An evaluation of negative reinforcement to increase self-feeding and self-drinking for children with feeding disorders.

Self-feeding with utensils represents an important step in a child's progression toward age-typical eating and emerges in the absence of intervention for most children. In contrast, children with feeding disorders may lack the skill or motivation to self-feed, which impedes progress toward age-typical eating. In the current study, experimenters used a multielement design to evaluate negative reinforcement in the form of meal termination to transition six participants with a feeding disorder from caregiver-fed to self-fed bites and drinks. Caregivers conducted meals in which they fed the participant or prompted them to self-feed. During self-fed meal-termination sessions, participants had the opportunity to end the meal contingent on self-feeding the presented bite(s) or drink(s). Self-feeding increased during meal-termination sessions for all participants. The experimenters discuss these results relative to their potential to inform interventions for children with feeding disorders that progress the child toward age-typical eating.

Relapse during the treatment of pediatric feeding disorders.

Resurgence and renewal are treatment-relapse phenomena in which previously extinguished behavior returns after the conditions for an alternative response worsen or the context changes, respectively. Recently, researchers have evaluated the prevalence of resurgence and renewal when treating destructive behavior with functional communication training. However, resurgence of inappropriate mealtime behavior has yet to be evaluated; perhaps because treatments involve qualitatively different resurgence opportunities (e.g., increased bite-presentation rate). We evaluated the prevalence of resurgence and renewal of inappropriate mealtime behavior across 22 and 25 applications of extinction-based treatments, respectively. Resurgence occurred in 41% (9/22) of applications, most often following presentation-rate increases. Renewal occurred in 52% (13/25) of applications, most often following feeder changes from therapist to caregiver. We discuss these findings in terms of their ability to inform relapse-mitigation strategies for resurgence and renewal of inappropriate mealtime behavior.

On the scope and characteristics of relapse when treating severe destructive behavior.

Prior studies on treatment relapse have typically examined the prevalence of resurgence or renewal of target behavior (e.g., destructive behavior) in isolation. This study analyzed both types of relapse during 25 consecutive treatments involving functional communication training during worsening reinforcement conditions for alternative behavior (i.e., schedule thinning) or following context changes. We also examined disruption of alternative behavior (i.e., functional communication requests, compliance). Resurgence and renewal of destructive behavior occurred in 76% and 69% of treatments, respectively, and in approximately a third of changes in reinforcement or context. Relapse of destructive behavior predicted alternative-response disruption and vice versa; the co-occurrence of these two events always exceeded the background probabilities of either event occurring in isolation. General reductions in treatment efficacy occurred across changes in reinforcement or context, with no apparent decrease in likelihood in later transitions. We discuss implications of our findings with respect to future studies examining treatment durability.

An evaluation of a renewal-mitigation procedure for inappropriate mealtime behavior.

Renewal, the increase in behavior during extinction following context changes, may be particularly concerning during intervention for feeding disorders because context changes are often necessary for intervention generality and maintenance (Podlesnik et al., 2017). In the current study, we tested for renewal and evaluated a renewal-mitigation procedure when we transferred intervention from a therapist to a caregiver, from clinic to the home, and changed the foods the feeder presented. We used an ABA arrangement to evaluate the generality of the renewal effect with 7 participants who engaged in inappropriate mealtime behavior. Context A was functional reinforcement. Context B was function-based extinction during the control and mitigation conditions and our renewal-mitigation procedure in the mitigation condition. The renewal test was function-based extinction in Context A. We observed renewal of inappropriate mealtime behavior in 4 of 7 participants, and our renewal-mitigation procedure was effective for 4 of 4 participants.

Pediatric Prevention: Feeding Disorders.

Applied behavior analysis has the most empirical support as intervention for pediatric feeding disorders, when a child does not eat or drink a sufficient quantity or variety of food to maintain proper nutrition. Interdisciplinary collaboration is crucial for diagnosis, referral, and management of pediatric feeding disorders because the etiology is complex and multifactorial. Thus, our aim is to provide information about how to recognize a feeding disorder, to delineate the environmental variables implicated in the etiology and maintenance of feeding disorders, and to provide recommendations for prevention and intervention for feeding disorders based on the applied-behavior analytic literature.