Abstract
There are well-established empirically-supported treatments for paediatric feeding disorders (avoidant/restrictive food intake disorder; ARFID); however, more research is needed on their sole use, outside of specialised multidisciplinary feeding hospitals, and with older ages. Additionally, there is little research on the use of an exit criterion treatment. An 11-year-old male participated in a 2-week in-home programme. Treatment was solely behaviour-analytic and consisted of demand fading, choice, differential attention, contingent access, and exit criterion. We conducted repeated edible preference assessments and used a changing criterion single-case experimental design across three food variety groups of decreasing preference. Variety reached 79 foods across food groups and 100% of goals were met. Caregivers reported high social acceptability and at 2-year follow-up the problem still resolved.
Similar content being viewed by others
References
Ahearn, W. H., Kerwin, M. L. E., Eicher, P. S., Shantz, J., & Swearingin, W. (1996). An alternating treatments comparison of two intensive interventions for food refusal. Journal of Applied Behavior Analysis, 29(3), 321–332. https://doi.org/10.1901/jaba.1996.29-321.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Publishers.
Babbitt, R. L., Hoch, T. A., Krell, D. M., & Williams, K. (1992). Exit criterion: Treating motivational absence of swallowing. Paper presented at the Association for Behavior Analysis, San Francisco, CA.
Babbitt, R. L., Hoch, T. A., & Coe, D. A. (1994a). Behavioral feeding disorders. In T. DN & W. RS (Eds.), Disorders of feeding and swallowing in infants and children (pp. 77–95). San Diego: Singular.
Babbitt, R. L., Hoch, T. A., Coe, D. A., Cataldo, M. F., Kelly, K. J., Stackhouse, C., & Perman, J. A. (1994b). Behavioral assessment and treatment of pediatric feeding disorders. Journal of Developmental and Behavioral Pediatrics, 15(4), 278–291. https://doi.org/10.1097/00004703-199408000-00011.
Berth, D. P., Bachmeyer, M. H., Kirkwood, C. A., Mauzy IV, C. R., Retzlaff, B. J., & Gibson, A. L. (2019). Noncontingent and differential reinforcement in the treatment of pediatric feeding problems. Journal of Applied Behavior Analysis, 52(3), 622–641. https://doi.org/10.1002/jaba.562.
Borrero, C. S. W., Schlereth, G. J., Rubio, E. K., & Taylor, T. (2013). A comparison of two physical guidance procedures in the treatment of pediatric food refusal. Behavioral Interventions, 28(4), 261–280. https://doi.org/10.1002/bin.1373.
Bullock, C. E., Fisher, W. W., & Hagopian, L. P. (2017). Description and validation of a computerized behavioral data program: “BDataPro”. The Behavior Analyst, 40(1), 275–285. https://doi.org/10.1007/s40614-016-0079-0.
Cohen, L. L., Feinstein, A., Masuda, A., & Vowles, K. E. (2013). Single-case research design in pediatric psychology: Considerations regarding data analysis. Journal of Pediatric Psychology, 39(2), 124–137. https://doi.org/10.1093/jpepsy/jst065.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd Ed.). Hoboken, NJ: Pearson.
DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of a multiple-stimulus presentation format for assessing reinforcer preferences. Journal of Applied Behavior Analysis, 29(4), 519–533. https://doi.org/10.1901/jaba.1996.29-519.
DeLeon, I. G., Fisher, W. W., Rodriguez-Catter, V., Maglieri, K., Herman, K., & Marhefka, J. M. (2001). Examination of relative reinforcement effects of stimuli identified through pretreatment and daily brief preference assessments. Journal of Applied Behavior Analysis, 34(4), 463–473. https://doi.org/10.1901/jaba.2001.34-463.
Farrell, D., Hagopian, L., & Kurtz, P. (2001). A hospital- and home-based behavioral intervention for a child with chronic food refusal and gastrostomy tube dependence. Journal of Developmental and Physical Disabilities, 13(4), 407–418. https://doi.org/10.1023/A:1012241630667.
