Incorporating social validity into practice: Treatment progression across pediatric feeding skill domains

A small but growing body of research in pediatric feeding disorders asserts the importance of comprehensively measuring social significance of goals, procedures, and effects of intervention, and incorporating social validity into practice to inform treatment. This report sought to extend this literature by detailing procedures to measure and improve social validity during a clinical case of a 3.5-year-old during a home-based intensive feeding program. A multiple baseline design demonstrated effectiveness of nonremoval and re-presentation added to a treatment package. Repeated choice via direct child preference assessments informed demand fading and gradual progression across six feeding skill domains (medication, cup drinking, independence, texture, volume, variety) and arrangements of response effort (preference, skill) with layers of reinforcer parameters (quality, magnitude, rate, immediacy). Indices of happiness definitions were modified, and extinction bursts examined. Fostering a collaborative approach, caregivers provided detailed input on social validity measures pretreatment, at discharge, and long-term follow-up (6-month, 1-year), inclusive of both qualitative and quantitative responses, written and verbal communication, and permanent product data. Further implications for practitioners included detailing the process for caregiver training and generalization to family meals with siblings and community settings, and providing adaptable full-text guidelines for free access/choice contexts.