Treatment of chronic food refusal in a young developmentally disabled child

Chronic food refusal is a common problem among young children with developmental disabilities. Children with chronic food refusal may require supplemental tube feedings or parental feedings. A multicomponent treatment package consisting of escape–avoidance extinction, shaping and positive reinforcement was effective in establishing a normal oral feeding pattern with a 1.5 years old developmentally disabled child who was fed by gastrostomic tube. Treatment effects generalized to the home setting and were maintained during follow‐up. After treatment, tube‐feeding was discontinued. Copyright © 1999 John Wiley & Sons, Ltd.     

TRAINING PROSOCIAL BEHAVIORS TO YOUNG CHILDREN: AN ANALYSIS OF RECIPROCITY WITH UNTRAINED PEERS

We examined the effects of a social skills training package on the play behaviors of three young girls. Two children were taught to invite their peers to play and to use social amenities during their conversations with other children. A combined reversal and multiple baseline across responses design demonstrated that both children directed more social behaviors to their classroom peers after training and that these two children's play invitations were maintained in the later absence of experimental contingencies. In addition, both target children received a greater number of play invitations from their peers during the free play periods. In contrast, a third child's play invitations were not reciprocated by peers; her invitations subsequently decreased in rate after training was discontinued. An interdependent group contingency produced a reciprocal exchange of invitations between this child and her classroom peers. A reversal design demonstrated partial maintenance of subject-peer exchanges after the group intervention was discontinued. The results obtained with the three target children suggest that peer reciprocity may facilitate the maintenance of children's play invitations over time.     

Evaluation of empirical pretreatment assessments for developing treatments for expulsion in pediatric feeding disorders

A common problem among children with feeding disorders is expulsion (removing or spitting food or drink from the mouth), which interferes with treatment success when the goal is consumption. Previous research has identified effective treatments to reduce expulsion, most commonly—re-presentation (presenting the expelled bite or a new bite of the same food immediately following the expulsion). However, there is not currently an assessment model in place to inform treatment decisions with a goal to reduce expulsion. In the present study, we used a multielement design to identify conditions under which little or no expulsion occurred with three children with feeding disorders. The results of the assessment were then used to inform treatment selection aimed to eliminate expulsion. The comparisons of the assessment included physical prompt, bite number, texture, preference, bite presentation style, and size of the bite. Results suggest that this assessment was useful for the design of individualized treatments for children who frequently expel food.     

AN ALTERNATING TREATMENTS COMPARISON OF TWO INTENSIVE INTERVENTIONS FOR FOOD REFUSAL

We compared two treatment packages involving negative reinforcement contingencies for 3 children with chronic food refusal. One involved physically guiding the child to accept food contingent on noncompliance, whereas the other involved nonremoval of the spoon until the child accepted the presented food. Subsequent to baseline, an alternating treatments comparison was implemented in a multiple baseline design across subjects. After each child had been exposed to at least nine sessions of each treatment condition and percentage of bites accepted had increased to at least 80%, the child's caregivers selected the preferred treatment package. The results indicated that both treatments were effective in establishing food acceptance. However, physical guidance was associated with fewer corollary behaviors, shorter meal durations, and parental preference.     

Teaching children with autism to ask questions about hidden objects

We taught 2 4‐year‐old children with autism to ask questions of an adult who held a closed box with a toy inside. The treatment package (modeling, prompting, and reinforcement) was evaluated with a multiple baseline design across the three question forms during training, generalization, and follow‐up evaluations. The first question form (“What's that?”) produced the name of the hidden item. The second form (“Can I see it?”) produced sight of it, and the third form (“Can I have it?”) produced the item itself. Both children learned to ask questions about hidden objects.     

