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1.
Behav Anal ; 39(1): 157-66, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27606196

RESUMO

Increased demand for applied behavior analysis (ABA) services has increased the need for additional masters-level practitioners and doctoral-level academicians and clinical directors. Based on these needs, the University of Nebraska Medical Center's (UNMC) Munroe-Meyer Institute has developed a PhD program. The academic structure at UNMC allowed us to create our PhD program in a relatively quick and efficient manner. Our PhD program has many unique features, including (a) close integration of didactic instruction with clinical and research training provided by leading experts in ABA in which students immediately apply concepts introduced in the classroom during coordinated clinical and research practica; (b) structured grant writing training in which students learn to write and submit an NIH-level grant;

2.
J Appl Behav Anal ; 55(1): 264-289, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34796485

RESUMO

Functional analyses allow clinicians to develop treatment targeting the variables maintaining a child's inappropriate mealtime behavior (Bachmeyer et al., 2019). Extended functional analyses can be inefficient, potentially delaying the onset of treatment. Researchers have suggested a trial-based functional analysis can increase assessment efficiency (Saini, Fisher, et al., 2019). This study compared trial-based functional analyses to extended functional analyses to determine the variables maintaining inappropriate mealtime behavior. We compared the efficiency and acceptability and evaluated treatments informed by the analyses. Exact correspondence between analyses was low (29%); however, most treatments indicated by the trial-based functional analyses (80%) resulted in improvements in the child's target behavior. The trial-based functional analysis required 71% less time than the extended functional analysis, and caregivers found analyses equally acceptable. Future researchers should continue refining trial-based functional analysis procedures to provide an efficient assessment that leads to efficacious treatment.


Assuntos
Comportamento Problema , Reforço Psicológico , Cuidadores , Criança , Comportamento Alimentar , Humanos , Refeições
3.
J Appl Behav Anal ; 54(3): 928-945, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33740261

RESUMO

Previous literature supports the use of functional analyses to prescribe treatments for children with feeding disorders (Bachmeyer et al., 2009). Nevertheless, clinicians often train caregivers to use healthy contingencies, independent of whether those contingencies are function based. However, it is unclear whether including nonfunction-based contingencies differentially affects inappropriate mealtime behavior. In the current investigation, the caregivers of 3 children with feeding disorders provided escape from bites and drinks and attention following inappropriate mealtime behavior. Results of a functional analysis showed escape from bites or drinks, but not attention, reinforced inappropriate mealtime behavior. We then tested the effects of escape extinction when the feeder either provided or withheld attention following inappropriate mealtime behavior. Inappropriate mealtime behavior decreased and acceptance increased when the feeder implemented escape extinction independent of whether they provided or withheld attention. We discuss the implications of including nonfunction-based components in the treatment of pediatric feeding disorders.


Assuntos
Transtornos de Alimentação na Infância , Terapia Comportamental , Criança , Extinção Psicológica , Comportamento Alimentar , Transtornos de Alimentação na Infância/terapia , Humanos , Refeições , Reforço Psicológico
4.
J Appl Behav Anal ; 54(3): 903-927, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33570178

RESUMO

Renewal, the increase in behavior during extinction following context changes, may be particularly concerning during intervention for feeding disorders because context changes are often necessary for intervention generality and maintenance (Podlesnik et al., 2017). In the current study, we tested for renewal and evaluated a renewal-mitigation procedure when we transferred intervention from a therapist to a caregiver, from clinic to the home, and changed the foods the feeder presented. We used an ABA arrangement to evaluate the generality of the renewal effect with 7 participants who engaged in inappropriate mealtime behavior. Context A was functional reinforcement. Context B was function-based extinction during the control and mitigation conditions and our renewal-mitigation procedure in the mitigation condition. The renewal test was function-based extinction in Context A. We observed renewal of inappropriate mealtime behavior in 4 of 7 participants, and our renewal-mitigation procedure was effective for 4 of 4 participants.


Assuntos
Extinção Psicológica , Comportamento Problema , Humanos , Refeições , Reforço Psicológico
5.
J Appl Behav Anal ; 54(1): 6-24, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33145801

RESUMO

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. In Experiment 1, we analyzed the data of participants who received follow-up both in-clinic and via telehealth. In Experiment 2, we analyzed goal attainment for participants who received outpatient follow-up either in-clinic exclusively or via telehealth exclusively. Results of both studies showed that outcomes were equivalent along most dimensions for in-clinic and telehealth services. We provide recommendations for telehealth feeding services and discuss other considerations relevant to telehealth service delivery.


Assuntos
Transtorno Alimentar Restritivo Evitativo , Telemedicina , Assistência ao Convalescente/métodos , Assistência Ambulatorial/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Humanos , Telemedicina/métodos
6.
J Appl Behav Anal ; 53(4): 2002-2023, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32342518

RESUMO

Change-resistant behavior, such as rigid and selective food consumption, is a core symptom of autism that can have significant negative consequences for the child (Flygare Wallén et al., 2018; Levy et al., 2019). In the current study, we used a matching-law-based intervention (Fisher et al., 2019) to treat the change-resistant feeding behavior of 7 young children with autism. The feeder gave the participant a choice between a change-resistant and an alternative food during free- and asymmetrical-choice conditions. Alternative-food consumption increased for 2 participants during asymmetrical choice when the feeder provided a preferred item for consuming the alternative food and no programmed consequence for consuming the change-resistant food. Alternative-food consumption increased for the other 5 participants after the feeder exposed at least 1 food to single choice in which the feeder guided the participant to put the bite of alternative food in his or her mouth if he or she did not do so within 8 s of presentation. Effects of the single-choice contingencies maintained during reversals and generalized to other alternative foods the feeder did not expose to single choice. These results are important because participants consumed alternative foods even when their change-resistant foods were present, which is similar to typical mealtime contexts in which children have choices among foods.


