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Archive for the ‘Feeding Intervention/Feeding Therapy’ Category

It has been a super busy fall! It all started in August when I spoke at the National Autism Conference in State College, PA. I spoke on Special Education Law and also on Ethical Issues in Using ABA to Address Feeding. This conference is actually how Matt Ciccoria and I got introduced. Jen Farris saw me speak on SPED Law and she reached out to Matt and then made the introduction. Conferences are truly for networking! For follow up on the SPED Talk, see my previous blog post.

Next up was FABA Conference! I served as the discussant on a lively panel regarding Ethical Issues in Functional Analysis and presented on the hot topic of Ethical Issues in Assessment. We are working on papers for both of these talks!

This was followed by the 19th Annual CARDAAC Conference in Baltimore with the fine team at Kennedy Krieger. There I spoke on PBIS Strategies at Tier 2 and Tier 3 implementation levels.

Once I finally stopped traveling, I sat down with Matt! I was incredibly nervous about doing this. But Matt put me right at ease. I seriously could have talked to him for hours on this topic! Take a moment to listen to the podcast when you are driving from client to client or school to school. You can download the podcast here: https://podcasts.apple.com/us/podcast/ethics-school-consultation-for-bcbas-session-101-missy/id1086413253?i=1000457591580 or you can go to the website for all the show notes here: https://behavioralobservations.com/the-ethics-of-school-consultation-for-bcbas-session-101-with-missy-olive/

There is a teaser too! If you listen to the show, you will find out about some upcoming CEs that are available! This special will be available for any of the webinars mentioned in the podcast through 2020!

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Feeding Clinic

Check out this really cool video from our colleagues at the Munroe-Myer Institute Pediatric Feeding Disorders Program.

Video Link

Other Feeding Related Posts

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We are pleased to announce the launch of our new website! It is the same URL address, just new updatesgraph to make it easier for mobile users to stay in touch.

Our applied behavior analysis (ABA) team has worked hard to complete professional photos, update bios, and introduce our new behavioral feeding page!

Don’t miss our upcoming webinars for 2017. We offer group rates for 3 or more individuals from the same agency who are taking the course from separate computers. Our best discount is for groups who will share a computer during the webinar! Register 1 person at full price and all others are only $10! That’s right, $10 for the whole course when you share a computer. To register, simply visit our website here, scroll to the very bottom, enter your name and other pertinent information, enter an abbreviated title, and follow the link to PayPal where you may pay with your account or with any credit card. We also accept purchase orders from school districts!

Did you know that ABS has a monthly journal club where you earn 1 CE each month? Did I mention that the  Journal Club is FREE? All you have to do is join the club, read the article, and be present for the discussion. Email the info line at: info at applied behavioral strategies dot com to join the journal club.

If you haven’t been to our page in a while, hop over for a visit to meet our amazing team of BCBAs. (As an aside, we are currently hiring full- and part-time BCBAs.  If you are bi-lingual Spanish, we would be thrilled. We are also hiring part-time behavior therapists.) Come join our awesome team!

And finally, if you just want to stay in touch, join our mailing list here.

If you like what you see, say so! Like this post, like our facebook page, or follow us on LinkedIn,

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Great news! We just learned that our paper has been published in Case Reports in Psychiatry. My colleagues at the Johnson Center for Child Health and Development in Austin co-authored the study with me.

If you are interested in the study, you may download it here.

Let me know if you have questions about the case. It was truly fascinating.

picky eater 3

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We are so pleased to announce that we have found a home for Applied Behavioral Strategies! We will be housed within the JCC of Greater New Haven on 360 Amity Road in Woodbridge, Connecticut. Give us some time to get settled and we will host a grand opening. We are looking forward to offering clinic based services for feeding, social skills, and parent training. We also hope to offer inclusive services for after school care, summer camps, and more.JCC

 

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Hi and welcome to Ask Missy Mondays where I respond to email questions from parents who are having difficulty with their child’s behavior. Today, we have a question in from Melany who writes: picky eater

I would like to create a program for a young boy who has difficulties with some specific textures. I thought about a fading procedure but there is maybe a better one?”

Before recommending anything specific for this child, it will be important for you to assess and have others assess the child thoroughly. We have learned that children with food allergies/sensitivities often have oral sensory issues. We have also learned that children who have oral motor deficits may have difficulties with certain textures. However, some children are simply scared of textures. Thus, a good assessment of the child’s medical and oral motor condition is important before commencing treatment for this child.

A substantial amount of research has proven a texture fading model to be effective. In a texture fading model, clinicians move from puree to table food by slowing increasing the texture. You will see this if you examine any commercially produced baby food in puree to stage 3 foods.

