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 #422
CE Offered: BACB
Comparing Effectiveness and Social Validity of Pediatric Feeding Disorders Treatments
Monday, May 27, 2024
10:00 AM–10:50 AM
Convention Center, 100 Level, 113 A
Area: AUT; Domain: Applied Research
Chair: Angelica Ibarra (University of Nebraska Medical Center Munroe Meyer Institute )
Discussant: Lisa Tereshko (Endicott College)
CE Instructor: Lisa Tereshko, Ph.D.

Empirically based treatment of pediatric feeding disorders include a variety of extinction and reinforcement-based procedures, such as escape extinction, attention extinction, and differential reinforcement. However, there is a lack of studies that have directly compared different components of treatment in regard to their effectiveness in decreasing inappropriate mealtime behavior, mitigation of side effects of escape extinction, or social validity. Given the gaps in the pediatric feeding literature, there is an essential need to further examine these dimensions of behavioral treatments. The present symposium aims to disseminate novel research that evaluates and compares overall effectiveness of different treatment packages in reducing inappropriate mealtime behavior, their mitigation of side effects of escape extinction, and social acceptability. The first presentation will compare the effects of escape extinction with or without a Nuk to open procedure at the onset of treatment, as well as evaluate caregiver acceptability of the procedures. The second presentation will compare and evaluate the effectiveness and social acceptability of escape extinction when combined with three different forms of adult attention, including attention extinction, noncontingent attention, and differential reinforcement of alternative behavior.

Instruction Level: Intermediate
Keyword(s): Escape Extinction, Feeding Disorders, Social Validity, Treatment comparison
Target Audience:

Graduate level students and clinicians working with children diagnosed with pediatric feeding disorders.

Learning Objectives: At the conclusion of the presentation participants will be able to: (1) Be able to describe similarities and differences in effectiveness and social acceptability of different treatment packages for IMB (2) Be able to describe different function-based treatments for IMB maintained by attention (3) Be able to describe social acceptability of different treatment packages for IMB.
Evaluating Effectiveness and Caregiver Acceptability of Escape Extinction With and Without a Nuk to Open Deposit
Abstract: Children with pediatric feeding disorders often engage in inappropriate mealtime behavior to escape the presented bite or drink. Previous studies have demonstrated the effectiveness of escape extinction for decreasing inappropriate mealtime behavior and increasing acceptance of novel foods (Kirkwood et al., 2021). Some children require deposit modifications to increase acceptance due to continued refusal behaviors, with one example being a Nuk to open procedure (Kadey et al., 2013, Rubio et al., 2021). Currently, no studies compare the effectiveness of escape extinction with or without the Nuk to open procedure at the onset of the treatment or the caregiver acceptability following exposure and training to both procedures via role plays with therapists . Participants in the current study were children (ages 3 to 7) diagnosed with a pediatric feeding disorder and admitted into an intensive day treatment feeding clinic. A reversal design with an embedded alternating treatment design was used to evaluate and compare the effectiveness of the treatments. Results indicated that both escape extinction with and without Nuk to open were effective in increasing acceptance and decreasing inappropriate mealtime behavior. Caregivers reported high acceptability of both procedures. These results show that additional studies with larger sample sizes are warranted to further investigate if there are benefits to starting treatment with Nuk to open procedures.

A Pilot Study Evaluating Effectiveness and Caregiver Acceptability of Three Forms of Adult Attention in Mitigating the Side Effects of Escape Extinction

JENNIFER M. KOZISEK (University of Nebraska Medical Center's Munroe-Meyer Institute)

Approximately 1 in 4 typically developing children and 8 in 10 children with a developmental disability display feeding difficulties (Field et al, 2003; Gouge & Ekvall, 1975; Milnes et al 2013; Palmer & Horn, 1978; Perkse et al, 1977). Feeding difficulties may lead to poor weight gain, dependence on supplemental feedings, dehydration, and even death (Volkert & Piazza, 2012). Treatment procedures conceptually based in applied behavior analysis (ABA) have the most empirical support for treating feeding difficulties (Volkert & Piazza, 2012). Research has shown that removing bites or drinks is the primary motivator for inappropriate mealtime behavior and therefore escape extinction, or non-removal of the spoon or cup, is the most well-established treatment component. Although there is a wealth of evidence demonstrating its effectiveness, escape extinction may initially result in temporary but negative side effects (e.g., increases in crying, running from the table). These may make it difficult for parents to observe or conduct this intervention and clinicians are always seeking ways to decrease these signs of child distress during escape extinction. In addition to escape, attention from the feeder is a common motivator for children engaging in inappropriate mealtime behavior (Piazza et al., 2003), but less is known regarding the impact or efficacy of different applications of feeder attention. Some studies have shown that when combined with escape extinction, including positive reinforcement in the form of feeder attention can mitigate side effects of increases in negative vocalizations and inappropriate mealtime behavior (Piazza et al., 2003). Three forms of attention that are noted in the literature include attention extinction, noncontingent attention, or differential reinforcement of alternative behaviors with attention. There has never been a direct comparison of these function-based interventions and their effectiveness in decreasing inappropriate mealtime behavior and negative vocalizations nor any studies of caregiver acceptability of the interventions. The purpose of the proposed project is to serve as a pilot study for evaluating the effectiveness of three forms of adult attention in mitigating the side effects of escape extinction as well as the social acceptability of each intervention when a child’s inappropriate mealtime behavior is motivated by both removal of bites and drinks and attention from the feeder. Six participants on the waitlist for the Department of Pediatric Feeding at the Munroe Meyer Institute will be included in the study. A multiple baseline design across participants with an embedded alternating treatments design will be used to evaluate and compare the treatments.




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