Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often ...recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.
Previous literature supports the use of functional analyses to prescribe treatments for children with feeding disorders (Bachmeyer et al., 2009). Nevertheless, clinicians often train caregivers to ...use healthy contingencies, independent of whether those contingencies are function based. However, it is unclear whether including nonfunction‐based contingencies differentially affects inappropriate mealtime behavior. In the current investigation, the caregivers of 3 children with feeding disorders provided escape from bites and drinks and attention following inappropriate mealtime behavior. Results of a functional analysis showed escape from bites or drinks, but not attention, reinforced inappropriate mealtime behavior. We then tested the effects of escape extinction when the feeder either provided or withheld attention following inappropriate mealtime behavior. Inappropriate mealtime behavior decreased and acceptance increased when the feeder implemented escape extinction independent of whether they provided or withheld attention. We discuss the implications of including nonfunction‐based components in the treatment of pediatric feeding disorders.
Self‐feeding with utensils represents an important step in a child's progression toward age‐typical eating and emerges in the absence of intervention for most children. In contrast, children with ...feeding disorders may lack the skill or motivation to self‐feed, which impedes progress toward age‐typical eating. In the current study, experimenters used a multielement design to evaluate negative reinforcement in the form of meal termination to transition six participants with a feeding disorder from caregiver‐fed to self‐fed bites and drinks. Caregivers conducted meals in which they fed the participant or prompted them to self‐feed. During self‐fed meal‐termination sessions, participants had the opportunity to end the meal contingent on self‐feeding the presented bite(s) or drink(s). Self‐feeding increased during meal‐termination sessions for all participants. The experimenters discuss these results relative to their potential to inform interventions for children with feeding disorders that progress the child toward age‐typical eating.
Renewal, the increase in behavior during extinction following context changes, may be particularly concerning during intervention for feeding disorders because context changes are often necessary for ...intervention generality and maintenance (Podlesnik et al., 2017). In the current study, we tested for renewal and evaluated a renewal‐mitigation procedure when we transferred intervention from a therapist to a caregiver, from clinic to the home, and changed the foods the feeder presented. We used an ABA arrangement to evaluate the generality of the renewal effect with 7 participants who engaged in inappropriate mealtime behavior. Context A was functional reinforcement. Context B was function‐based extinction during the control and mitigation conditions and our renewal‐mitigation procedure in the mitigation condition. The renewal test was function‐based extinction in Context A. We observed renewal of inappropriate mealtime behavior in 4 of 7 participants, and our renewal‐mitigation procedure was effective for 4 of 4 participants.
To date, there is no research on the measurement of indices of happiness and unhappiness for children receiving behavior‐analytic treatment for feeding disorders and the research on caregiver ...treatment acceptability during feeding treatment is limited. The purpose of the current study was to measure child indices of happiness and unhappiness during extinction‐based treatment with and without noncontingent reinforcement and to evaluate caregiver treatment acceptability through the course of treatment. Child indices of happiness were idiosyncratic, while indices of unhappiness increased at the onset of treatment and were higher during extinction without noncontingent reinforcement, but eventually decreased. Overall, caregiver treatment acceptability remained high despite temporary increases in emotional responding. The current study introduces measures of social validity to use during feeding treatment (i.e., indices of happiness and unhappiness) and provides evidence that dense schedules of noncontingent reinforcement could serve to mitigate indices of unhappiness during the initial implementation of extinction‐based treatment.
Children diagnosed with autism or autism spectrum disorders (ASD) are more likely than other children to exhibit behaviors characteristic of a feeding or sleeping disorder. Parents of children with ...these disorders may be extremely concerned about the health and safety of their child. Sleeping and feeding problems can cause a great deal of stress to parents and other family members. Behavioral assessment and treatment procedures have been developed to address behavior problems related to sleeping and feeding disorders. This article reviews the literature about assessment and treatment, and provides recommendations regarding services to family members of individuals diagnosed with ASD and feeding or sleeping disorders.
Food selectivity is a common problem for children with autism spectrum disorder (ASD; Schreck, Williams, & Smith, 2004). Behavior‐analytic interventions have the most empirical support for feeding ...disorders (Sharp, Jaquess, Morton, & Miles, 2011). However, there are no randomized controlled trials that have evaluated its effects with a well‐defined cohort of children with ASD. In the current investigation, we randomly assigned 6 young children with ASD and food selectivity to either an applied behavior analytic intervention or a wait‐list control. We used a crossover randomized controlled trial to evaluate the effects of a multicomponent applied behavior analytic intervention on independent acceptance and mouth clean of 16 novel foods. We subsequently exposed the wait‐list control group to the intervention. We also evaluated the effects of the intervention on individual participants with single‐case designs. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait‐list control group until we implemented the intervention.
Visual inspection is the traditional method behavior analysts use to interpret functional‐analysis results. Limitations of visual inspection include lack of standardized rules, subjectivity, and ...inconsistent interrater reliability (Fisch, 1998). To address these limitations, researchers have developed, evaluated, and refined structured criteria to aid interpretation of functional analyses of destructive behavior (Hagopian et al., 1997; Roane et al., 2013; Saini et al., 2018). The current study applied the structured criteria Saini et al. (2018) described to functional analyses of inappropriate mealtime behavior. We assessed its predictive validity and evaluated its efficiency relative to 3 post hoc visual inspection procedures. Validity metrics were lower than those in Saini et al. however, ongoing visual inspection increased the efficiency of functional analyses by more than 30%. We discuss these findings relative to the procedural differences between functional analyses of destructive behavior and inappropriate mealtime behavior.
The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying ...treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function‐based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function‐based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function‐based extinction with high levels of integrity.
Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional ...communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training FCT, extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) SD during the FCT phase to signal the availability of reinforcement for the FCR and (b) SΔ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the SD during the FCT phase, nor the SΔ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the SD during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the SΔ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the SD was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.
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