We have completed the first day of our intensive feeding clinic. Needless to say, teaching 5 children to eat over the course of the day adds up to 15 meals in the day. Between two people, it is exhausting. All we can say is “Thank Goodness for staff who are there to assist!”
Thanks to Dr. Tom Zwicker and The Eastern Seals for hosting the clinic.
Thanks to Yolanda, Applied Behavioral Strategies Office Manager, for bringing us lunch.
Thanks to Maria, Applied Behavioral Strategies intern for taking data.
Thanks to Laura for videotaping, assisting with data collection, serving as a generalization therapist, and for all around good emotional support.
Thanks to the parents for having faith in us to help your children. And thank you Kendal for bringing the strawberry fluff!
Focus on Jackson
As much as we would love to share the stories of all of our clients, we are going to focus on one client for the entire week. We are going to introduce you to Jackson and his mother Kendal.
Jackson is an adolescent male with autism. Jackson is about 5’9″ and weighs about 120 lbs. He towers over Missy and he is eye-to-eye with Rebecca.
Jackson is mostly non-verbal and he has only a handful of words and word approximations in his vocabulary. Let’s get this clear, the boy can say “NO!” as plain as day! Jackson can also type and spell and he has a fairly large and accurate written vocabulary.
Jackson greeted Missy with his upbeat “NO!” and he used that word for everything including following simple instructions such as “sit down” and “it’s time to eat.”
When they entered the therapy room, Jackson continued his cordial behaviors by grabbing Missy by the hair on her head (what little she has). He also attempted to shove her so that he could escape the room. You should see Missy hold her own against someone bigger than her!
It’s All About Reinforcement!
Then, Kendal whipped out the strawberry flavored fluff. Instantly, Jackson sat down and indicated his interest in this new activity. (note: parents know their children! Kendal knew that Jackson would work for Fluff–and he can almost say “fluff”).
Jackson was not happy about this new arrangement. He was not interested in eggs, Gluten Free toast, breakfast potatoes, or watermelon. He tried to pack up his mother’s things to GET OUT! He turned off the iPad. He turned off his communication device. He wanted no part of this—until the fluff. Missy told him, “Want fluff? Then eat. First egg, then fluff”. Jackson thought about it. He had not had fluff in quite a while thanks to Kendal’s determination to help her child. HE WANTED THE FLUFF! So, he accepted the egg. In it went, out it came. He accepted the egg again, and again. Finally, he chewed it and swallowed it. SUCCESS! Then Jackson savored his fluff.
Missy repeated this with each of the remaining foods. First take a bite, then fluff. In behavior analysis, we call this DRA or differential reinforcement of an alternative behavior. The alternative behavior is eating (instead of food refusal). This is also contingent reinforcement. When Jackson eats, he receives the preferred item instantly.
During breakfast, Jackson grabbed Missy’s hair multiple times (10-15 is the best guess without looking at the data sheet). He also attempted to elope multiple times. But the biggest success is that Jackson ate new and healthy foods for the first time in many years!
Jackson did not want to come back for lunch. He typed on a phone notepad: car, lays potato chips, fluff. Jackson knows what he wants! And given his size and challenging behaviors, he often gets it.
For lunch, Missy used the same intervention. Jackson at a turkey sandwich. His first sandwich EVER! This time, Missy started increasing the demands. She expected Jackson to eat two bites before receiving fluff. Within this same session, she was able to get Jackson to eat three bites of new foods before eating fluff.
During lunch, Jackson grabbed Missy’s hair less and he attempted to escape less.
Jackson ate a hamburger, broccoli, mashed potatoes, and cantaloupe for dinner and he drank coconut milk! Missy continued to increase the expectations and she decreased the size of the fluff bites.
During dinner, Jackson grabbed Missy’s hair only once and he did not attempt to elope until the end of the meal.
What an amazing first day of therapy for Jackson! Check back tomorrow to see how Jackson responds to Day 2 of intensive feeding therapy.