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Scott V, Saini V, Totino M. On the efficacy and efficiency of treating pediatric feeding disorder. J Appl Behav Anal 2024. [PMID: 39266221 DOI: 10.1002/jaba.2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 08/16/2024] [Indexed: 09/14/2024]
Abstract
Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal. The purpose of this study was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of research using single-case experimental designs. We examined the extent to which different interventions resulted in decreases in IMB while also producing increases in food acceptance. This meta-analysis was also used to examine the efficiency of different interventions in achieving clinical significance. We identified 38 studies involving 266 cases in which IMB was treated with a behavioral intervention. The results indicated interventions that combined escape extinction and non-escape extinction had greater effect sizes for both reducing IMB and increasing food acceptance than either escape extinction alone or non-escape extinction alone. However, interventions that included escape extinction were slightly less efficient at decreasing IMB than were interventions that did not include escape extinction. We discuss the implications of these findings and provide recommendations for future research.
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Affiliation(s)
- Victoria Scott
- Department of Applied Disability Studies, Brock University, St. Catharines, ON, Canada
| | - Valdeep Saini
- Department of Applied Disability Studies, Brock University, St. Catharines, ON, Canada
| | - Micaela Totino
- Department of Applied Disability Studies, Brock University, St. Catharines, ON, Canada
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2
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Vincent LB, Stone-Heaberlin M, Kandarpa K, McIntire H, Turner K, Krebs K. Clinical Outcomes from an Interdisciplinary Outpatient Feeding Treatment Pilot Program. J Clin Psychol Med Settings 2024; 31:208-223. [PMID: 37178340 PMCID: PMC10182748 DOI: 10.1007/s10880-023-09963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Many children with developmental disabilities experience feeding challenges, including food refusal and food selectivity. Feeding concerns are often multifaceted and, therefore, an interdisciplinary approach to treatment is needed. A pilot of an interdisciplinary outpatient feeding program was conducted in a hospital medical center by psychologists and occupational therapists. The pilot program focused on caregiver training and improvements in targeted feeding goals in both the clinic and home settings. Treatment outcomes from this pilot program found increases in bite acceptance, decreases in inappropriate mealtime behaviors, increases in caregiver-reported number of foods consumed, and mastery of most individualized feeding goals for children who participated in the treatment program. Additionally, caregivers reported decreased concerns related to feeding and increased confidence in addressing their child's feeding concerns after participation in the treatment. Caregivers also reported high levels of satisfaction with this pilot program and reported the intervention to be feasible.
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Affiliation(s)
- Lori B Vincent
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA.
| | - Meg Stone-Heaberlin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kavya Kandarpa
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA
| | - Hannah McIntire
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA
| | - Krystin Turner
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathy Krebs
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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3
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Gover HC, Hanley GP, Ruppel KW, Landa RK, Marcus J. Prioritizing choice and assent in the assessment and treatment of food selectivity. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:53-65. [PMID: 36743323 PMCID: PMC9897803 DOI: 10.1080/20473869.2022.2123196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/18/2023]
Abstract
Food selectivity affects up to 72% and 45% of individuals with and without disabilities, respectively, and there is a need for interventions that rely on positive, unrestrictive strategies. We evaluated an assessment and treatment package for food selectivity for young children with developmental disabilities that prioritized caregiver collaboration, client autonomy, and did not rely on restrictive procedures (e.g. escape extinction). The process involved: (a) collaborating with caregivers on the selection of foods and design of the children's functional analyses; (b) indirectly and directly measuring food preferences prior to treatment; (c) evaluating the sensitivity of mealtime problem behavior to environmental variables through an interview-informed synthesized contingency analysis (IISCA); and (c) incorporating the assessment results into a progressive treatment process consisting of choice-making opportunities and differential reinforcement of successive approximations to consumption. Children also had the ability to opt in and out of treatment sessions. The treatment was effective in increasing consumption of nonpreferred foods and successfully extended to caregivers. Practical implications and directions for future research are discussed.