Assuntos
Transtorno do Espectro Autista/psicologia , Preferências Alimentares , Transtorno Autístico/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Refeições
7.
Pediatr Clin North Am ; 67(3): 451-467, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32443986

RESUMO

Applied behavior analysis has the most empirical support as intervention for pediatric feeding disorders, when a child does not eat or drink a sufficient quantity or variety of food to maintain proper nutrition. Interdisciplinary collaboration is crucial for diagnosis, referral, and management of pediatric feeding disorders because the etiology is complex and multifactorial. Thus, our aim is to provide information about how to recognize a feeding disorder, to delineate the environmental variables implicated in the etiology and maintenance of feeding disorders, and to provide recommendations for prevention and intervention for feeding disorders based on the applied-behavior analytic literature.


Assuntos
Terapia Comportamental/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Transtorno Alimentar Restritivo Evitativo , Criança , Preferências Alimentares , Humanos , Necessidades Nutricionais , Estado Nutricional , Prognóstico , Índice de Gravidade de Doença
8.
J Appl Behav Anal ; 52(4): 1005-1020, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31642527

RESUMO

The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function-based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function-based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function-based extinction with high levels of integrity.


Assuntos
Transtornos de Alimentação na Infância/terapia , Refeições/psicologia , Comportamento Problema/psicologia , Reforço Psicológico , Pré-Escolar , Extinção Psicológica , Transtornos de Alimentação na Infância/psicologia , Generalização Psicológica , Humanos , Masculino , Recidiva
9.
J Appl Behav Anal ; 52(4): 895-917, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31642526

RESUMO

Food selectivity is a common problem for children with autism spectrum disorder (ASD; Schreck, Williams, & Smith, 2004). Behavior-analytic interventions have the most empirical support for feeding disorders (Sharp, Jaquess, Morton, & Miles, 2011). However, there are no randomized controlled trials that have evaluated its effects with a well-defined cohort of children with ASD. In the current investigation, we randomly assigned 6 young children with ASD and food selectivity to either an applied behavior analytic intervention or a wait-list control. We used a crossover randomized controlled trial to evaluate the effects of a multicomponent applied behavior analytic intervention on independent acceptance and mouth clean of 16 novel foods. We subsequently exposed the wait-list control group to the intervention. We also evaluated the effects of the intervention on individual participants with single-case designs. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait-list control group until we implemented the intervention.


Assuntos
Transtorno do Espectro Autista/complicações , Transtornos de Alimentação na Infância/terapia , Seletividade Alimentar , Preferências Alimentares , Transtorno do Espectro Autista/psicologia , Terapia Comportamental , Criança , Pré-Escolar , Transtornos de Alimentação na Infância/etiologia , Transtornos de Alimentação na Infância/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
10.
Behav Anal Pract ; 10(2): 167-171, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28630821

RESUMO

Self-drinking is an important skill for children to acquire as they transition from infancy to early childhood; however, the literature is limited (e.g., Collins, Gast, Wolery, Holcombe, & Leatherby, 1991; Peterson, Volkert, & Zeleny, 2015). We manipulated the consequences associated with self-drinking relative to those associated with being fed along the dimension of response effort. Results demonstrated that self-drinking increased when the child could either choose to self-feed one drink or be fed one drink and 5 practice trials with an empty cup.

11.
J Appl Behav Anal ; 49(3): 485-511, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27449267

RESUMO

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M-SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M-SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M-SOS. We subsequently implemented ABA with the children for whom M-SOS was not effective and observed a potential treatment generalization effect during ABA when M-SOS preceded ABA.


Assuntos
Transtorno do Espectro Autista/reabilitação , Terapia Comportamental/métodos , Cuidadores/psicologia , Comportamento Alimentar/fisiologia , Preferências Alimentares , Sensação/fisiologia , Comportamento Verbal , Criança , Pré-Escolar , Intervenção Educacional Precoce , Feminino , Humanos , Masculino , Boca/inervação
12.
J Appl Behav Anal ; 48(2): 436-41, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25931021

RESUMO

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. Results showed that differential positive reinforcement with tangible items increased self-drinking for both children in the absence of nonremoval of the cup.


Assuntos
Terapia Comportamental/métodos , Comportamento de Ingestão de Líquido/fisiologia , Transtornos de Alimentação na Infância/terapia , Reforço Psicológico , Pré-Escolar , Transtornos de Alimentação na Infância/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
13.
Behav Modif ; 38(5): 705-29, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24902589

RESUMO

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. The current study adds to a small body of literature on chewing and mastication of children with feeding disorders. Suggestions for future research are also discussed.


Assuntos
Terapia Comportamental , Deglutição/fisiologia , Comportamento Alimentar/psicologia , Transtornos de Alimentação na Infância/terapia , Mastigação/fisiologia , Pré-Escolar , Protocolos Clínicos , Comportamento Alimentar/fisiologia , Transtornos de Alimentação na Infância/fisiopatologia , Transtornos de Alimentação na Infância/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
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