Association for Behavior Analysis International

Over the past decade, behavior analysts have developed a variety of procedures to assess and treat pediatric feeding disorders. These talks will present data that extends the knowledge base on such treatments and will provide outcome data on the long-term efficacy of behaviorally based procedures. The first talk will describe the use of a sequentially arranged behavioral hierarchy procedure that was used to assess different feeding skills in2 children who were selective eaters. Once assessed, these outcomes were used to develop effective procedures for increasing food variety. The second study describes data for2 participants in which negative reinforcement contingencies were implemented to bias responding toward self-feeding as opposed to being fed by a caregiver. The final study will present outcome data for 34 participants who received service in an outpatient clinic that specializes in the treatment of pediatric feeding disorders. These data will describe outcomes for oral acceptance and decreased tube feedings. The results of all3 investigations will be discussed in relation to the existing literature on the assessment and treatment of pediatric feeding disorders.

A feeding disorder is characterized by restricted food intake, limited variety, and the presence of inappropriate behaviors (e.g., screaming, batting at or blocking food presentations). Unfortunately, the diagnosis and symptoms of a feeding disorder does not dictate which treatment options will be most effective for a particular child. Thus, a key to effectively treating feeding disorders is conducting assessments that will provide information necessary for developing effective treatments. For example, paired-choice preference assessments can be helpful in determining preferred and non-preferred foods that can be used in positive or negative reinforcement-based treatments. Yet, pairedchoice preference assessments do not always produce reliable results. In the current investigation, a behavioral hierarchy assessment was used to determine relative food preferences. Specifically, two participants responded differentially to sequentially arranged hierarchal steps (e.g., smelling food, holding food in mouth) across different foods. These response patterns were then used to determine which treatments would be most useful for increasing food intake. Data will be presented on the assessment, treatment, and generalization of food intake for individuals with pediatric feeding disorders. Results will be discussed in terms of how supplemental assessments can inform treatment development and recommendations for successful generalization will be provided.

Children with feeding disorders often do not independently acquire self-feeding skills. Negative reinforcement has been demonstrated as a useful tool to increase consumption (Kelley, Piazza, Fisher, & Oberdorff, 2003) for children with feeding disorders. Only one study to our knowledge has increased self-feeding using a negative reinforcement-based procedure (Vaz, Volkert, & Piazza, in press). Within this study, response effort and quality of reinforcement were manipulated to favor self-feeding. In the current investigation, we used similar procedures to increase self-feeding in two children with a feeding disorder. Initially, we provided the participants the option to self-feed one bite of target food or have the therapist feed an increased number of target or non-preferred food bites. After these manipulations were unsuccessful in increasing self-feeding, we incorporated the use of a swallow facilitation procedure in an attempt to shift responding to self-fed bites. That is, the child could self-feed one bite of target food to avoid being fed one non-preferred bite and contacting swallow facilitation with a Nuk if packed or the child could self-feed one bite of target food to avoid being fed the target bite using a flipped spoon presentation. Results showed that these manipulations increased self-feeding for both children.

A body of literature exists in applied behavior analysis that establishes some empirically supported treatments for pediatric feeding disorders (Kerwin, 1999; Sharp et al., 2010). Research on the outcomes of various service delivery models utilizing these treatments is warranted. We examined the outcome data for 34 children who received treatment for a range of feeding problems in an outpatient behavioral clinic at the University of Iowa Hospitals and Clinics between 2006 and 2010. Services involved daily 3-hr visits over 2 to 3 consecutive weeks and subsequent monthly follow-up visits. A second observer reviewed the records of 35% of the participants and agreement of the outcome measures was above 80%. Outcome data indicate that bite/drink acceptance increased and refusal decreased after 2 to 3 weeks of intensive outpatient therapy for over 90% of the children. Treatment effects resulted in tube feed reductions for children dependent on enteral nutritional feeds after intensive therapy and throughout follow-up. The variety of foods consumed increased for 100% of children exhibiting food selectivity. The advantages of an intensive outpatient model for behavioral treatment of pediatric feeding problems will be discussed.