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Posts Tagged ‘Picky Eater’

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!

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: Breakfast

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: Lunch

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: Dinner

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.

 

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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.

 

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers regarding a behavioral problem. Recently, Rebecca and I were contacted by a parent who is struggling with their child’s picky eating habits. She desperately wanted her child to receive feeding therapy and she had heard how great the outcomes in our clinic have been. For case examples from our clinic, read here, here, or here. The problem, she explained, is that she works and summer is the only time she is available to participate with her child.

Need Summer Feeding Therapy

Unfortunately, this mother is not alone. We have been contacted by 6 or 7 other parents who are desperately seeking services and they need the services this summer. Addressing feeding behaviors during the summer offers many benefits.

  1. Children are often out of school
  2. Parents may have a modified work schedule during the summer
  3. Many outdoor activities are available to get children out of the house and distract them between meals

Summer Clinic

As a result of these requests, Rebecca and I have decided to offer a summer feeding clinic. We have teamed up with Dr. Zwicker at The Easter Seals in Stamford. Their office will supply the space for therapy and Rebecca and I will provide the therapy.

Clinic Versus Home Therapy

In the clinical model, we run two concurrent feeding sessions each hour. Rebecca is 1:1 with a child in one room and I am 1:1 with the child in another room. We generalize therapy from us to one and/or both parents as well as any other individuals in your child’s life (e.g., speech therapist, behavior therapist, grandparents, or nannies). We also generalize therapy to community settings such as a restaurant or to your home if you live near Stamford.

Additional Information

The clinic is set to run from August 13 through August 17. During that time, your child will receive up to 15 sessions including generalization sessions to restaurants or home. Sessions also include parent training. The cost for the feeding clinic  includes the intake and record review, an exit report, and any follow-up consultations that are needed after therapy has finished. We require parent participation at every session. We also make accommodations for other individuals to participate as often as they are interested and available (e.g., spouses, grandparents, teachers, ABA therapists, etc).

Please contact us if you have questions or need additional information. We look forward to sharing the success of the clinic in our What Works Wednesdays postings.

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be. Today’s story is about a young man we call “Dennis”.

Dennis came to us just slightly before his third birthday. He carried a diagnosis of autism. Like many of our children, he also had a history of reflux. His reflux was so bad that his parents reported having to place a plastic covering on the floor under his crib to protect the flooring.

Dennis was non-verbal but he had no problem making his needs known. One way that he communicated his wants and needs was by vomiting. Initially, when a non-preferred food was presented to him, he vomited until it was removed. Over time, he began to control what his Mommy ate too. If he saw her eating something he didn’t like, he vomited. By the time he got to us, he had whittled his diet down to only 3 foods: a certain brand of potato chips, peanut butter, and a beverage. His poor Mom couldn’t eat in front of him and was limited to consuming Coca Cola only in his presence. Can you even try to imagine the family stress in that house?

Readers should know that Dennis was the most adorable picky eater. His chubby cheeks were just ripe for the squeezing. His toddler hands and feet were precious. He was the kind of child that you just want to pick up and hug and kiss over and over again. With a child that cute, you know behavioral feeding therapy is going to be a challenge! It is really hard to be firm with a cutie-pie.

Because of the seriousness of the behavior and the extreme food selectivity, we asked that the parents have a complete medical work up prior to starting feeding therapy. Dennis came back clean as a whistle–he had no major issues other than the reflux.

On the first day of feeding therapy, we realized that we needed help. We rushed out to the nearest store to purchase protective gear–plastic aprons. Dennis could vomit without any effort at all and our clothes were doomed without protection. (Dennis is the worst case of vomiting we have seen in our practice to date.) In the first three sessions alone, he vomited 13 times when a total of 30 bites had been presented! When Dennis vomited, we simply cleaned up the area and re-presented a clean but identical bite of food. Dennis tried to use gagging to replace vomiting. When he gagged, we simply closed his mouth by gently pressing his chin up.

Dennis did not give up his preferences willingly. He fought us for the first two days. In addition to vomiting and gagging, he used head turns, crying, spoon batting, and other disruptive behaviors to avoid new foods. We ultimately used physical prompting to encourage him to open his mouth and take a bite. Once he accepted the bite, he discovered that it didn’t taste quite so bad. Keep in mind that Dennis was also hungry for each session. His parents did not feed him before or after therapy so if he didn’t eat with us, he didn’t eat again until the next therapy session a few hours later.

