Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


50th Annual Convention; Philadelphia, PA; 2024

Event Details

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Symposium #486
CE Offered: BACB
Evaluations of Intensive Care for Pediatric Feeding Disorders
Monday, May 27, 2024
3:00 PM–3:50 PM
Convention Center, 100 Level, 103 C
Area: AUT; Domain: Applied Research
Chair: Ronald J. Clark (University of Florida)
Discussant: Meeta R. Patel (Clinic 4 Kidz & Stanford University School of Medicine )
CE Instructor: Ronald J. Clark, Ph.D.
Abstract: Pediatric feeding disorders are heterogeneous and may include concerns like dependence on a gastrostomy-tube or a narrow range of foods. As such, when intensive services are necessary, coordination of care with several disciplines and specialized environments are critical to provide safe and efficient therapy. However, few studies have reported on specific aspects of these settings and the rapidity of achievement with indicated goals. This symposium will show data related to these areas and will give considerations for clinicians who are interested in multidisciplinary feeding intervention. The first presentation will review a study in which researchers measured performance across variables related to feeding staff behavior and different areas of a day-treatment feeding program (e.g., pantry, therapy room). The outcome of this study will highlight implications for variables that influence service delivery during intensive feeding therapy. Relatedly, the second presentation will describe another aspect of specialized feeding services related to rapid tube weaning. Results of this study will add to our understanding of factors that impact the transition to oral feeding. Finally, data from both studies will advance our understanding of models of care associated with intensive multidisciplinary feeding intervention.
Instruction Level: Basic
Keyword(s): Assessment, Feeding, Intensive Care, Tube Weaning
Target Audience: Basic understanding of what pediatric feeding therapy is.
Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Identify variables that contribute to an intensive feeding program; (2) Distinguish variables that differ between feeding and general EI ABA services according to key environmental variables; (3) Describe the benefit of multidisciplinary care when incorporating tube weaning as an adjunct to multidisciplinary feeding intervention.
A Direct Assessment of the Setting of Care for Intensive Feeding Services
RONALD J. CLARK (University of Florida), Angie Van Arsdale (University of Florida), Vivian F Ibanez (University of Florida)
Abstract: Grauerholz-Fisher et al. (2019) used momentary time sampling to measure the quality of care (e.g., staff behavior, environmental condition) across three ABA centers. Their results showed this approach's utility in understanding areas that may influence service delivery in the context of general early intervention. Caring for children with feeding disorders, however, may require different categories of measurement. For example, the high prevalence of gastrointestinal medical conditions like food allergies among children with feeding disorders requires specific food preparation procedures to minimize cross-contamination. Therefore, we were interested in extending Grauerholz-Fisher et al. to evaluate a specialized facility in a day-treatment feeding program across categories that are critical for safe care. In the current investigation, we measured performance across variables related to staff behavior, the environment in a feeding therapy room, and a pantry for food/liquid preparation and storage. Like Grauerholz-Fisher, results of the assessment have indicated areas in need of improvement (e.g., patient food labels), so we will use the Performance Diagnostic Checklist - Human Service (1.1; Jimenez et al., 2023) to inform indicated intervention across these variables. We will discuss the implications of these outcomes for settings associated with specialized and intensive feeding therapy.
Rapid Tube Weaning as an Adjunct to Intensive Multidisciplinary Feeding Intervention
MEARA X. H. MCMAHON (Marcus Autism Center and Emory School of Medicine), Valerie M. Volkert (Marcus Autism Center and Emory School of Medicine), Scott Gillespie (Emory University School of Medicine), Emily Malugen (Children’s Healthcare of Atlanta), Heather Farling (Children’s Healthcare of Atlanta), Rashelle Berry (Children’s Healthcare of Atlanta), Caitlin Waddle (Children’s Healthcare of Atlanta), William G. Sharp (The Marcus Autism Center)
Abstract: Children with chronic medical problems are more likely to experience ARFID with estimates researching as high as 70%. Many children with complex medical and/or developmental histories and ARFID require supplementation via feeding tube. Management of the underlying medical difficulties does not necessarily promote oral intake and reductions in tube feeding due to a long-standing history of conditioned food aversion compounded by limited food exposure resulting in poor oral-motor skills and failure to reach key feeding milestones. Behavioral intervention and tube weaning (i.e., hunger manipulation, or evoking a state of hunger to encourage oral consumption by rapidly weaning from the tube) are among the most common treatment approaches used in intensive multidisciplinary feeding intervention (IMFI) programs. However, there is a lack of consensus regarding the criteria for, rate of, and timing of weaning from enteral feeds. The purpose of the current study was to assess the feasibility of applying a rapid tube weaning approach for children receiving IMFI. Sixteen patients with ARFID and feeding tube dependence participated in a randomized control trial comparing IMFI standard of care to IMFI with rapid tube weaning. Feasibility specifications, safeguards, and considerations for practice will be discussed.



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