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Affiliation(s)
- Holly C. Gover
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Western New England University, Springfield, MA, USA
| | - Gregory P. Hanley
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Western New England University, Springfield, MA, USA
| | - Kelsey W. Ruppel
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Western New England University, Springfield, MA, USA
| | - Robin K. Landa
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Western New England University, Springfield, MA, USA
| | - Juliana Marcus
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, Western New England University, Springfield, MA, USA
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Saini V, Andersen AS, Jessel J, Vance H. On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis. J Appl Behav Anal 2021; 55:513-528. [PMID: 34971457 DOI: 10.1002/jaba.901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022]
Abstract
Functional analysis is the primary assessment used to determine the function of inappropriate mealtime behavior in children with feeding disorders. Based on single-case experimental design studies and recent reviews, the prevalence of negative reinforcement alone in the maintenance of inappropriate mealtime behavior appears to be much greater than positive reinforcement alone. We conducted a retrospective consecutive-controlled case series to determine the generality of previous findings. Results of the epidemiological analysis support prior research in that negative reinforcement in the form of escape (44.8%), and multiple control (i.e., positive and negative reinforcement) in the forms of escape and attention (37.2%), are considerably more prevalent than positive reinforcement alone (2.5%). We discuss the relationship between functional analysis of inappropriate mealtime behavior and treatment utility. Further, we describe avenues of future research designed to advance the application of functional analysis in feeding disorders beyond inappropriate mealtime behavior.
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Tereshko L, Weiss MJ, Olive ML. Ethical Considerations of Behavioral Feeding Interventions. Behav Anal Pract 2021; 14:1157-1168. [PMID: 34868819 PMCID: PMC8586383 DOI: 10.1007/s40617-021-00559-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/28/2022] Open
Abstract
Children with autism spectrum disorder (ASD) often display repetitive and restrictive patterns of behavior, which can be seen in food selectivity and other feeding problems. Feeding problems in children with ASD not only lead to medical complications for the child but also can lead to increased caregiver stress. In order for behavior analysts to ensure adherence to the Professional and Ethical Compliance Code for Behavior Analysts, many factors need to be addressed prior to and during feeding assessments and interventions. The need for interdisciplinary collaboration and ethical situations that may arise are reviewed. The purpose of this article is to assist the behavior analyst in determining best practices for feeding assessments and interventions while maintaining ethical compliance.
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Affiliation(s)
- Lisa Tereshko
- Endicott College, Beverly, MA 01915 USA
- Beacon ABA Services, Inc., Milford, MA USA
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6
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Flanagan J, Penrod B, Silbaugh BC. Further evaluation of contingency modeling to increase consumption of nutritive foods in children with autism and food selectivity. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- JeNell Flanagan
- Department of Psychology California State University Sacramento California USA
| | - Becky Penrod
- Department of Psychology California State University Sacramento California USA
| | - Bryant C. Silbaugh
- Trendline ABA, LLC San Antonio Texas USA
- Maraca Learning Inc. Boise Idaho USA
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7
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Kirkwood CA, Piazza CC, Peterson KM. A comparison of function- and nonfunction-based extinction treatments for inappropriate mealtime behavior. J Appl Behav Anal 2021; 54:928-945. [PMID: 33740261 DOI: 10.1002/jaba.825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/27/2021] [Accepted: 11/24/2020] [Indexed: 01/11/2023]
Abstract
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.
