We try to review a research article each week. Today, since one of us is conducting a 4-hour workshop on feeding in Dubai, it seems appropriate to review a study related to feeding. William Sharp and his colleagues at Marcus Autism Center (David Jaquess, Jane Morton, and Caitlin Herzinger) authored the study titled, “Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes”. The Journal Clinical Child and Family Psychology Review published the study in 2010.
This paper is a literature review or literature synthesis. In research papers like this, the authors search for all the studies on a particular topic and then they analyze the results collectively and use those results to make treatment recommendations. These authors did just that. They identified the topic of interest and consulted a search on all studies of treatment for severe food refusal or selectivity. We have written about this topic on several occasions because many of the children we see have food selectivity (where they will eat only a few things) in addition to their autism. You can read more about our case studies here, here, or here.
Food Refusal and Food Selectivity
The Journal publishing this paper, is a peer-reviewed research journal. This means that a review panel of experts read the paper and deemed it scientific and valid. Thus, the authors only included studies in the review that utilized strong experimental control or what you, as readers may call, a good experiment. With these criteria in place, the authors identified 46 published studies wherein a total of 96 children received treatment for food refusal or food selectivity.
The authors noted that the majority of studies in the review had been published after 2000. Many of the children in these studies were male and most had a developmental issue of some sort including global developmental delay or autism. Over half of the children in these studies also had an underlying medical condition including Failure to Thrive (FTT), Gastroesophageal Reflux Disease (GERD), and gastrointestinal problems. Treatment occurred in hospitals, homes, schools, and outpatient centers and was provided by highly trained therapists. The majority of studies reported extremely favorable outcomes (large effect size) for participating children. Authors reported other positive changes such as a decreased need for tube feeding, complete removal of tube feeding, weight gain, discontinuance of bottle feeding, and improved consumption.
The authors reported that for all reviewed studies, researchers used a behavioral approach to feeding therapy. The authors noted that they could not locate any well-controlled studies utilizing other treatment methods.Within behavioral treatments, the authors noted that escape extinction (not getting out of the non-preferred bite) was the most widely used treatment with over 83% of the studies utilizing it in some form. Non-removal of the spoon and physical guidance were also used to prevent escape or avoidance of non-preferred foods. Also within behavioral treatments, authors used differential reinforcement of alternative (DRA) behaviors. Specifically, when the child engaged in eating, he was provided with a reinforcing toy, game, or possibly even food.
The authors of the review noted the continued support for behavioral treatment to address food refusal and selectivity. While a great number of studies utilized escape extinction procedures, it should be noted that the authors reviewed the literature on severe feeding disorders. As such, milder cases may not require the use of escape extinction. In our practice, many of our children arrive eating 5 foods or fewer. In our opinion, that is a severe situation and prompt treatment is warranted.
The review authors also point out that escape extinction was never used in isolation but was rather, a part of a complex package of intervention treatments. This is also important because we know from other research that extinction alone can result in an increase in problem behaviors and that when extinction is paired with reinforcement, the severity of the behaviors is reduced.
We want to hear from you. Did your child participate in feeding therapy? Were behavioral procedures used? Was feeding therapy effective?
If you are interested in behavioral feeding therapy, we offer this service in the convenience of your home. We also collaborate with your child’s school and ABA team to ensure successful maintenance of behaviors following intervention. Please contact us for additional information: info at appliedbehavioralstrategies dot com.