Schwartz, 2000). Feeding difficulties are primarily diagnosed in children with complex medical histories and co-morbid developmental disabilities, autism spectrum disorder, and/or related neurological disorders. Children with feeding disorders engage in active and/or passive refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well-established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when escape extinction alone is ineffective. The finger prompt (Borrero, Schlereth, Rubio, & Taylor, 2013) has been evaluated once in the literature to treat active food refusal and needs further examination. Therefore, the purpose of this study was to assess a variation of finger prompt procedure to treat active and/or passive food refusal and caregivers’ acceptability of it. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. Across all participants, the finger prompt was effective in increasing bite acceptance and decreasing or maintaining inappropriate behavior at low levels for these participants.|