Descriptive analyses of pediatric food refusal: the structure of parental attention

Eating Behavior of Children and Feeding Attitudes of Mothers

Aim: Nutritional problem is one of the most common behavioral problems in children. This study was carried out as a descriptive study in order to determine the eating behavior problems of infants and children and to determine the mothers' feelings, thoughts and approaches about feeding process. Method: The population of the study consisted of mothers of children aged 9-72 months who applied to the children's outpatient clinics of a state hospital between April and June 2019; and the sample consisted of 217 mothers who agreed to participate in the study and met the selection criteria. Data were collected using the “Mother-Child Information Form”, “Behavioral Pediatric Feeding Assessment Scale” and “Mother’s Attitudes Towards the Feeding Process Scale”. Number, percentage distribution, mean and Pearson correlation analysis were used to evaluate the data. Results: The total score of the mothers from the Behavioral Pediatric Feeding Assessment Scale was 84.16±16.10; and the total score of the Mother’s Attitudes Towards the Feeding Process Scale was 75.20±17.49. It was found that there was a statistically significant relationship between the mean Behavioral Pediatric Feeding Assessment Scalescore of the mothers and the mean Mother’s Attitudes Towards the Feeding Process Scale score. Conclusion: The results of the study indicated that children have moderately problematic eating behavior and feeding habits. On the other hand, it shows that mothers have moderate problems related to their attitudes towards feeding process. It was also concluded that, as children's eating behavior problems increased, mothers' negative attitudes towards feeding process also increased. Keywords: mothers, feeding, attitude, child, feeding behavior

A Comparison of Descriptive and Functional Analyses of Inappropriate Mealtime Behavior

In recent years, rather than being used to assess the potential function of a response, descriptive assessment methods have been applied to evaluate potential consequences or contingencies for problem behavior (Borrero, Woods, Borrero, Masler, & Lesser in Journal of Applied Behavior Analysis, 43, 71-88. doi: 10.1901/jaba.2010.43-71, 2010) or to assist with designing baseline conditions to approximate caregiver behavior (Casey et al. in Behavior Modification, 33, 537-558. doi: 10.1177/0145445509341457, 2009). It has been shown that descriptive assessments of some forms of problem behavior (e.g., self-injury, aggression) are not good indicators of behavioral function and should not be used exclusively when conducting functional behavior assessments (Thompson & Iwata in Journal of Applied Behavior Analysis, 40, 333-338. doi: 10.1901/jaba.2007.56.06/epdf, 2007). However, the extent to which descriptive assessments of inappropriate mealtime behavior can predict behavioral function is not yet clear. We conducted descriptive assessments of inappropriate mealtime behavior and compared the results to functional analyses for ten children with severe food refusal. Results showed that, for 71 % of participants, the descriptive and functional analyses matched. These results suggest that the correspondence between descriptive and functional analyses, at least for inappropriate mealtime behavior, may be higher than that for other forms of problem behavior.

RELATIVE CONTRIBUTIONS OF PARENT-PERCEIVED CHILD CHARACTERISTICS TO VARIATION IN CHILD FEEDING BEHAVIOR

Few studies have examined the relative impact of co-occurring child characteristics on problematic feeding behavior. The aim of the current study was to assess the relative contributions of parent-perceived child characteristics in multivariable models of child feeding behavior. One hundred sixty-one mothers reported on their child's feeding behavior and a number of key child characteristics. These characteristics were entered into controlled multivariable models of child feeding behavior, using child and parent frequency domains of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; W. Crist et al., 1994) as outcome measures. Child feeding problems were positively associated with food neophobia and external behavioral and social issues, but not with most domains of temperamental difficulty or sensory sensitivity. Feeding problem frequency was associated with externalizing symptoms whereas parental perceptions of problems and coping were associated with social-interaction problems in the child. Population feeding problems appear to be external and interactive problems rather than driven by innate or internalizing factors. The association with externalizing symptoms suggests that feeding problems at this level may fall within a wider profile of challenging behavior; however, the existence of problematic feeding behaviors may constitute a challenge for parents only when the child's social interactions also are seen to be deficient.

REDUCING AMBIGUITY IN THE FUNCTIONAL ASSESSMENT OF PROBLEM BEHAVIOR

Severe problem behavior (e.g., self-injury and aggression) remains among the most serious challenges for the habilitation of persons with intellectual disabilities and is a significant obstacle to community integration. The current standard of behavior analytic treatment for problem behavior in this population consists of a functional assessment and treatment model. Within that model, the first step is to assess the behavior-environment relations that give rise to and maintain problem behavior, a functional behavioral assessment. Conventional methods of assessing behavioral function include indirect, descriptive, and experimental assessments of problem behavior. Clinical investigators have produced a rich literature demonstrating the relative effectiveness for each method, but in clinical practice, each can produce ambiguous or difficult-to-interpret outcomes that may impede treatment development. This paper outlines potential sources of variability in assessment outcomes and then reviews the evidence on strategies for avoiding ambiguous outcomes and/or clarifying initially ambiguous results. The end result for each assessment method is a set of best practice guidelines, given the available evidence, for conducting the initial assessment.

Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis

OBJECTIVE

The aim of this study was to examine whether lag sequential analysis could be used to describe eye gaze orientation between clinicians and patients in the medical encounter. This topic is particularly important as new technologies are implemented into multiuser health care settings in which trust is critical and nonverbal cues are integral to achieving trust. This analysis method could lead to design guidelines for technologies and more effective assessments of interventions.

BACKGROUND

Nonverbal communication patterns are important aspects of clinician-patient interactions and may affect patient outcomes.

METHOD

The eye gaze behaviors of clinicians and patients in 110 videotaped medical encounters were analyzed using the lag sequential method to identify significant behavior sequences. Lag sequential analysis included both event-based lag and time-based lag.

RESULTS

Results from event-based lag analysis showed that the patient's gaze followed that of the clinician, whereas the clinician's gaze did not follow the patient's. Time-based sequential analysis showed that responses from the patient usually occurred within 2 s after the initial behavior of the clinician.

CONCLUSION

Our data suggest that the clinician's gaze significantly affects the medical encounter but that the converse is not true.

APPLICATION

Findings from this research have implications for the design of clinical work systems and modeling interactions. Similar research methods could be used to identify different behavior patterns in clinical settings (physical layout, technology, etc.) to facilitate and evaluate clinical work system designs.