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 #398
CE Offered: BACB
Measures Related to Social Validity During Intensive Feeding Treatment
Monday, May 27, 2024
8:00 AM–9:50 AM
Convention Center, 100 Level, 104 AB
Area: DDA/AUT; Domain: Applied Research
Chair: Vivian F Ibanez (University of Florida)
Discussant: Kerri P. Peters (University of Florida)
CE Instructor: Kerri P. Peters, Ph.D.

Outcomes of behavior-analytic feeding intervention have important implications because they contribute to reducing child health risks, mental health problems, and increased health care costs. As such, throughout a clinical course of treatment, there are various perspectives from which social validity and caregiver input can be considered. Studies in this symposium will highlight a few of these areas, ranging from indices of child happiness to a caregiver’s role as participants in their child’s feeding therapy. More specifically, the first presenter will show data on child indices of happiness and unhappiness during and outside of mealtimes. Next, data on the agreement between caregiver-reported data and therapist-reported data for child mealtime behavior will be shared. The third presentation will focus on daily social validity ratings during intensive home-based services. Finally, the last presenter will discuss the findings of a manualized feeding intervention during intensive services, including caregiver training and the experience's opinions. Taken together, results of these talks show mostly neutral behavior during and outside of meals, along with high degrees of caregiver satisfaction and involvement across clinic- and home-based services. Important directions for the measurement of how meaningful, practical, and impactful behavior-analytic feeding services are will be discussed.

Instruction Level: Basic
Keyword(s): ARFID, caregiver acceptability, feeding disorders, social validity
Target Audience:


Learning Objectives: t the conclusion of the presentation, participants will be able to: 1) Describe at least two considerations related to social validity during behavior-analytic intervention for pediatric feeding disorders 2) Explain the role of a caregiver during intensive behavior-analytic feeding services 3) Identify future directions related to the measurement of child behavior and caregiver input during clinic- and home-based feeding services
Social Validity Measures During Intensive Feeding Treatment
KARLY M BARRETO (Children’s Specialized Hospital), Christopher W Engler (Children's Specialized Hosptial), Kathryn M. Peterson (Rutgers University and Children's Specialized Hospital), Emma Auten (Children’s Specialized Hospital—Rutgers University Center for Autism Research, Education, and Services (CSH—RUCARES)), Jaime Crowley-Zalaket (Children's Specialized Hospital), Casey Toutoungi (Caldwell University)
Abstract: Behavior-analytic interventions are empirically supported for the treatment of pediatric feeding disorders. However, measures of social validity are often excluded from research (Taylor & Taylor, 2022). When included, measures have been limited to surveys or questionnaires (e.g., Ahearn et al., 1996). Phipps et al. (2022) is one exception in which authors measured caregiver satisfaction while also measuring indices of child happiness and unhappiness during mealtime. The goal of the current study was to include a broader scope of social validity practices throughout a child’s admission to an intensive feeding program. We extended Phipps et al. by examining indices of happiness and unhappiness during the full admission, including inside and outside of mealtimes. Across two participants, average indices of happiness (10-14% during meals, 13-19% between meals) and unhappiness (11% during meals, 1-2% between meals) were low relative to indices of neutral behavior (74-79% during meals, 79-85% between meals). We will discuss these findings in conjunction with our recommendations for improving social validity in the context of treating children with feeding disorders.

Accuracy of Caregiver Report for Evaluating Treatment Effects for Feeding Disorders

DENISE PICHARDO (Kennedy Krieger Institute), Lesley A. Shawler (Southern Illinois University, Carbondale)), Elizabeth A. Masler (Kennedy Krieger Institute ), Alison M. Kozlowski (Kennedy Krieger Institute), Jessica Becraft (Kennedy Krieger Institute )

Interventions focused on the principles of applied behavior analysis are highly effective at treating pediatric feeding disorders by increasing appropriate mealtime behaviors and decreasing inappropriate mealtime behaviors. Treatment effectiveness is usually evaluated with data collected by trained observers. Unfortunately, trained observers may not always be available or present to monitor child behavior. To address this barrier, parents may be able to track their child’s treatment progress. A preliminary study suggested that some parents’ data may correspond well with trained observers and that parents can detect large changes in challenging behavior (Becraft et al., in press). In this study, we replicated and extended Becraft et al. with 8 parents of children receiving treatment for a feeding disorder. Overall, parent data were significantly correlated with observer data for inappropriate and appropriate mealtime behavior for 7 out of 8 parents. These data suggest that parent data may be used to track treatment progress and determine whether there is a treatment effect with little to no formal data collection training.


Daily Treatment Acceptability Ratings From an Intensive In-Home Feeding Program

SEAN D. CASEY (Hartland Feeding), Meara X. H. McMahon (Marcus Autism Center and Emory School of Medicine)

Current research widely supports the use of behavioral intervention to address a variety of feeding concerns for children with pediatric feeding disorder. These interventions are often delivered as a treatment package that undergoes data-based decision making and is subject to change over time. Previous feeding studies that measured social validity demonstrate mixed results over treatment acceptability and choice, even when considering common treatment components, such as antecedent strategies, escape extinction, and/or multiple forms of reinforcement. However, there are few studies that continuously evaluate social validity during a child’s admission to intensive feeding programs. Researchers of the current study administered a brief, daily measure of treatment acceptability (a modified version of the Abbreviated Acceptability Rating Profile) to caregivers to monitor social validity throughout each child’s intensive in-home feeding program admission. Clinicians were blind to treatment acceptability measure outcomes through the duration of the study. Results revealed overall high ratings throughout each child’s admission regardless of changes in treatment and behavior. Findings related to feasibility of ongoing social validity measurement and treatment acceptability when using escape extinction will be discussed.

Outcomes of a Caregiver-Mediated Intervention for Food Selectivity
SANDHYA RAJAGOPAL (Marcus Autism Center), Valerie M. Volkert (Marcus Autism Center and Emory School of Medicine), Ivanna Betancourt (Marcus Autism Center, Children’s Healthcare of Atlanta), Tanisha Jordan (Marcus Autism Center, Children’s Healthcare of Atlanta), Courtney David (Marcus Autism Center, Children’s Healthcare of Atlanta), William G. Sharp (The Marcus Autism Center)
Abstract: A retrospective chart review was conducted to examine the outcomes and clinical presentations for 12 autistic children with avoidant/restrictive food intake disorder who received treatment in an intensive, feeding-focused ABA clinic. Families were admitted to the program for three to four weeks and received care from a BCBA-D, an RBT, and a dietitian. The clinic employed a revised version of a manualized intervention including caregiver training on improving reliable consumption of established foods and introducing novel foods (i.e., MEAL Plan; Sharp et al., 2013). Self-feeder protocols for introducing novel foods were implemented in conjunction with prompting, antecedent strategies, and reinforcement and without common escape-extinction procedures (e.g., nonremoval of the spoon, representation). Findings suggest that this caregiver-mediated intervention was effective in increasing consumption of novel foods and these foods were maintained at follow up. Additionally, caregivers and clients participated in social validity surveys that suggested an overall positive perception of the intervention. Implications and future directions are discussed.



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