Finally, please do not try this at home. Just because you have learned how to use a fading protocol in your coursework, it does not mean that you can or should implement a fading protocol in feeding. Appropriate training and supervised clinical experiences are essential prior to addressing feeding issues. Additionally, other clinicians may be needed to assist you. These include physicians, occupational therapists, speech and language therapists, and/or nutritionists or dietitians.

If you have a behavior that you need assistance on, please email me at askmissy at applied behavioral strategies dot-com. Thank you!

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Hi and welcome to What Works Wednesdays where the focus is usually the description of a successful case story. Today’s story actually comes from a popular video. In this video, the photographers captured the faces of several young children as they tried new food for the first time. Matt Gilmour, the creative director and Hugh Miller, the cinematographer, capture the children’s reactions in 500 frames per second.

As a BCBA who has helped many, many children learn to eat new foods, I cannot help but recognize that the children in this video are not scared. The children in the video are willingly trying new food. Sadly, for children who have autism, trying new foods does not look like this. Trying new foods can result in aggressive behaviors, self-injurious behaviors, even vomiting!

However, after effective behavioral feeding therapy, children with autism can learn to try [and like] new foods. If you have a child who engages in picky eating, reach out for assistance from a behavioral feeding program; mealtime does not have to be stressful.

Related Articles

 

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I came across this news piece over the weekend.

adult-picky-eater-will-only-consume-three-kinds-of-food.html

While no one asked me for my opinion, I’m certainly going to provide it.

Medical Assessment

First, this woman needs a complete medical work up. I would be willing to bet that she has anemia and bone density issues. Having low cholesterol is simply not good enough.

GI Workup

The TV journalist did not mention this but I would also want to know this woman’s GI habits. Is she constipated? Does she have diarrhea? Are there bouts of these? Additionally, does she experience acid reflux? If not now, did she as a child?

Nutritional Evaluation

Marla needs to see a nutritionist or dietician. Chances are, Marla is also deficient in important minerals like zinc. Research has shown that zinc deficiencies can result in altered taste and smells.

Does Marla have any food allergies? or Food sensitivities? I would be willing to bet she is sensitive to Gluten and Dairy (and possibly potato). This should be evaluated.

Treatment

Once the assessments have been completed, Marla needs to start some good behavior therapy. She needs to learn to associate good things with all the foods that she is currently scared to eat. We currently use the iPad with various applications, games, and movies. However, she may need something a little more powerful.

All of the foods that she is currently eating need to be stopped immediately and completely. The foods she is eating cause cravings which prevent her from wanting other foods. When she stops eating those foods, she will be able to tolerate and appreciate new foods.

Withdrawals

However, when Marla stops eating those same 3 foods, she is more than likely going to experience extreme withdrawal symptoms (much like those experienced by drug addicted individuals). We have written about this before and we have experienced it with several of our client.s

I wish  the best to Marla and her counselor and I hope that they get these issues resolved for her.

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled, Intervention for Food Selectivity in a Specialized School Setting: Teacher Implemented Prompting, Reinforcement, and Demand Fading for an Adolescent Student with Autism (wonder if they could make that a little longer?). A journal called Education and Treatment of Children published the article and Maria Knox, Hanna C. Rue, Leah Wildenger, Kara Lamb, and James K. Luiselli authored it. (If you want to read the entire article, you will find it on www.freelibrary.com)

Background

Many children with autism engage in picky eating or what researchers call “food selectivity“. For example some children live on a white foods diet (chicken nuggets, french fries, and bread) while others remain stuck in pureed foods.

Applied Behavior Analysis (ABA) is one intervention that has been demonstrated repeatedly to be effective at addressing picky eating behavior. However, the intervention often results in challenging behaviors that make it difficult for parents and caregivers to implement on their own. In fact, most of the research to date has been implemented by highly trained therapists.

Purpose of the Study

Thus, authors set out to determine if an intervention could be implemented by school staff in the school setting.

Study Method: Participants

The authors enrolled one child in the study. “Anna” was 16 and had autism. She was verbal and she could follow simple instructions. Anna could feed herself. However, she limited her diet to  a few brand-specific crackers, dry cereal, and apple juice . During the study, Anna’s mother provided new foods including one main food (chicken nuggets, macaroni and cheese, or turkey and cheese sandwich) and two side foods (cheese cubes, vegetable chips, carrots, mandarin oranges, or apples).

The authors implemented all study procedures at the school in Anna’s lunchroom or her classroom. The teacher and the teaching assistants collected all the data for the study.

Study Method: Design

The authors used a changing criteria design which is one type of single subject design. In this design, the expectations are gradually increased across phases. Thus, the teacher required Anna to eat more and more food across the study.