LIQUID TO BABY FOOD FADING IN THE TREATMENT OF FOOD REFUSAL

In the current investigation, we identified two young children who consistently consumed liquids, but not baby food, after treatment with positive reinforcement for mouth clean (an indirect measure of swallowing) and physical guidance with re‐presentation of food. We examined the effects of an 11‐step stimulus fading procedure that involved gradually altering the concentration of liquid by adding baby food to the liquid. High levels of mouth clean were maintained in both children throughout fading, and increased mouth clean during probes of 100% baby food was obtained after conducting all 11 fading steps with one child and 6 of 11 fading steps with the second child. Negative vocalizations decreased during probes of 100% baby food after conducting the remaining fading steps with the second child. Gram intake of 100% baby food increased with both children after we completed all fading steps. Copyright © 2013 John Wiley & Sons, Ltd.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

Prevalence of Psychiatric Disorders Among Children of Different Ethnic Origin

The present study assesses the population prevalence of DSM-IV disorders among native and immigrant children living in low socio-economic status (SES) inner-city neighborhoods in the Netherlands. In the first phase of a two-phase epidemiological design, teachers screened an ethnically diverse sample of 2041 children aged 6–10 years using the Strengths and Difficulties Questionnaire (SDQ). In the second phase, a subsample of 253 children was psychiatrically examined, while their parents were interviewed. In addition, teachers completed a short questionnaire about 10 DSM-IV items. Prevalence was estimated using the best-estimate diagnosis based on parent, child and teacher information. Projected to the total population, 11% of the children had one or more impairing psychiatric disorders, which did not differ between native and non-native children. In the total group a clear relationship was observed between the prevalence of psychiatric disorders and gender, parental psychopathology, peer problems and school problems, but not among all ethnic groups separately. This study suggests that the prevalence of psychiatric disorders among non-treated minority and native children in low SES inner-city neighborhoods does not materially differ. However, associated mechanisms may be influenced by ethnicity.     

A Review of: Growing Up With Autism: Working With School-Age Children and Adolescents With Autism,edited by Robin L. Gabriels and Dina E. Hill (Eds.).

The influence of adult presence, peer smiling, and peer praise on the unprogrammed generalization of physical sharing over time was investigated. During free play three groups of five preschool children were taught to share toys via a behavioral training package composed of instructions, modeling, behavior rehearsal, prompts, and praise. Immediately following free play the children were given art materials and observed in the presence of different adults. An ABA design with a manipulation of adult presence nested within east phase was used. For all three groups, regardless of the adult presence manipulation, treatment facilitated sharing in both settings. In addition, two groups continued to share in both settings after termination of the training. The presence of an adult was necessary for unprogrammed maintenance of treatment gains in both settings whereas peer smiling and peer praise were not. Observer presence suppressed physical sharing and smiling prior to, during, and after treatment. Implications for behavioral assessment and applied significance are discussed.     

PEER MODELING OF RESPONSE CHAINS: OBSERVATIONAL LEARNING BY STUDENTS WITH DISABILITIES

Peer models (classmates without disabilities) who were proficient in performing a task completed one response chain each day and described the steps they performed while their classmates with disabilities observed. Three students with disabilities participated, and their performance of the response chains was assessed immediately prior to and following the peer modeling each day. A multiple probe design across response chains, replicated across children with disabilities, was used. In addition, participation and social interactions of children with disabilities and their peer models were assessed in classroom activities after daily modeling sessions. The results indicate that the peer models performed the response chains accurately and quickly, and students with disabilities acquired the response chains. Across the study, participation in classroom activities was high, social interactions were low, and neither was affected by the peer modeling intervention.     

PARENT EDUCATION PROJECT III: INCREASING AFFECTION AND RESPONSIVITY IN DEVELOPMENTALLY HANDICAPPED MOTHERS: COMPONENT ANALYSIS,GENERALIZATION, AND EFFECTS ON CHILD LANGUAGE

We evaluated the effects of a parent training program consisting of verbal instruction, modeling, and feedback on the affection and responsivity of 3 developmentally handicapped mothers towards their children. The results indicated the following: First, the training package increased maternal physical affection, praise, and imitation of child vocalizations. These parenting skills increased to levels found in comparison groups of nonhandicapped mothers. Second, the training package was more effective than verbal instruction alone, the latter being the predominant method presently used by social service workers. Third, most maternal gains were maintained over a 3- to 18-month follow-up period, although one mother required a reinforced maintenance procedure. Fourth, instructing mothers to generalize served to increase the generalization of newly acquired skills from play times (the training context) to child-care tasks (e.g., diapering, feeding). Fifth, teaching the parents to imitate child vocalizations was related to gains in both the frequency and quality of verbal behavior of the two language delayed children as measured by standardized developmental tests and in vivo comparisons with age-matched children (who had nonhandicapped parents). These results show that behavioral instruction can improve important child-rearing skills of developmentally handicapped mothers, with corresponding benefits to their children.     

