Posted in Feeding Intervention/Feeding Therapy, tagged ABA and feeding, feeding and autism, feeding intervention, feeding therapy, picky eating on March 10, 2016| 1 Comment »
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.
Posted in ABA, Feeding Intervention/Feeding Therapy, Picky Eater, What Works Wednesdays, tagged ABA, Applied Behavior Analysis, Autism, autism and feeding therapy, autism and picky eating, feeding intervention, feeding therapy, picky eating, try new foods on May 15, 2013| Leave a Comment »
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.
Posted in Feeding Intervention/Feeding Therapy, Research Review, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, feeding difficulties, feeding intervention, feeding therapy, food selectivity, Picky Eater, picky eating on September 18, 2012| 1 Comment »
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)
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.
Thus, authors set out to determine if an intervention could be implemented by school staff in the school setting.
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.
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.
The researchers taught the teacher how to implement the intervention prior to the beginning of intervention.
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.
Additionally, Anna earned verbal praise and stickers for eating new food. Anna cashed her stickers in for small trinkets.
The teaching staff verbally prompted Anna to eat her lunch, if, 30 seconds after swallowing she had not taken her bite.
Gradually, the teaching staff increased the amount of food that Anna needed to eat in order to get her preferred foods.
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!
Posted in Funny, Picky Eater, tagged feeding intervention, feeding therapy, food selectivity, One Big Happy, Picky Eater, picky eating, picky eating cartoons on August 24, 2012| 3 Comments »
How did Friday get here so quickly? School starts back for us next week so we are going to try to squeeze every last minute of fun time with our families. In wrapping up our description of a week-long feeding therapy “boot camp”, we thought this cartoon would be perfect! Thanks to Rick Detorie for the wonderful One Big Happy humor.
Readers, what strategies have you tried to distract your children while eating?
Posted in Feeding Intervention/Feeding Therapy, Intervention, Picky Eater, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, behavioral feeding therapy, challenging behavior, Eating, feeding difficulties, feeding intervention, feeding therapy, food selectivity, Picky Eater, picky eating on August 23, 2012| 1 Comment »
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.
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.
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.
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!
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:
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!
Posted in Feeding Intervention/Feeding Therapy, Intervention, Picky Eater, What Works Wednesdays, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, challenging behavior, Eating, feeding difficulties, feeding intervention, feeding therapy, food selectivity, Picky Eater, picky eating on August 22, 2012| Leave a Comment »
Needless to say, Rebecca and I were running on fumes at this point in our week. We started the day hoping that 3 of 5 clients would graduate if all goes well. Because of his great success, Jackson was scheduled for only 2 meals: Breakfast with his brother and dinner with his father watching.
For breakfast, Kendall brought bananas, yogurt (coconut milk), gluten-free hot cereal, and raspberries. Jackson engaged in quite a few behaviors today which is common each time we change the conditions. He engaged in 20 verbal/vocal refusals, 6 physical refusals, and he cried two times. His brother, on the other hand, gagged a few times and had to leave the room several times. Hmmmm, maybe we should enroll another client in feeding therapy!
Jackson was ready to show off his mad skills to his dad. Kendall brought sauerkraut and wieners, quinoa, beets, pears, and dried cranberries. What a champion! Jackson ate everything and he had only 2 gags! (beets would make us gag as well!) Throughout the meal, Jackson engaged in only 5 instances of verbal/vocal refusal. Dad was floored! He could not believe how much progress his son had made in just 4 days.
We also taught Jackson how to eat potato chips without making a mess. In the past, he ate them like a wood chipper with chip crumbs flying around. We taught him how to place the entire chip in his mouth without making crumbs.
Be sure to tune in tomorrow to see how Jackson handles going to the mall when he cannot eat his favorite Auntie Annie pretzels!
Posted in Feeding Intervention/Feeding Therapy, Intervention, Picky Eater, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, feeding intervention, feeding therapy, Picky Eater on August 21, 2012| Leave a Comment »
Feeding therapy has been going great. So well, in fact, that one of our clients has transitioned to eating at home with his mom! Two other clients are eating with their moms at the clinic. Jackson is one of those two!
Kendal came in bragging about the standoff she had with Jackson the night before. When asked who won, she replied, “me, of course!”
Jackson started the day by generalizing his eating skills to a new therapist. Jackson ate gluten-free waffles, bacon, blueberries, and hash browns. He also started working on cutting his food. He consumed a total of 36 bites.
