Applied Behavior Analysis in the Treatment of Pediatric Feeding Problems

1. Applied Behavior Analysis in the Treatment of Pediatric Feeding Problems Jonathan K. Fernand, M.A., BCBA University of Florida B.E.S.T. Consulting, Inc., Sacramento, CA Conferința Națională de Analiză Aplicată a Comportamentului (ABA), Ediția a III-a

2. Overview • Types of Feeding Problems • What Constitutes a Feeding Problem • Signs of a Feeding Problem • Considerations Before Intervening • Antecedent-based Interventions • Consequence-based Interventions

3. Overview of Feeding Problems • Prevalence • 35-45% of typically developing children • 80% of children with intellectual disabilities • Negative outcomes • Weight loss, malnutrition, growth retardation, impaired intellectual development, lethargy, death • Self-injury, aggression, tantrums, property destruction, disruption, expulsion, vomiting

4. Types of Feeding Problems Total Food Refusal Food Selectivity Type Texture Brand Presentation, smell, location… Skill Deficits Fine-motor Oral-motor Difficulties swallowing On a green plate Only white bread Only certain brand of jelly Only smooth peanut butter Cut diagonally…into 4 slices

5. Other Types of Problems • Problematic Mealtime Behaviors • Rumination • Packing • Pica

6. Problem? • Not growing according to developmental norms • Restricting food from a major food group (i.e., fruit, vegetable, protein, starch) • Refusal of most novel foods when presented • Inflexible or rigid in feeding routines • Skill deficit(s) • Refusal has an impact on functioning

7. Signs of a Feeding Problem • Arching or stiffening of the body • Coughing, gagging, vomiting during meals • Excessive drooling or food/liquid coming out of nose/mouth • Refusing to eat an age-appropriate variety of foods/textures • Exhibits mealtime problem behavior • Lengthy mealtimes (e.g., > 30 minutes)

8. Some more Signs • Family does not go into public to eat • Family cooks the same thing for every meal • Child does not eat what the rest of the family eats • Child is not eating what same-aged peers eat

9. Initial Considerations • Gastroesophageal reflux (GER) • Constipation • Diarrhea • Oral motor delays • Dysphagia • Food allergies

10. Assessment • Food Logs & Conditional Probabilities • Functional Assessments • Preference Assessments Piazza et al., 2003 Munk & Repp, 1994 Fernand et al. (in review)

11. Antecedent-Based Interventions • Presentation Methods • Simultaneous versus Sequential Methods • High-probability Instructional Sequence Kern & Marder, 1996 Penrod, Gardella, & Fernand, 2012

12. Antecedent-Based Interventions • Providing Choices Fernand et al. (in review)

13. Antecedent-Based Interventions • Modeling Fu et al. (in review)

14. Antecedent-Based Interventions: Fading • Bite Fading (Demand Fading) • Flavor Fading • Distance Fading • Texture Fading

15. Antecedent-Based Interventions: Fading Puree: Smooth Texture

16. Antecedent-Based Interventions: Fading Wet Ground: Small Lumps

17. Antecedent-Based Interventions: Fading Ground: Lumps & Thicker

18. Antecedent-Based Interventions: Fading Chopped: Size of Bacon Bits

19. Antecedent-Based Interventions: Fading Table Top: Typical Bite

20. Fading Fernand et al.

21. Consequence-Based Interventions: DRA Riordan et al., 1980

22. Consequence-Based Interventions: Escape Extinction • Nonremoval of the spoon (NRS) • Nonremoval of the meal (NRM) • Physical guidance/prompts • Utensil guidance • Chin prompt • Bite representation • Expulsion • Bite redeposit • Packing

23. Consequence-Based Interventions: Escape Extinction • Nonremoval of the spoon (NRS) Fernand et al., (in review)

24. jkfernand@ufl.edu