Translational evaluation of a lag schedule and variability in food consumed by a boy with autism and food selectivity

"Still work?" Design and effect of interventions used to modify feeding problems in children with autism: A systematic review of studies employing group designs

BACKGROUND

Feeding problems in children with autism jeopardize the well-being of both children with autism and their families. Mixed findings were reported from previous interventions, which were mostly evaluated by single subject research design (SSRD) studies. Moreover, feasibility assessment and social validity measurement were unaddressed by these SSRD studies. To fill this substantial knowledge gap, the present review systematically summarized and evaluated feeding interventions implemented in children with autism, which were assessed by studies employing group designs.

METHOD

An extensive literature search in eight established online databases was conducted, and a total of 17 eligible studies published in 2009-2021 were included for further analysis. A descriptive account of the features of the investigations is provided, including assessment of study quality.

RESULTS

A total of 449 children with autism and 203 parents/caregivers participated in the included studies. The multiple use of five strategic intervention components were highlighted in this review, including nutrition education/consultations, environmental modifications, sensory exposure, cognitive components, and behaviour interventions. The reviewed interventions showed a preliminarily positive effect for modifying feeding problems in children with autism. Furthermore, the evaluation based on the RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) demonstrated that an interdisciplinary multi-component intervention strategy may achieve high effectiveness and feasibility in improving feeding problems in a wide range of children with autism.

CONCLUSIONS

This review found that interventions achieved and maintained a positive effect on modification of feeding problems in groups of children with autism. Information and gaps identified and summarized in the implementation process may assist both researchers and stakeholders to further support these vulnerable children.

Consistency in Single-Case ABAB Phase Designs: A Systematic Review

The current article presents a systematic review of consistency in single-case ABAB phase designs. We applied the CONsistency of DAta Patterns (CONDAP) measure to a sample of 460 data sets retrieved from 119 applied studies published over the past 50 years. The main purpose was to (a) identify typical CONDAP values found in published ABAB designs and (b) develop interpretational guidelines for CONDAP to be used for future studies to assess the consistency of data patterns from similar phases. The overall distribution of CONDAP values is right-skewed with several extreme values to the right of the center of the distribution. The B-phase CONDAP values fall within a narrower range than the A-phase CONDAP values. Based on the cumulative distribution of CONDAP values, we offer the following interpretational guidelines in terms of consistency: very high, 0 ≤ CONDAP ≤ 0.5; high, 0.5 < CONDAP ≤ 1; medium, 1 < CONDAP < 1.5; low, 1.5 < CONDAP ≤ 2; very low, CONDAP > 2. We give examples of combining CONDAP benchmarks with visual analysis of single-case ABAB phase designs and conclude that the majority of data patterns (41.2%) in published ABAB phase designs is medium consistent.

Evaluation of Lag Schedules and Rules on Persistent Response Variability With Preschoolers in a Group

In the present study, experimenters evaluated the influence of lag schedules of reinforcement in combination with accurate and inaccurate (complete and incomplete) rules on the response variability of naming category items for typically developing preschoolers in a group format. Results showed that when lag schedules were introduced with 2 categories, response variability generalized to the third category. Furthermore, after participants experienced the lag schedule, variability persisted when the contingency no longer required variability. Participants continued to vary their responses unless the rule and contingency required them to repeat responses. We discuss potential clinical applications of using lag schedules in a group format and including rules during teaching, as well as directions for future research in this area.

Replication and Extension of the Effects of Lag Schedules on Mand Variability and Challenging Behavior During Functional Communication Training

More is known about how to reduce challenging behavior with functional communication training (FCT) than how to mitigate its resurgence during or following a course of treatment. Research suggests reinforcing mand variability during FCT may mitigate the resurgence of challenging behavior, but validated procedures for reinforcing mand variability are limited and poorly understood. Lag schedules can reinforce variability in verbal behavior such as manding in individuals with autism, but studies have been largely limited to nonvocal mand modalities. Therefore, in the current study, we further evaluated the effects of FCT with lag schedules on vocal mand variability and challenging behavior in children with autism. The results suggest lag schedules alone or in combination with response prompt-fading strategies during FCT can increase mand variability and expand mand response classes but may fail to produce clinically significant reductions in challenging behavior.

Interventions for Increasing Acceptance of New Foods Among Children and Adults with Developmental Disorders: A Systematic Review

People with developmental disorders (DD) often display high levels of selective eating, which can result in micronutrient deficiencies. It is therefore essential to explore ways to increase dietary variety in this population. To identify different types of interventions promoting increased acceptance of new foods or dietary variety for DD populations and to determine their effectiveness. Thirty-six studies met criteria for inclusion in the review. Twenty-two types of intervention were identified with 34 studies being reported as effective and 33 of these incorporating components drawn from learning theory. Multi-component interventions centred on operant conditioning, systematic desensitisation and changes to environment and familial practices were reported as effective for individuals.

An evaluation of the additive effects of lag schedules of reinforcement

Lag schedules of reinforcement represent an increasingly researched strategy for addressing restricted and repetitive social communication of individuals with autism spectrum disorder (ASD). Although the body of literature suggests that lag schedules of reinforcement are generally effective for this purpose, studies have varied in their utilization of verbal rules describing the contingency. Furthermore, research has yet to evaluate generalized effects of lag schedules of reinforcement to social communication with peers. This study evaluated the implementation of a social skills curriculum, modified to incorporate lag schedules of reinforcement, on novel responding of participants with ASD. Participants attended training twice per week, with probes of novel responding collected with both researchers and non-participating peers. Results indicate that social skills training that incorporated lag schedules of reinforcement generally resulted in larger increases in novel responding than social skills training alone. Furthermore, effects of training generalized to novel responding to non-participant peers.

Lag Schedules and Functional Communication Training: Persistence of Mands and Relapse of Problem Behavior

We evaluated the effects of lag schedules of reinforcement and functional communication training (FCT) on mand variability and problem behavior in two children with autism spectrum disorder. Specifically, we implemented FCT with increasing lag schedules and compared its effects on problem behavior with baseline conditions. The results showed that both participants exhibited low rates of problem behavior during treatment relative to baseline during and following schedule thinning (up to a Lag 5 schedule arrangement). Variable and total mands remained high during schedule thinning. With one participant, variable manding persisted when the value of the lag schedule was reduced to zero. The current results are discussed in terms of implications for training multiple mand topographies during FCT for the potential prevention and/or mitigation of clinical relapse during challenges to treatment.