He engaged in only 21 verbal or vocal behaviors and only 1 attempt to elope.
At lunch, we transitioned Kendall in to the driver’s seat. She supervised Jackson as he ate tuna sandwich on gluten-free bread, apple slices, and salad with dressing. His sitter, Chardonnay, made humus and he ate that with cucumbers and corn chips.
During lunch, Jackson realized that his mom was “in on it”. He cried for the first time. In fact, he cried 26 times. He laid on the floor and he refused to eat for 3 minutes. He also engaged in verbal/vocal refusal a total of 26 times. But, he continued to eat. He ate a total of 53 bites of food with only 1 gag and 4 expels.
At one point, Jackson reached out to grab his mom and she showed him her open palm indicating that he could push his chin on her hand for deep pressure. He pushed his chin into her hand over and over. He leaned back up in his chair and was ready to eat again. Kendall looked around at her fan club (therapists, interns, and sitters) with tears in her eyes. Then she said beneath her tears of joy, “In the past he would have attacked me.”
Kendal and Jackson came back for dinner with baked ham and pineapple, baked sweet potato, raisins, and green beans. In this meal, he didn’t cry, not even once. Instead, we saw the opposite. Jackson was happy and laughing and felling wonderful. He ate a total of 58 bites. He engaged in 10 verbal and vocal behaviors and he pressed on his eyes a few times. He did not try to elope and he did not gag at all. He tried to expel just one bite. He started engaging in some eye pressing but we coached Kendall how to interrupt the behavior without calling attention to it.
As if all this learning was not enough, Jackson learned how to drink from a straw! A few years ago, he knew how to drink from a straw but he lost the skill. Using coconut milk, a newly acquired beverage, Jackson quickly re-mastered it!
Day 3 was a continued success. Check back tomorrow to see how Jackson handles eating with his brother, going to the mall, eating at a restaurant, and having Dad observe.
Posted in Feeding Intervention/Feeding Therapy, Intervention, Picky Eater, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, Eating, feeding difficulties, feeding intervention, feeding therapy, food selectivity, Picky Eater, picky eating on August 20, 2012| Leave a Comment »
The feeding clinic was busier than we had expected (or perhaps we were too ambitious to think we could post every day). So, we will post Jackson’s daily progress each day this week.
For starters, we could not believe all of the progress that our clients made in the first 2 days. By the end of day 2, three children were eating well! One child was having severe withdrawals from his gluten and dairy. If you have not heard of this (his physicians had not either), you can read more about what another little girl went through as she came off her addicting Sonic Grilled Cheese here. The other little boy who is still struggling to eat has a combination of physiological (he has oral motor delays) and non-physiological feeding difficulties (behavioral issues around food preferences for flavor and texture).
Changing ReinforcersMeanwhile, we tried to move Jackson from fluff to a different, more natural reinforcer. Jackson loves Lay’s potato chips so we tried to see if he would eat new foods in exchange for a few chips. Again, Kendall had to keep Jackson from having chips during other times of the day and this is not an easy task but she was a champ and she made it happen.
Jackson had gluten-free pancakes, sausage, strawberries, and grilled tomatoes for breakfast. He consumed a total of 30 bites. After the 8th bite, we began requiring Jackson to eat 2 bites before he could get his reinforcer. As his food acceptance and consumption increased, his behaviors decreased. He expelled only 4 bites, he tried to elope only twice, and he had only 12 instances of aggression towards Missy. Jackson engaged in 9 instances of verbal and vocal refusal and he engaged in 8 instances of physical refusal. How many adolescents do you know who will eat grilled tomato for breakfast? What a champ!
Lunch on the second day of therapy included coconut milk yogurt with gluten-free granola, ham sandwich with gluten-free bread, oranges, and gluten-free cookies for dessert. Jackson consumed another 30 bites during lunch. He expelled food on 9 times but he did not elope at all. He stood up once as if to elope but he sat down when Missy asked. Jackson had 2 gags during lunch and both were with oranges. Fruit has proven to be hard for him. This is probably due to its wet texture. Jackson has dyspraxia so he obviously has some oral motor issues as well. He is learning to chew and keep his lips closed but this will take continued practice.
Jackson engaged in 20 instances of verbal and vocal refusal and 12 instances of physical refusal (e.g., turning his head or pushing the spoon). Jackson started a new behavior of bouncing up and down in his seat. It was unclear to us if this was a new avoidant behavior or if he was happy about learning to eat these new foods. He engaged in this behavior 22 times.
