Children diagnosed with pediatric feeding disorder (PFD) or avoidant/restrictive food intake disorder (ARFID) may present with comorbid oral-motor delays that often contribute to their failure to consume an adequate volume and/or variety of foods. Once the food enters the mouth, these children may exhibit additional problematic behavior such as expulsion and packing that further averts oral intake. Previous research has evaluated the impact of modified-bolus placement methods, including flipped spoon and NUK® brush, in comparison to upright spoon on expulsion and packing. Whether responses are due to performance or skill deficits, researchers hypothesize that modified-bolus placement may assist with reducing the response effort associated with swallowing. This retrospective consecutive controlled case series assessed the clinical application of an additional modified-bolus placement method, underspoon, to increase food consumption and decrease problematic behavior that interfere with mouth clean for children with PFD or ARFID.
In the present study a comprehensive protocol to assess chewing in four children with Down syndrome is provided and described. One baseline and four assessment meals were conducted across four textures of foods to investigate the presence or absence of components of chewing (bite down, chew and tongue lateralization), as well as movements associated with the development of chewing. Results showed that at baseline all participants ate their typical diet (i.e., pureed food) but no chewing components or movements were observed. The findings of the assessment protocol indicated that it offers a prescriptive assessment of chewing and its components across different food textures. The results of the assessment provided useful information for clinicians by identifying a potential starting point for interventions to address chewing deficits. Furthermore, the findings add to the existing literature on the role of tongue lateralization and specific tongue movements in chewing. Implications of the findings for chewing interventions and future research are discussed.
Relatively few empirical studies of pediatric chewing interventions have been published in the psychology literature. The purpose of this paper was to systematically review chewing interventions within the applied behavior analysis literature. We identified a small, but growing, behavior analytic literature demonstrating the effectiveness of various multicomponent treatment packages to teach and improve chewing skills. Future researchers should consider a range of participant characteristics, including results of oral motor assessments, explore a more extensive definition of chewing to target the complex nature of chewing as well as component skills, and examine the necessary and sufficient components of chewing interventions along with the potential benefits of multidisciplinary interventions.
Successful feeding intervention ultimately requires generalization and adoption of treatment into the home. Treatment models, however, differ regarding how and when caregivers are integrated into care delivery process. Some treatments involve a primary model of parent training with caregivers serving as co-therapist at the onset of intervention, while others involve a complimentary model where a therapist delivers the intervention and caregiver training occurs once the child's behavior is stable. This review systematically evaluates the evidence-base regarding behavioral feeding intervention for children with autism spectrum disorder (ASD), with a specific focus on interventions involving parent training. Results provide further evidence regarding the potential benefits of behavioral intervention to improve feeding concerns in ASD, while also highlighting growing attention to documenting and/or evaluating parent training within the treatment literature. Important questions remain regarding factors guiding the use of a primary or complimentary model of parent training.
The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field.
This systematic review of reviews is the first to summarize peer tutoring outcomes for students with or at-risk for emotional and behavioral disorders (EBD). Eleven narrative literature reviews, three systematic reviews, and two meta-analyses of peer tutoring interventions that met inclusion criteria were summarized. Participants across the 16 reviews included more than 2,404 students with or at-risk for EBD in pre-kindergarten through grade 12 across 73 individual, unduplicated studies. Findings support the efficacy of peer tutoring for students with or at-risk for EBD regarding academic and behavioral outcomes. Lessons learned, and implications for research and practice derived from these reviews are provided.
In an effort to address some of the criticisms of Behavioral Parent Training programs (BPT; high attrition, reliance on caregiver report measures), the current study examined the feasibility, acceptability, and outcome of an intensive behavior treatment program (120-minute sessions for 5 days/week over the course of 2 weeks). Using a changing criterion single case experimental design, 12 children (M child age = 4.9 years) and their primary caregivers completed the 2-week function-based intervention procedure designed to increase children's frustration tolerance via a wait training procedure based on the principles of applied behavior analysis. Using both direct observation and standardized measures, results indicated that the treatment was effective in reducing childhood behavior problems, both within and between appointments (Cohen's ds = 3.2 and 1.37, respectively). Preliminary evidence suggests that a compressed treatment package designed to train caregivers in function-based intervention strategies is feasible and acceptable.
In recent years, virtual manipulatives have been explored and used as an alternative to concrete manipulatives in mathematics for students on their own and as part of manipulative-based instructional sequences. Researchers examining virtual manipulative-based instructional sequences tend to focus on students documented with disabilities, as opposed to students at-risk or struggling with mathematics, as well as students' acquisition of the target skill, despite students experiencing learning in four stages: acquisition, fluency, maintenance, and generalization. This study explored the virtual-representational-abstract (VRA) instructional sequence across four stages of learning for three elementary students struggling in mathematics. In the single-case design study, researchers found a functional relationship between the VRA instructional sequence delivered online via explicit instruction and students' computational accuracy in their targeted area of mathematics need. Researchers also found limited influence on fluency rate or generalization to word problem accuracy but that students did maintain.