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Posts Tagged ‘feeding therapy’

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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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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Last week, I (Missy) shared information about the Congressional Hearings on autism and I questioned why the news media had not picked up on the story. Clearly, they had more important things to talk about:

  • Lindsey Lohan getting arrested again
  • The lucky winners of the Powerball

Clearly, relying on television news media is not the best

Image representing Google Alerts as depicted i...

Image via CrunchBase

way to keep current on all things autism. For those of you who want to be in the know but who lack endless hours in front of the computer, I will share a few of my tricks with you.

RSS Feeds

One way to keep current, is to find your favorite webpages and set up RSS feeds so that you are alerted each time there is a change. I like to set up my RSS feeds right in my Outlook calendar so they appear like emails. You can also use Google to help you.

Google Alerts

I have several Google alerts set up including alerts for autism and applied behavior analysis. This is super easy! Visit this website and enter the term or terms that you are interested in. You will then receive alerts when those news items appear. Please note that you can set up weekly alerts and daily alerts and so forth.

Twitter Feeds

Several Twitter programs are available to assist you with information on Twitter. I tend to lean towards TweetDeck. I can set up columns on topics such as Step Parenting, Parenting, Autism, and behavior analysis. Within those columns I can read the twitter feed on that topic. You can also set up lists so that you organize your Tweeps by topic or content. I have a list on autism, GFCF, and behavior analysts. I have also written more in depth on Twitter and you can read about that here.

So, don’t feel overwhelmed as you try to keep up with the latest on your favorite topic. Many resources are available at your fingertips!

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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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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?

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