Over time, he began to fight less and less and he began accepting bites willingly. By the third day of treatment (9 sessions) Dennis had stopped vomiting.  Across the last three sessions of treatment, Dennis gagged only 2 times out of 142 bites of food and he had no vomits.

On the fourth day of treatment, we transitioned Dennis’ parents in to replace the feeding therapists. On this day, Dennis had begun to feed himself and his parents were there to make sure that his bites were not too big. His parents also reminded him to take a bite if he slowed down or looked as if he might be trying to avoid a food. It was also on this day that we taught Dennis how to eat cake for his upcoming birthday party. We all cried tears of joy to see him willingly scoop up gluten-free (GF) and dairy/casein-free birthday (CF) cake (and yes, GFCF cake tastes delicious)!

Dennis was discharged after only 12 sessions of treatment (4 days)! A few days later, his parents sent us pictures from his 3rd birthday party where he was happily eating his real birthday cake.

This success story did not come without extremely hard work by the parents. It was emotionally draining for them to see their child put up such a fight to avoid foods. It is not easy watching your baby vomit repeatedly at the sight of new/non-preferred foods. It is not easy hearing him cry repeatedly for an entire session. But they stuck with it. They stood their ground and they supported our treatment by not feeding him between meals and by requiring him to participate in therapy 3 times each day despite his tears. Congratulations on your success! The hard work paid off!

We would love to hear from readers. Have any of you worked with children who vomit? Parents, are any of your children vomiting to avoid foods? Parents, teachers, and behavior analysts, would you be able to stick with it like the parents and the therapists did?

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be. Today’s story is about a young man we call “Jack”. Today’s post is slightly different from previous posts because it was written (and illustrated) by Jack’s 8-year-old sister. Please note that Jack and his mother participated in feeding therapy for a total of 5 days.

Before!

Oh no! Mom is trying to feed Jack mush, but Jack is crying, hitting, and pushing the spoon away!

Now!

Yay! Mom is turning on Wonder Pet Shows on the iPad and putting cookies and parsnips on his plate and Jack is feeding himself!

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be. Today’s story is about a young man we call Boost (you will see why a bit later in this post).

Boost came to us with a long history of feeding difficulties and he was only 7. He was diagnosed with autism and he was also non-verbal. Boost had previously eaten food but only in wet ground form. By the time he got to us, he consumed only Boost and apple juice. Both liquids were consumed from a bottle with the top of the nipple cut off so the liquid would literally pour into his mouth.

Prior to any behavioral feeding therapy, we require a thorough record review and assessment to assess for any possible underlying issues. (Honestly, all intervention programs should be preceded by a thorough assessment to help with program planning. We have written about that previously here.) For Boost, we completed a record review to determine if any assessments were needed prior to therapy. Boost had a long history of gastrointestinal (GI) issues so we referred his family to a gastroenterologist for a thorough work up.

The gastroenterologist completed an endoscopy during which the gastroenterologist inserted a pill camera to complete an assessment of the entire small bowel. He discovered that Boost had serious inflammation in his GI tract. Specifically, Boost’s pylorus was so inflamed that even the pill camera would not pass. You heard us correctly. A tiny pill camera would not pass through his pylorus. And we all wondered why he had limited his calorie consumption to a pure liquid diet.

You see, Boost was non-verbal. He could not tell us that he had GI pain. He could not tell us that it hurt to eat. Had we started therapy without the GI Assessment, we could have caused Boost a great deal of pain. This case is an excellent example for demonstrating the importance of assessment prior to treatment.

The GI Doctor placed Boost on an elemental formula and anti-inflammatory medication so that Boost could obtain appropriate nutrition while allowing his GI tract to heal, a process that took 6 months.

Parents, if you have a picky eater, please make sure that you obtain assessment in all areas to rule out underlying issues. Behavior analysts, do due diligence in the assessment process to ensure that you do no harm in your behavioral feeding therapy.

We would love to hear from readers. Please share what types of information you have gained from the assessment process prior to behavioral feeding therapy.

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today’s post is a follow-up for a case we have described previously. You should read the original post first to gain a full understanding of how far this child and his family have come.

Many blogs do Wordless Wednesdays where they simply post a picture with no words. Yes, we realize we have already written words, but you need them to fully understand the photo. February marks one year since Nathan had behavioral feeding therapy. This is a picture from his meal from last week. As you can see, he is going strong! This meal consists of  artichoke hearts, roasted red peppers, Brussels sprouts, olives, brown rice, chicken, sausage, and garlic. What you cannot see is the side of broccoli steamed with lemon juice. Bravo Nathan! You are doing great and your mom and dad are an invaluable support team.

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