TEACHING FUNCTIONAL COMMUNITY SKILLS TO AUTISTIC CHILDREN USING NONHANDICAPPED PEER TUTORS

In this study, two autistic children were paired with normal peers who, after pretraining sessions, taught community skills to the autistic children. Data were collected during three conditions: baseline, modeling, and peer tutoring. Results demonstrated that no identified skills were acquired during the baseline and modeling conditions. However, direct instruction of each child by a peer tutor resulted in the learning and maintenance of functional community skills.     

An interest‐based intervention package to increase peer social interaction in young children with autism spectrum disorder

The literature suggests that children with autism spectrum disorder (ASD) educated in inclusive settings generally do not interact with typically developing classmates during social activities. This study assessed whether an intervention package consisting of interest‐based structured play activities involving adult instruction, modeling, and response to child questions would result in an increase in social interaction with typically developing peers. A multiple baseline design across four participants with an embedded reversal was used to demonstrate the effects of the intervention on social interaction during structured play sessions. Initiations, responses, and interactive play increased for all participants. Generalization to novel peers was observed, and treatment gains were maintained during 6‐week follow‐up sessions. Recommendations for practitioners working with children with ASD in inclusive settings and potential areas of future research are discussed.     

Parental strategies and trajectories of peer victimization in 4 to 5 year olds

This study was designed to examine how parental strategies contribute to explaining trajectories of peer victimization in young children. A total of 73 4 and 5 year old children identified as victims of peer aggression in the fall semester and their parents were recruited from 46 classrooms in 18 schools in the Netherlands. All children were followed-up twice in order to determine for whom victimization was stable. Hypothetical vignettes describing various forms of victimization were presented to one parent of each child in order to assess parental responses to victimization events. Findings indicated that autonomy supporting and autonomy neutral strategies were associated with a decrease of victimization in the first semester of the school year. No protective effects were found in the second semester. Autonomy undermining strategies were not related to the course of peer victimization. These findings underscore the importance of joint and coordinated efforts of teachers and parents as partners in supporting victimized young children at school.     

Differential reinforcement of high rate behavior to increase the pace of self‐feeding

Although numerous studies have examined treatments for increasing food consumption among children with pediatric feeding disorders, very few have examined treatment of other mealtime‐related difficulties. One such problem is a slow pace of self‐feeding, which can lead to caregivers failure to adhere to treatments or be disruptive to others. We examined the effects of a differential reinforcement of high rate (DRH) intervention to increase a 9‐year‐old boy's pace of self‐feeding. During treatment, the child received reinforcement contingent on consuming his meal within 30 min. Results showed an increase in the pace of self‐feeding and a concomitant decrease in meal duration as compared to baseline. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of video modeling on social initiations by children with autism

We examined the effects of a video modeling intervention on social initiation and play behaviors with 3 children with autism using a multiple baseline across subjects design. Each child watched a videotape showing a typically developing peer, and the experimenter engaged in a simple social interactive play using one toy. For all children, social initiation and reciprocal play skills were enhanced, and these effects were maintained at 1- and 3-month follow-up periods.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

A COMPARISON OF PEER VIDEO MODELING AND SELF VIDEO MODELING TO TEACH TEXTUAL RESPONSES IN CHILDREN WITH AUTISM

Peer video modeling was compared to self video modeling to teach 3 children with autism to respond appropriately to (i.e., identify or label) novel letters. A combination multiple baseline and multielement design was used to compare the two procedures. Results showed that all 3 participants met the mastery criterion in the self‐modeling condition, whereas only 1 of the participants met the mastery criterion in the peer‐modeling condition. In addition, the participant who met the mastery criterion in both conditions reached the criterion more quickly in the self‐modeling condition. Results are discussed in terms of their implications for teaching new skills to children with autism.