In baseline, the food were presented. If Anna did not eat within 2.5 minutes, the food was removed. After 10 minutes, Anna was allowed to eat her preferred foods.

Study Method: Intervention Technique

The researchers taught the teacher how to implement the intervention prior to the beginning of intervention.

Prespecified Reinforcement (First-Then)

During intervention, the teacher presented the new food on a separate plate and told Anna when she ate the new food (small amount at first), she could have her preferred food.

Reinforcement

Additionally, Anna earned verbal praise and stickers for eating new food. Anna cashed her stickers in for small trinkets.

Prompts

The teaching staff verbally prompted Anna to eat her lunch, if, 30 seconds after swallowing she had not taken her bite.

Demand Fading (Increasing the Volume Slowly)

Gradually, the teaching staff increased the amount of food that Anna needed to eat in order to get her preferred foods.

Results

By the 23rd lunch session, Anna consumed 100% of the new food and she repeated this on the 24th and 25th lunch sessions. The authors came back to assess her eating 2 weeks, 6 weeks, and 7 months later. Anna continued to eat 100% of her new food.

Congrats to Anna and the research team on such a successful intervention. ABA works!

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Technically, Jackson met our requirements for graduation at breakfast on the 4th day. He successfully ate breakfast with his mom and his brother and he engaged in almost no challenging behavior. However, before we discharge, we like to make sure that our clients can generalize their behaviors to school or to a community restaurant (or both!). So, we used Friday to work on generalization.

Pretzel’s at the Mall

Kendall told us that one of the most difficult times had been when they went to the mall and Jackson tried to get pretzels. Since starting the gluten-free diet, he would not be able to eat those pretzels and she worried that he would have a tantrum if she told him no. So, we agreed to meet her at the mall to work on an intervention.

Jackson walked right past the pretzels to meet us in the middle of the mall. However, when we arrived, he took off walking. He was a man on a mission! He went straight for the pretzels. We told him “no pretzels today, we are going to eat lunch”. He grabbed his communication device and typed out “PRETZEL”. We affirmed his request and simply restated that we would not be having a pretzel but instead we would go to lunch and he could eat pizza (we had already selected a gluten-free pizza place). We showed him the picture of a pizza.

Jackson took off walking through the mall. He had one things on his mind: Pretzels! After circling the mall and arriving at the pretzels again, he walked over to the display and pointed. We reminded him again that we would not be having pretzel and that we were going to lunch. With that, he decided it was time to leave and he proceeded to his car.

Well that seemed a little too easy.

Planet Pizza

 

When we arrived at Planet Pizza, the manager was restocking the chips. Yes, you remembered correctly. Jackson has a thing for Lay’s potato chips. He was super excited! He went over, picked up a bag of chips and appeared happy as a clam. We reminded him that he was here for pizza and not for chips. We asked him to put the chips back. At first he was reluctant but we remained firm. Please put the chips away, we are going to eat pizza. Jackson put the chips away and we asked him to pick out a drink.

Prior to starting feeding therapy, Jackson only drank water. He drank water out of a faucet and out of the Long Island Sound. Wherever he could find water, Jackson drank it! We told him, “No water today, pick something else.” He told us no but we held up two types of juice and he picked one.

Then we escorted him to find a table while the pizza cooked.

  1. Note: Kendall brought her own dairy free cheese and the staff cooked the gluten-free crust with the special cheese.
  2. Note: Bring things to do in restaurants while you wait!

While we are great at helping kids in the community, we have so much knowledge and training that we have a hard time remembering to teach the parents all that we know. We forgot to prep Kendall for the things that Jackson would need to keep himself busy. Luckily, we had iPhones so he tried to watch YouTube while waiting.

Jackson made a few noises during his wait. Unfortunately, restaurant patrons stared at us. The staring makes all parents uncomfortable. We let Kendall know that bringing Jackson out actually helps to educate others. Plus, Jackson has every right to be there too!

Success

The pizza arrived after only a 15-minute wait but then we had to wait for it to cool. Finally, Jackson could try pizza for the first time in many, many years. He loved it! He didn’t mind the spinach or the broccoli. He even picked up his fork and stabbed a few pieces on his own. He ate the entire piece that Kendall had prepared for him. He did this without aggression and without any expels!

Jackson still has some skills to work on:

  • cutting his own food
  • stabbing his own food using the fork
  • scooping his own food with a spoon
  • learning to wait quietly at restaurants
  • wiping his mouth with a napkin without reminders

However, he has come a tremendous distance in only 5 short days. Congratulations Kendall on all of your hard work. Jackson is a champion eater and you are a champion mom!

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