For dinner on the second day of therapy, Jackson ate cooked carrots, white rice, chicken, and grapes. He ate 3/4 of an entire chicken breast, a portion of rice, and several carrots. After dinner, Jackson ate a gluten-free cupcake with dairy free icing. In the past, he only wanted to lick the icing so Kendall wanted him to learn to eat the cupcake and icing together. He ate about 1/2 of the dessert.
Jackson’s behaviors improved dramatically for this least meal of the day. He engaged in only 1 vocal refusal. He stood up 3 times (but he sat down when asked). He tried to take Missy’s gloves off once (as if to finish the meal). Jackson gagged only once during this meal (over the carrot). After the first 8 bites, we moved Jackson to a fixed ratio schedule meaning that he had to eat 3 bites of new food before he could have a chip.
Jackson’s sitter, Chardonnay learned to help with data collection during this session (thanks for the help–any chance you want a job?!?!). Meanwhile, Kendall will learn to implement the intervention tomorrow. Stay tuned to see how Jackson progresses!
Posted in Feeding Intervention/Feeding Therapy, Intervention, Picky Eater, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, Autism, Eating, feeding intervention, feeding therapy, food selectivity, Picky Eater, picky eating on August 13, 2012| 1 Comment »
We hope that you all are enjoying your summer as much as we are enjoying ours. We have each taken time off to spend non-work time with our families. Time off means that our blog suffers. Despite our absence, we truly appreciate the fact that readers are continuing to visit and have not given up hope on “fresh posts”.
This week we are going to do something a little different. Historically, we have used our “What Works Wednesdays” to focus on our clinical success stories. Since we are running a clinic for intensive feeding therapy this week, we are going to take one of our clients, and highlight his/her progress each day.
Please check back each day for a brief summary of the child’s progress from the previous day. We think the results will surprise you.
Posted in autism, Challenging Behavior, Intervention, What Works Wednesdays, tagged ABA, Applied Behavior Analysis, Applied Behavioral Strategies, challenging behavior, children with autism and fear, fear of public places, feeding intervention, picture schedules, social story, social story about toileting, toilet training, visual schedules, visual supports on July 11, 2012| Leave a Comment »
Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files.Today’s success story is a follow up to a previous clinical case. Do you remember Little Cherub? She first came to us over a year ago. Little Cherub’s dad attended a presentation we did in Atlanta. He desperately wanted help because she had very restricted eating. After listening to dad talk about her symptoms, we suggested that Little Cherub be seen by a specialist to determine if she had celiac, an autoimmune condition that leaves the body unable to digest gluten, a type of protein found in bread, pasta, and cakes.
Sure enough, Little Cherub had celiac. After putting her on a gluten-free (GF) diet, she further restricted her eating. After 5 of the toughest days imaginable, we finally helped Little Cherub learn that new foods are not scary and that, in fact, new foods can actually taste good. Little Cherub’s parents were amazed to see her chasing them down to get more cantaloupe!
In addition to her eating behaviors, Little Cherub has a fear of many new things. Take toileting for example. Little Cherub wanted to continue using her pull up for toileting. Urinating on the toilet was not painful for her. But from the look on her face and the behaviors she exhibited, one would think she felt extreme pain on the toilet. In the same week we taught her to eat, we taught her to use the toilet for urinating and defecating. We made a simple visual schedule to show her that “pee” goes in the toilet.
Within 2 days, Little Cherub overcame her fears of using the toilet. We reserved her very favorite jalapeno corn chips as a treat and she learned to associate positive things with the toilet.
Less than 10 months after overcoming her fears of new foods and toilets, Little Cherub began showing fear-like behaviors in public places such as Target and grocery stores. Little Cherub’s dad reached out to us again for assistance.
Public places can be very scary for children on the spectrum. Public places are loud, they have strange lighting, and things are not always predictable. However, once you teach children the routine, and associate the public place with something positive, children learn that public places are not scary after all.
Little Cherub’s parents used the same intensive model we used with feeding. They began taking her to public places two times per day, every day, for a week. Little Cherub’s dad writes,
She went from cowering to smiling when we went twice a day for a week and explained to her what everything was she was seeing and hearing.
Congrats again to Little Cherub and her parents for working so hard on overcoming these fears. The work parents do is never easy but with success stories like this, it makes all the work worthwhile!
Applied Behavioral Strategies 