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Luis J, Leon Y, Campos C. Further evaluation of noncontingent reinforcement to treat mealtime problem behavior. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jeanne Luis
- School of Behavior Analysis Florida Institute of Technology Melbourne Florida USA
| | - Yanerys Leon
- Department of Psychology University of Miami Miami Florida USA
| | - Claudia Campos
- School of Behavior Analysis Florida Institute of Technology Melbourne Florida USA
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9
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Tereshko L, Leaf JB, Weiss MJ, Rich A, Pistorino M. A systematic literature review of antecedent and reinforcement‐based behavioral feeding interventions without the implementation of escape extinction. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa Tereshko
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
- Beacon ABA Services, Inc Milford Massachusetts USA
| | - Justin B. Leaf
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
- Autism Partnership Foundation Seal Beach California USA
| | - Mary Jane Weiss
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
| | - Amy Rich
- Beacon ABA Services, Inc Milford Massachusetts USA
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10
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Crowley JG, Peterson KM, Fisher WW, Piazza CC. Treating food selectivity as resistance to change in children with autism spectrum disorder. J Appl Behav Anal 2020; 53:2002-2023. [DOI: 10.1002/jaba.711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - Wayne W. Fisher
- University of Nebraska Medical Center's Munroe‐Meyer Institute
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11
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O'Connor E, Cividini‐Motta C, MacNaul H. Treatment of food selectivity: An evaluation of video modeling of contingencies. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Erin O'Connor
- Department of Child & Family StudiesUniversity of South Florida Florida
| | | | - Hannah MacNaul
- Department of Child & Family StudiesUniversity of South Florida Florida
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12
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Saini V, Kadey HJ, Paszek KJ, Roane HS. A systematic review of functional analysis in pediatric feeding disorders. J Appl Behav Anal 2019; 52:1161-1175. [PMID: 31523816 DOI: 10.1002/jaba.637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/16/2019] [Indexed: 11/07/2022]
Abstract
We conducted a systematic review of the functional analysis of inappropriate mealtime behavior in peer-reviewed studies in PsycINFO, ERIC, PubMed, and the Journal of Applied Behavior Analysis between 2000-2016. We identified 18 studies involving 86 functional analyses. We coded descriptive data and calculated summary statistics in addition to conducting a quality appraisal of the literature. We identified escape, exclusively or in part, as the maintaining reinforcer for inappropriate mealtime behavior in 92% of cases. Results indicate that differentiated functional analyses of inappropriate mealtime behavior can be obtained, and outcomes are consistent with etiological theories of food refusal behavior. We discuss procedural differences across studies as well as directions for future research.
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Impact of Behavioral Feeding Intervention on Child Emotional and Behavioral Functioning, Parenting Stress, and Parent-Child Attachment. J Pediatr Gastroenterol Nutr 2019; 69:383-387. [PMID: 31107793 DOI: 10.1097/mpg.0000000000002382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Behavioral intervention is the only treatment for pediatric feeding problems with well documented empirical support. However, parents may be hesitant to pursue behavioral intervention because of concerns about possible negative side effects on child behavioral health and the parent-child relationship. This study investigated associations between behavioral feeding treatment and parenting stress, internalizing and externalizing behavior problems in young children, and parent-child attachment quality. METHODS Participants included 16 mother-child dyads seeking treatment from a behavioral feeding clinic at a large Midwestern university medical center. Children were between the ages of 30 and 45 months (adjusted) at baseline. Caregivers completed the Child Behavior Checklist for ages 1.5 to 5 (CBCL/1.5-5), the Parenting Stress Index, 3rd Edition Short Form (PSI/SF), and mother-child dyads participated in the Strange Situation procedure at baseline and again after 6 months. The treatment group (n = 12) began outpatient behavioral feeding intervention following the baseline evaluation, whereas the control group (n = 12) remained on the clinic waitlist until after the 6-month follow-up. RESULTS The treatment group demonstrated decreases in internalizing and externalizing child behavior problems and parenting stress compared with the control group. No significant differences were demonstrated in parent-child attachment quality within or between groups. CONCLUSIONS Behavioral feeding intervention had positive effects on perceptions of child emotional and behavioral functioning and maternal parenting stress. Intervention also did not impact the quality of the mother-child attachment relationship. Further research with a larger sample size and additional observational measures of behavior is needed to support the replicability and generalizability of these results.
