CHARGE Syndrome and Comorbid Feeding Difficulties: A Summary of Outcomes following Behavior Analytic Treatment.

CHARGE syndrome is a genetic disorder caused by mutation of the CHD7 gene. Children with CHARGE syndrome often experience vision and hearing impairments, delayed growth and development, heart abnormalities, and artesia/stenosis of the chonae. Although not part of the diagnostic criteria, many individuals with CHARGE syndrome experience feeding and gastrointestinal difficulties. Interventions most commonly recommended and utilized to address feeding difficulties for children with CHARGE syndrome include tube feedings (medical approach) and oral-motor therapy. Despite the effectiveness of a behavior analytic approach to address feeding difficulties for a variety of pediatric populations, this approach is not routinely considered as a viable treatment option to address feeding difficulties for children with CHARGE syndrome. Outcome data of four children with CHARGE syndrome who participated in an intensive behavioral-based feeding program were reviewed. Variables reviewed included percentage of admission goals achieved, treatment strategies utilized, and changes in growth status, feeding tube dependence, texture and variety of foods consumed, and occurrence of inappropriate mealtime behavior. Outcomes evaluated in this review support the effectiveness of a behavior analytic approach for addressing feeding difficulties for children with CHARGE syndrome.

Comparing behavioral treatment of feeding difficulties and tube dependence in children with cerebral palsy and autism spectrum disorder.

BACKGROUND: Feeding disorders are multifaceted with behavioral components often contributing to the development and continuation of food refusal. In these cases, behavioral interventions are effective in treating feeding problems, even when medical or oral motor components are also involved. Although behavioral interventions for feeding problems are frequently employed with children with autism, they are less commonly discussed for children with cerebral palsy. OBJECTIVE: The purpose of this study was to compare the effectiveness of using applied behavior analytic interventions to address feeding difficulties and tube dependence in children with autism and children with cerebral palsy. METHOD: Children ages 1 to 12 years who were enrolled in an intensive feeding program between 2003 and 2013, where they received individualized behavioral treatment, participated. RESULTS: Behavioral treatment components were similar across groups, predominately consisting of escape extinction (e.g., nonremoval of the spoon) and differential reinforcement. For both groups, behavioral treatment was similarly effective in increasing gram consumption and in decreasing refusal and negative vocalizations. A high percentage of individualized goals were met by both groups as well as high caregiver satisfaction reported. CONCLUSIONS: Behavioral interventions for food refusal are effective for children with cerebral palsy with behavioral refusal, just as they are for children with autism.

The Prevalence of Food Allergies in Children Referred to a Multidisciplinary Feeding Program.

OBJECTIVE: To assess the prevalence of food allergy in children presenting to a multidisciplinary feeding program. METHODS: A retrospective chart review was conducted from 302 patients. We recorded history of food reaction, family history of any atopic disease, radioallergosorbent testing, prematurity, birth weight, breastfeeding history, Z-scores, age, and gastrointestinal mucosal biopsy reports with eosinophilic infiltrate. Three categories of possible food allergy were stratified based on increasing evidence of allergy. RESULTS: Possible food allergy was found for 18% (n = 54), likely food allergy for 6% (n = 18), and very likely food allergy for 16% (n = 47) for a total of 40% classified in a food allergy group. Having been breastfed correlated with likelihood of food allergy but tube-feeding dependence did not. CONCLUSION: This study revealed a higher proportion of children in a feeding program with food allergy compared to the general population, but larger prospective studies are needed to confirm the association.

Treatment outcomes for severe feeding problems in children with autism spectrum disorder.

There is abundant research to support that children with autism spectrum disorder (ASD) exhibit challenging feeding behaviors. Despite increase in empirical evidence supporting the role of behavior analysis in treating severe feeding problems, evaluation of the short- and long-term effects of these treatments for a large group of children with ASD is warranted. The purpose of the current study was to evaluate treatment outcomes of an interdisciplinary feeding program for 46 children with ASD. A retrospective chart analysis indicated these children were treated successfully overall and follow-up data suggest gains were maintained following discharge from the program.

Decreasing expulsions by a child with a feeding disorder: using a brush to present and re-present food.

Previous research has demonstrated that extinction in the form of re-presentation of expelled bites is an effective intervention for treating food expulsion. The current study compared the effectiveness of re-presenting expulsions with a spoon to re-presenting with a Nuk brush for a 4-year-old boy with a feeding disorder. Fewer expulsions were observed when using the brush for re-presentation, and further reductions were observed when the brush was also used for initial presentations.