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Handbook of applied behavior analysis
Describing the state of the science of applied behavior analysis (ABA), this handbook provides information about theory, research, and intervention. The contributors present practices in behavioral assessment and demonstrate evidence-based strategies for supporting positive behaviors and reducing problem behaviors. Conceptual, empirical, and procedural building blocks of ABA are reviewed and specific applications described in education, autism treatment, safety skills for children, and other areas. The volume also addresses professional and ethical issues. --Book cover.
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Long-Term Outcomes after Behavior-Analytic Intervention for Pediatric Feeding Disorders
Many children with autism spectrum disorder experience feeding difficulties that can lead to increased health risks (e.g., severe nutrition deficiencies, obesity-related illnesses) if left untreated. Intensive feeding programs that use behavior-analytic interventions have reported positive outcomes for treating challenging behavior associated with pediatric feeding disorders at discharge and up to 1 year post discharge. Whether these children achieve and maintain long-term goals is unknown. The purpose of the current study was to evaluate outcomes of behavior-analytic intervention for pediatric feeding disorders among children with and without autism spectrum disorder in an intensive feeding program post discharge. Caregivers of former patients reported on the positive and negative impact of the program and their child’s growth and diet variety at follow-up. 85% of caregivers reported the program had a positive impact. Increases in height-for-age
z
scores were significant from admission to discharge from the intensive program, and progress in growth and diet variety remained the same or improved for most children at follow-up. Results suggest that behavior-analytic intervention in an intensive feeding program produced positive short- and long-term outcomes for children and their families.
Journal Article
A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS
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.
Journal Article
FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR
Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function‐based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.
Journal Article
ESCAPE AS REINFORCEMENT AND ESCAPE EXTINCTION IN THE TREATMENT OF FEEDING PROBLEMS
Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.
Journal Article
AN EVALUATION OF TEXTURE MANIPULATIONS TO INCREASE SWALLOWING
The purpose of the current investigation was to identify an appropriate texture for initial treatment of 1 child's feeding problem. Variability in mouth clean (a product measure of swallowing) during a texture assessment suggested that individual pureed foods differentially affected feeding behavior. A single‐food assessment identified individual problematic foods. We used the results of these assessments to inform treatment, resulting in high levels of mouth clean across foods.
Journal Article
Analysis of self-feeding in children with feeding disorders
In the current investigation, we evaluated a method for increasing self‐feeding with 3 children with a history of food refusal. The children never (2 children) or rarely (1 child) self‐fed bites of food when the choice was between self‐feeding and escape from eating. When the choice was between self‐feeding 1 bite of food or being fed an identical bite of food, self‐feeding was low (2 children) or variable (1 child). Levels of self‐feeding increased for 2 children when the choice was between self‐feeding 1 bite of food or being fed multiple bites of the same food. For the 3rd child, self‐feeding increased when the choice was between self‐feeding 1 bite of food or being fed multiple bites of a less preferred food. The results showed that altering the contingencies associated with being fed increased the probability of self‐feeding, but the specific manipulations that produced self‐feeding were unique to each child.
Journal Article
Syringe fading as treatment for feeding refusal
The efficacy of nonremoval of the cup or spoon as treatment for feeding refusal is dependent on prevention of escape from presentations. In the current investigation, 1 child with feeding refusal escaped presentations during nonremoval of the cup and spoon by clenching his teeth. Therefore, we used a syringe to deposit liquids and solids, increased the volume of liquids and solids in the syringe, and conducted syringe‐to‐cup and syringe‐to‐spoon fading.
Journal Article
Utensil manipulation during initial treatment of pediatric feeding problems
Children with feeding disorders exhibit a variety of problem behaviors during meals. One method of treating problem mealtime behavior is to implement interventions sequentially after the problem behavior emerges (e.g., Sevin, Gulotta, Sierp, Rosica, & Miller, 2002). Alternatively, interventions could target problem behavior in anticipation of its emergence. In the current study, we implemented nonremoval and re‐presentation of bites either on a spoon or on a Nuk for 12 children with feeding problems. The nonremoval and re‐presentation treatment improved feeding behavior for 8 of 12 children. Of those 8 children, 5 had lower levels of expulsions, and 4 of the 8 children had higher levels of mouth clean with the Nuk than with the spoon. We describe the subsequent clinical course of treatment and present follow‐up data for 7 of the 8 children who responded to the nonremoval and re‐presentation treatment with the spoon or Nuk. The data are discussed in terms of potential reasons why the utensil manipulation improved feeding behavior for some children.
Journal Article
USING A CHASER TO DECREASE PACKING IN CHILDREN WITH FEEDING DISORDERS
Packing is a problematic mealtime behavior that is characterized by pocketing or holding solids or liquids in the mouth without swallowing. In the current study, we examined the effects of a chaser, a liquid or solid consistently accepted and swallowed by the child, to decrease packing of solid foods in 3 children with feeding disorders. During the chaser procedure, the therapist presented the chaser immediately for 2 children or 15 s after each bite presentation for 1 child. The chaser was effective in decreasing packing for all 3 children. The results are discussed in terms of the clinical importance of the findings and directions for future research.
Journal Article