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14
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Retzlaff BJ, Fisher WW, Akers JS, Greer BD. A translational evaluation of potential iatrogenic effects of single and combined contingencies during functional analysis. J Appl Behav Anal 2019; 53:67-81. [PMID: 31282005 DOI: 10.1002/jaba.595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Abstract
Recent research suggests that combining putative reinforcers for problem behavior into a single, synthesized contingency may increase efficiency in identifying behavioral function relative to traditional functional analysis (FA). Other research suggests potential shortcomings of synthesized contingency analysis (SCA), such as the potential for false-positive outcomes. In prior comparisons of traditional FAs and SCAs, investigators could not ascertain with certainty the true function(s) of the participants' problem behavior for use as the criterion variable. We conducted a translational study to circumvent this limitation by training a specific function for a surrogate destructive behavior prior to conducting a traditional FA and SCA. The traditional FA correctly identified the previously established function of the target response in all six cases and produced no iatrogenic effects. The SCA produced differentiated results in all cases and iatrogenic effects (i.e., an additional function) in three of six cases. We discuss these findings in terms of the mechanisms that may promote iatrogenic effects.
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Saini V, Jessel J, Iannaccone JA, Agnew C. Efficacy of functional analysis for informing behavioral treatment of inappropriate mealtime behavior: A systematic review and meta‐analysis. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Valdeep Saini
- Department of Applied Disability StudiesBrock University St. Catharines Canada
| | - Joshua Jessel
- Department of PsychologyQueens College New York NY United States of America
| | | | - Charlene Agnew
- Department of PsychologyQueens College New York NY United States of America
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Dymond S. Overcoming avoidance in anxiety disorders: The contributions of Pavlovian and operant avoidance extinction methods. Neurosci Biobehav Rev 2019; 98:61-70. [DOI: 10.1016/j.neubiorev.2019.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 01/29/2023]
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Hodges A, Davis TN, Kirkpatrick M. A Review of the Literature on the Functional Analysis of Inappropriate Mealtime Behavior. Behav Modif 2018; 44:137-154. [PMID: 30132340 DOI: 10.1177/0145445518794368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A functional analysis is a well-established and widely used assessment in the treatment of challenging behavior. Given the fact that functional analysis results can inform treatment selection and procedures, a review of the current literature regarding functional analysis of inappropriate mealtime behavior (IMB) is warranted as it may guide researchers in conducting a functional analysis prior to treating IMB. This review summarizes the literature regarding functional analysis of IMB. Fourteen studies that implemented a functional analysis of IMB were identified and summarized based on procedural components of the functional analysis, results, and treatment selection. Results indicate functional analysis of IMB to be effective in the identification of variables maintaining IMB. Although functional analysis of IMB has been found to be helpful, several areas for further research and evaluation are identified.
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18
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Vazquez M, Fryling MJ, Hernández A. Assessment of Parental Acceptability and Preference for Behavioral Interventions for Feeding Problems. Behav Modif 2018; 43:273-287. [PMID: 29338312 DOI: 10.1177/0145445517751435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study evaluates the treatment acceptability and preference for behavioral interventions for feeding problems with parents of children with Autism Spectrum Disorder and other developmental disabilities. The impact of behavioral severity on acceptability and preference was also evaluated by comparing results of parents who responded with respect to a vignette of a child with food refusal with those who responded to a vignette of a child with food selectivity. Overall, parents rated differential reinforcement of alternative behavior as the most preferred and most acceptable strategy across both food selectivity and food refusal groups. Escape extinction was the least acceptable and least preferred across both groups, and the severity of the behavior had no impact on acceptability or preference scores. Implications for future research on the social validity of feeding interventions are provided.
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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Gosa MM, Carden HT, Jacks CC, Threadgill AY, Sidlovsky TC. Evidence to support treatment options for children with swallowing and feeding disorders: A systematic review. J Pediatr Rehabil Med 2017; 10:107-136. [PMID: 28582883 DOI: 10.3233/prm-170436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE A rise in pediatric patients with swallowing and feeding problems has resulted in increased interest in multidisciplinary treatments to address these issues. This evidence based systematic review (EBSR) examined the published evidence for the use of common strategies used by clinicians across disciplines to treat pediatric swallowing and feeding problems. METHODS A systematic search of 10 electronic databases was completed to identify relevant, peer reviewed literature published in English prior to December 2015 reporting original data that addressed at least one of the five identified clinical questions. RESULTS Sixty-one studies of varying methodological quality were included. The majority of the included studies (60/61) focused on the use of behavioral therapies to remediate swallowing and feeding disorders in children and reported mixed findings across all of the targeted outcomes. CONCLUSION There is insufficient quantity of evidence to determine the effects of oral motor, sensory, and pharmaceutical therapies on functional feeding outcomes in pediatric populations. A larger body of phase 1 evidence is available that establishes the efficacy of behavioral strategies to treat some swallowing and feeding difficulties in small cohort and single subject studies. This analysis identified limited high quality (phase 4) research articles that establish the efficacy and benefit of joint nutrition and behavior intervention programs and systematic desensitization and operant conditioning behavioral therapy approaches to improve functional feeding and swallowing outcomes in children.
