Association for Behavior Analysis International

This treatment evaluation was conducted to assess implementation of a prompting procedure which would be effective in decreasing the rate of prompts per minute with regards to activity engagement for an adult client. Assessments and direct observation were conducted to assess the most preferred reinforcer or reinforcing activity to increase independence in activity completion. Data were collected on staff’s total prompts per minute per session. During baseline, staff attempted to verbally prompt activity engagement (e.g., “it’s time to clean your room”) at a rate of about one prompt per minute. Direct support staff were then trained on specific prompting strategies that consisted of if/then statements as an antecedent and implementation of variable ratio (2 min) schedules of reinforcement. These were then implemented during sessions as a replacement for previous verbal prompting of task reminders only. Data during intervention shows a slight decrease in the rate of prompts per minute, showing an average of ½ a prompt per min (or 1 prompt every two minutes). The results of this treatment evaluation suggest that providing staff training on prompting strategies plus reinforcer delivery is effective at reducing rates of prompting per minute, while still maintaining client activity engagement.

Behavioral treatment of children with feeding disorders has been widely documented; however the research of the treatment of adolescents with feeding difficulties is limited. This study focuses on Brandon, a 13-year-old boy with a history of anxiety symptoms and limited food variety, during his daily outpatient admission in a behavioral psychology feeding program to increase his food variety and decrease gagging in the presence of novel/non-preferred foods. Therapists worked with caregivers and Brandon to develop a list of target foods that Brandon would eat at age-appropriate portions, organized by least-to-most anxiety producing per Brandon’s report, while utilizing coping skills (e.g., deep breathing and muscle relaxation) and food strategies (e.g., alternating bites of non-preferred and preferred foods, taking small bites, and taking sips of water between bites). Brandon’s treatment package included demand fading procedures to decrease anxiety symptoms and gagging behaviors during meals. With exposure to the target foods, Brandon’s gagging decreased across sessions, and on average, resulted in lower levels of gagging during portion challenges. In addition to the five target foods that Brandon wanted to incorporate into his diet, he increased his food variety by 21 novel foods within his six week admission. The methods utilized in this study may be useful to practitioners to extend the behavioral treatment components to older children and adolescents with feeding disorders, and warrants further evaluation in future research.

Previous research has demonstrated that therapist-fed functional analyses can be used to identify the environmental events that maintain inappropriate mealtime behavior of children with feeding disorders (Bachmeyer et al., 2009; Girolami & Scotti, 2001; Piazza et al., 2003) and has indicated the necessity of a matched, function-based treatment to achieve clinically acceptable levels of inappropriate mealtime behavior (Bachmeyer et al., 2009; Iwata et al., 1994; Smith et al. (1993). However, Ringdahl and Sellers (2000) demonstrated that results of functional analyses of problem behavior can vary across caregivers and therapists. If problem behavior is more prevalent during caregiver-conducted sessions, an evaluation of caregiver-fed versus therapist-fed functional analyses of inappropriate mealtime behavior is warranted. Our team previously analyzed functional analysis data for 5 participantsfrom an intensive feeding programand determined that in 78% of cases the function matched across caregiver and therapist. The current investigationextended thesefindings by evaluatingand comparingthe outcomes of a caregiver-versustherapist-fed functional analysisfor 5 additionalparticipants.Overall, we found that the functionsmatchedfor 88% of cases.Implications for function-based treatments and considerations for future research in the assessment and treatment of pediatric feeding disorders are discussed.

Functional analyses are used to better understand the effects of environmental variables on inappropriate mealtime behavior when developing effective interventions for children with feeding disorders (Bachmeyer et al., 2009; Bachmeyer, et al., in press; Piazza et al., 2003). Trained therapists typically serve as feeders during functional analyses and provide previously observed caregiver-delivered consequences following inappropriate mealtime behavior. It is unclear if the same environmental variables would be identified as functions if a caregiver served as the feeder. Previous literature suggests that caregivers can be trained to implement pediatric feeding protocols, including a functional analysis of inappropriate mealtime behavior (Anderson & McMillian, 2001; Najdowski et al., 2008; Mueller et al., 2003). Caregiver-conducted functional analyses could be beneficial, as caregiver-delivered prompts and consequences better mimic the natural mealtime and potentially serve as discriminative stimuli within the mealtime context. We observed correspondence between identified functions for 7 of 8 therapist-fed versus caregiver-fed functional analyses. We discuss implications for creating and implementing function-based treatments.

Variety fading is an antecedent-intervention strategy based on the high-p instructional sequence which is used to increase bite acceptance in the treatment of pediatric feeding disorders. While initial studies have demonstrated its efficacy, only six studies have been published evaluating the components of the high-p instructional sequence in feeding. Additionally, previous studies have focused on bite acceptance, with limited data examining inappropriate mealtime behavior (IMB), such as pushing the spoon away or head turning. The present study is an evaluation of a clinical application of variety fading for children admitted to a day-treatment feeding program for food selectivity. The protocol implemented included the presentation of non-preferred food interspersed with empty spoon (or preferred food) presentations within five-bite sessions. As bite acceptance increased and IMBs decreased, we systematically interspersed additional non-preferred foods, with novel food probes between each phase change. Data indicated that acceptance increased and IMB decreased to low levels once all non-preferred foods were introduced, and remained at low levels during probes of novel foods. Results suggest variety fading may be useful to increase acceptance of nonpreferred food while minimizing bursts in IMB, but more research is needed for replication and to identify specific protocol elements related to efficacy.