Fischer, A. J., Luiselli, J. K., & Dove, M. B. (2015). Effects of clinic and in-home treatment on consumption and feeding-associated anxiety in an adolescent with avoidant/restrictive food intake disorder. Clinical Practice in Pediatric Psychology, 3(2), 154–166. https://doi.org/10.1037/cpp0000090.
González, M. L., Mulderink, T. D., & Girolami, P. A. (2018). Avoidant restrictive food intake disorder. In A. Maragakis & W. T. O'Donohue (Eds.), Principle-based stepped care and brief psychotherapy for integrated care settings (pp. 53–64). Cham: Springer.
Hagopian, L. P., Fisher, W. W., Sullivan, M. T., Acquisto, J., & LeBlanc, L. A. (1998). Effectiveness of functional communication training with and without extinction and punishment: A summary of 21 inpatient cases. Journal of Applied Behavior Analysis, 31(2), 211–235. https://doi.org/10.1901/jaba.1998.31-211.
Hoch, T. A., Babbitt, R. L., Coe, D. A., Krell, D. M., & Hackbert, L. (1994). Contingency contacting: Combining positive reinforcement and escape extinction procedures to treat persistent food refusal. Behavior Modification, 18(1), 106–128. https://doi.org/10.1177/01454455940181007.
Iwata, B. A., Pace, G. M., Cowdery, G. E., & Miltenberger, R. G. (1994). What makes extinction work: An analysis of procedural form and function. Journal of Applied Behavior Analysis, 27(1), 131–144. https://doi.org/10.1901/jaba.1994.27-131.
Kerwin, M. L. E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal of Pediatric Psychology, 24(3), 193–214. https://doi.org/10.1093/jpepsy/24.3.193.
Kerwin, M. L. E., Ahearn, W. H., Eicher, P. S., & Burd, D. M. (1995). The costs of eating: A behavioral economic analysis of food refusal. Journal of Applied Behavior Analysis, 28(3), 245–260. https://doi.org/10.1901/jaba.1995.28-245.
Kozlowski, A. M., Taylor, T., Pichardo, D., & Girolami, P. A. (2016). The impact of emerging liquid preference in the treatment of liquid refusal. Journal of Developmental and Physical Disabilities, 28(3), 443–460. https://doi.org/10.1007/s10882-016-9482-4
Ledford, J. R. (2018). No randomization? No problem. American Journal of Evaluation, 39(1), 71–90. https://doi.org/10.1177/1098214017723110.
Lukens, C. T., & Silverman, A. H. (2014). Systematic review of psychological interventions for pediatric feeding problems. Journal of Pediatric Psychology, 39(8), 903–917. https://doi.org/10.1093/jpepsy/jsu040.
Martens, B. K., Witt, J. C., Elliott, S. N., & Darveaux, D. X. (1985). Teacher judgments concerning the acceptability of school-based interventions. Professional Psychology: Research and Practice, 16(2), 191–198. https://doi.org/10.1037/0735-7028.16.2.191.
Penrod, B., & VanDalen, K. H. (2010). An evaluation of emerging preference for non-preferred foods targeted in the treatment of food selectivity. Behavioral Interventions, 25(3), 239–251. https://doi.org/10.1002/bin.306.
Piazza, C. C., Milnes, S. M., & Shalev, R. A. (2015). A behavior-analytic approach to the assessment and treatment of pediatric feeding disorders. In H. S. Roane, J. E. Ringdahl, & T. S. Falcomata (Eds.), Clinical and organizational applications of applied behavior analysis (pp. 69–94). Cambridge: Academic Press.
Roane, H. S., Lerman, D. C., & Vorndran, C. M. (2001). Assessing reinforcers under progressive schedule requirements. Journal of Applied Behavior Analysis, 34(2), 145–167.
Seiverling, L., Williams, K., Sturmey, P., & Hart, S. (2012). Effects of behavioral skills training on parental treatment of childrens food selectivity. Journal of Applied Behavior Analysis, 45(1), 197–203. https://doi.org/10.1901/jaba.2012.45-197.
Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13(4), 348–365. https://doi.org/10.1007/s10567-010-0079-7.
Sharp, W. G., Volkert, V. M., Scahill, L., McCracken, C. E., & McElhanon, B. (2017). A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care? The Journal of Pediatrics, 181, 116–124. https://doi.org/10.1016/j.jpeds.2016.10.002.
Tarbox, J., Schiff, A., & Najdowski, A. C. (2010). Parent-implemented procedural modification of escape extinction in the treatment of food selectivity in a young child with autism. Education and Treatment of Children, 33(2), 223–234 Retrieved from http://www.scopus.com/inward/record.url?eid=2-s2.0-77951153373&partnerID=40&md5=8ccd92c651a1ebc033d66fb172dd3153.
Taylor, T. (2018). Intensive paediatric feeding treatment and the use of a side deposit for a clinical case within the home setting in Australia. European Journal of Behavior Analysis, 19(2), 208–227. https://doi.org/10.1080/15021149.2018.1472852.
Taylor, T. (2020). Side deposit with regular texture food for clinical cases in-home. Journal of Pediatric Psychology, 45(4), 399–410. https://doi.org/10.1093/jpepsy/jsaa004.
Taylor, S., & Taylor, T. (2020). The distance between empirically-supported treatment and actual practice for paediatric feeding problems: An international clinical perspective. International Journal of Child and Adolescent Health.
Taylor, T., Haberlin, A., & Haberlin, J. (2019a). Treatment of avoidant/restrictive food intake disorder for a teenager with typical development within the home setting. Journal of Adolescence, 77, 11–20. https://doi.org/10.1016/j.adolescence.2019.09.007.
Taylor, S. A., Virues-Ortega, J., & Anderson, R. (2019b). Transitioning children from tube to oral feeding: A systematic review of current treatment approaches. In Speech Language and Hearing (pp. 1–14). https://doi.org/10.1080/2050571X.2019.1684068.
Taylor, T., Blampied, N., & Roglić, N. (2020). Consecutive controlled case series demonstrates how parents can be trained to treat paediatric feeding disorders at home. Acta Paediatrica. https://doi.org/10.1111/apa.15372.
Volkert, V. M., & Piazza, C. C. (2012). Pediatric feeding disorders. In P. Sturmey & M. Hersen (Eds.), Handbook of evidence-based practice in clinical psychology (Vol. 1, pp. 323–338). Hoboken: Wiley.
Williams, K. E., Riegel, K., Gibbons, B., & Field, D. G. (2007). Intensive behavioral treatment for severe feeding problems: A cost-effective alternative to tube feeding? Journal of Developmental and Physical Disabilities, 19(3), 227–235. https://doi.org/10.1007/s10882-007-9051-y.
Williams, K. E., Paul, C., Pizzo, B., & Riegel, K. (2008). Practice does make perfect. A longitudinal look at repeated taste exposure. Appetite, 51(3), 739–742. https://doi.org/10.1016/j.appet.2008.05.063.
Woods, J. N., & Borrero, C. S. W. (2019). Examining extinction bursts in the treatment of pediatric food refusal. Behavioral Interventions, 34(3), 307–322. https://doi.org/10.1002/bin.1672.
Acknowledgements
This case history was conducted in the context of a treatment evaluation for a clinical case and is a retrospective report of existing non-identifiable data. Participant name was changed to protect confidentiality. This case has been previously included in a clinical outcome study (T. Taylor et al. 2020). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author reports no conflicts of interest
Ethical Approval
This study was performed in accordance with ethical standards laid out in the 1964 Declaration of Helsinki and its later amendments and APA ethical standards in the treatment of humans.
Informed Consent
Parents provided written informed consent.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 191 kb)
Rights and permissions
About this article
Cite this article
Taylor, T. Use of an Exit Criterion for a Clinical Paediatric Feeding Case in-Home. J Dev Phys Disabil 33, 475–488 (2021). https://doi.org/10.1007/s10882-020-09759-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10882-020-09759-5