A comparison of Nuk presentation and Nuk redistribution to treat packing

Children with feeding disorders may pack food when they lack the oral‐motor skills, the motivation, or both to swallow. Presenting bites on the tongue with a Nuk brush, or redistribution, replacing packed food on the tongue, are two treatments whose relative efficacy is untested. In the current study, we compared the effects of (a) presenting on an upright spoon, (b) presenting on a Nuk, and (c) redistributing with a Nuk on two product measures of swallowing, which we refer to as 15‐s and 30‐s mouth clean, for three children with feeding disorders. Nuk presentation produced the highest levels of 15‐s mouth clean relative to Nuk redistribution and upright‐spoon presentation across participants. Levels of 30‐s mouth clean were higher during Nuk presentation and Nuk redistribution relative to upright‐spoon presentation for two participants. We discuss the oral‐motor skills and motivational deficits that might account for the findings.     

The magnitude-of-reinforcement function in closed and open economies.

It has been hypothesized that the magnitude-of-reinforcement effect may differ in closed and open experimental economies. We determined the relationship between magnitude of reinforcement and response rate in three feeding conditions: a closed economy in which total intake was unrestricted, a closed economy in which total intake was restricted so as to maintain body weight at 85% of free-feeding weight, and a traditional open economy in which subjects received food outside the experimental session. In the closed economies, regardless of body weight, the rats responded faster for smaller pellets and when the fixed ratio for pellets was higher. In the open economy, there was no reliable effect of pellet size or pellet cost on response rate. It is concluded that although there are circumstances in which response rate is an immediate function of the parameters of reinforcement, rate is not necessarily a measure of response strength. Response rate may instead, or additionally, contribute to a strategy of reducing the costs associated with resource utilization.     

The effects of sleep disruption on the treatment of a feeding disorder

We evaluated the effects of sleep disruption on the mealtime behavior of a young boy with developmental disabilities. Results showed that bite acceptance was less likely to persist during meals following disrupted sleep, but only when escape extinction was not implemented. Findings are discussed in terms of establishing operations and the effects of sleep disruption on the assessment and treatment of feeding problems.     

TO WAIT OR TO RESPOND?

Emitting a certain response and waiting for a specified time without making that response had the same consequence. In Experiment 1, food-deprived pigeons were as likely to wait as to respond only if waiting provided food at a much higher frequency than did pecking. In Experiment 2, the consequence for humans was a brief light flash and tone. People were not biased for responding over waiting. Instead, their choices suggested crude payoff maximization. In Experiment 3, pigeons again obtained food, but they were not food deprived and could eat freely at each opportunity. Their behavior was more like that of the humans of Experiment 2 than that of food-deprived pigeons given small quantities of food at each feeding opportunity. The three experiments together showed that biases for responding over waiting were neither inherent characteristics of species nor inevitable outcomes of particular schedules. Choice between active search and waiting depended on ecological–motivational factors even when species and schedules were held constant.     

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory‐integration‐based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.     

Development of oral motor behavior related to the skill assisted spoon feeding

Milestones in the typical development of eating skills are considered to be nippling (breast or bottle), eating from a spoon, drinking from a cup, biting and chewing.The purpose of this research was to study the development and consolidation of oral motor behavior related to the skill assisted spoon feeding in young infants. The present study longitudinally investigated the development of this skill in 39 healthy children from the start of spoon feeding until the skill was acquired. The Observation List Spoon Feeding with 7 observation items for oral motor behavior and 6 items for abnormal behavior was used. Results showed that infants between 4 and 8 months of age needed 5.7 weeks (SD 2.1), with a range of 8 weeks (from 2 to 10 weeks) to acquire this skill. No significant correlation (p = .109) between age at start spoon feeding and weeks needed to develop the skill was found. During this period oral motor behavior consolidated and abnormal behavior diminished.With this study it is shown that the period in weeks needed to acquire the oral motor behavior for the skill assisted spoon feeding is important in case of feeding problems.     

Additive,Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder

This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components—including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading—were introduced sequentially as the focus of treatment shifted to address refusal topographies along the chain of behaviors associated with consumption. The assessment process, treatment planning and sequencing, and generalization of treatment gains to caregivers are presented in detail. In doing so, the study illustrates the core features involved in applying a flexible, evidenced-based approach to treat severe feeding difficulties.     

RECENT STUDIES ON FEEDING PROBLEMS IN CHILDREN WITH AUTISM

This paper reviews recent studies on behavioral interventions for children with autism and feeding problems. The applicability of interventions that have been tested with other populations of children with feeding problems is discussed, as well as directions for future research.