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Affiliation(s)
- Memorie M Gosa
- The University of Alabama, Tuscaloosa, AL, USA
- Le Bonheur Children's Hospital, Memphis, TN, USA
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21
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González ML, Rubio EK, Taylor T. Inappropriate mealtime behavior: the effects of noncontingent access to preferred tangibles on responding in functional analyses. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3655-3664. [PMID: 25255166 DOI: 10.1016/j.ridd.2014.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
An understanding of the functional variables associated with inappropriate mealtime behavior (IMB) is critical to developing an effective and efficient treatment for food refusal. To this aim, functional analysis methodology has been modified for the meal context, and previous research has shown that multiple sources of reinforcement maintain IMB. Functional analysis literature, related to severe problem behavior, suggests that access to preferred stimuli may abolish or compete with social reinforcers in some cases. The role of noncontingent access to preferred stimuli during the assessment of IMB has not been evaluated. The purpose of the current study was to examine the effects noncontingent access to preferred toys/activities on IMB in the presence and absence of social consequences. The specific aims were to evaluate: (1) levels of IMB when the spoon is held stationary at the child's lips when preferred tangible stimuli are present noncontingently vs. absent; (2) levels of IMB when social consequences were provided contingent upon IMB when preferred tangible stimuli are present noncontingently vs. absent. For many participants, levels of IMB were reduced with the inclusion of preferred toys/activities; while for one, levels of IMB increased. Possible implications of these findings on functional analyses of IMB will be discussed.
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Affiliation(s)
- Melissa L González
- Kennedy Krieger Institute, United States; Johns Hopkins University School of Medicine, United States.
| | | | - Tessa Taylor
- Kennedy Krieger Institute, United States; Johns Hopkins University School of Medicine, United States
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Rivas KM, Piazza CC, Roane HS, Volkert VM, Stewart V, Kadey HJ, Groff RA. Analysis of self-feeding in children with feeding disorders. J Appl Behav Anal 2014; 47:710-22. [DOI: 10.1002/jaba.170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 05/05/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Kristi M. Rivas
- University of Nebraska Medical Center's Munroe-Meyer Institute
| | | | - Henry S. Roane
- University of Nebraska Medical Center's Munroe-Meyer Institute
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Langthorne P, McGill P, Oliver C. The motivating operation and negatively reinforced problem behavior: a systematic review. Behav Modif 2013; 38:107-59. [PMID: 24285781 DOI: 10.1177/0145445513509649] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The concept of motivational operations exerts an increasing influence on the understanding and assessment of problem behavior in people with intellectual and developmental disability. In this systematic review of 59 methodologically robust studies of the influence of motivational operations in negative reinforcement paradigms in this population, we identify themes related to situational and biological variables that have implications for assessment, intervention, and further research. There is now good evidence that motivational operations of differing origins influence negatively reinforced problem behavior, and that these might be subject to manipulation to facilitate favorable outcomes. There is also good evidence that some biological variables warrant consideration in assessment procedures as they predispose the person's behavior to be influenced by specific motivational operations. The implications for assessment and intervention are made explicit with reference to variables that are open to manipulation or that require further research and conceptualization within causal models.
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Addison LR, Piazza CC, Patel MR, Bachmeyer MH, Rivas KM, Milnes SM, Oddo J. A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. J Appl Behav Anal 2013; 45:455-71. [PMID: 23060661 DOI: 10.1901/jaba.2012.45-455] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/26/2012] [Indexed: 11/22/2022]
Abstract
We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.
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