Using telehealth to provide outpatient follow-up to children with avoidant/restrictive food intake disorder.

The COVID-19 global health crisis compelled behavior analysts to consider alternatives to face-to-face services to treat children with feeding disorders. Research suggests telehealth is one method behavior analysts could use to initiate or continue assessment of and treatment for feeding disorders. In the current paper, we conducted pilot studies in which we analyzed chart records of patients with Avoidant/Restrictive Food Intake Disorder; who graduated from an intensive, day-treatment program; and transitioned to an outpatient follow-up program.

Food preferences before and during treatment for a pediatric feeding disorder.

Little is known about the food preferences of children with a feeding disorder and medical diagnoses. Therefore, we conducted repeated paired-stimulus-preference assessments with foods to which we either exposed or did not expose 3 children with a feeding disorder and medical diagnoses during clinical treatment. Responding was relatively equivalent for exposure and nonexposure foods throughout the preference assessments, suggesting that preferences for foods did not change due to exposure during treatment.

Increasing self-drinking for children with feeding disorders.

Children with feeding disorders often do not self-drink without treatment. Unfortunately, the literature on self-drinking is scarce. We evaluated differential positive reinforcement to increase self-drinking for 2 children with feeding disorders.

A clinical protocol to increase chewing and assess mastication in children with feeding disorders.

Children with feeding disorders often cannot or do not chew when presented with table food. Children with chewing deficits also often swallow the bite before masticating it appropriately, which we will refer to as early swallowing. In the current study, we evaluated a clinical protocol to increase chews per bite, assess mastication, and eliminate early swallowing with three children with feeding disorders.

An evaluation of texture manipulations to increase swallowing.

The purpose of the current investigation was to identify an appropriate texture for initial treatment of 1 child's feeding problem. Variability in mouth clean (a product measure of swallowing) during a texture assessment suggested that individual pureed foods differentially affected feeding behavior. A single-food assessment identified individual problematic foods.

Spoon-to-cup fading as treatment for cup drinking in a child with intestinal failure.

We treated a child with intestinal failure who consumed solids on a spoon but not liquids from a cup. We used spoon-to-cup fading, which consisted of taping a spoon to a cup and then gradually moving the bowl of the spoon closer to the edge of the cup. Spoon-to-cup fading was effective for increasing consumption of liquids from a cup.

Escape as reinforcement and escape extinction in the treatment of feeding problems.

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.

Calibration of observational measurement of rate of responding.

The quality of measurement systems used in almost all natural sciences other than behavior analysis is usually evaluated through calibration study rather than relying on interobserver agreement. We demonstrated some of the basic features of calibration using observer-measured rates of free-operant responding from 10 scripted 10-min calibration samples on video. Five novice and 5 experienced observers recorded (on laptop computers) response samples with a priori determined response rates ranging from 0 to 8 responses per minute.