Feeding/Eating problems in children: Who does (not) benefit after behavior therapy? A retrospective chart review.

Background: Treating disordered feeding at a young age reduces risks of future feeding problems, but not all children profit equally; can we define predictors of a worse prognosis? Objectives: In 252 children, with a mean age of 4; 7 years (SD = 3 years; range 5 months to 17; 10 years), who had undergone behavioral day treatment in the past, several variables were investigated, retrieved from initial consultation (t1) and re-assessed at follow-up (t2). Method: Logistic regressions were carried out with sex, gastro-intestinal problems, refusal of the first nutrition, syndrome/intellectual disability, Down's syndrome, autism spectrum disorder, comorbidity of medical diseases (other than gastro-intestinal problems), restrictive caloric food intake and selective food intake, as the predictor variables from t1, and age-appropriate food intake at t2 as the dependent variable. The potential role of sensory processing problems was reviewed at t2. Results: About 73% had improved towards an age-appropriate food intake. Sex (boys), syndrome/intellectual disability, and a lack of varied nutritional intake at t1 were predictors of a worse prognosis. We found a small, but significant correlation between current selective eating patterns and general sensory processing problems. Conclusion: Feeding disordered children, especially boys, with intellectual disabilities or selective eating patterns are at risk for not achieving an age-adequate food intake at a later age, despite behavioral treatment.

Feeding/Eating Problems in Children Who Refrained From Treatment in the Past: Who Did (Not) Recover?

Background: Young children with disordered feeding may be at increased risk for problematic eating in the future. This retrospective study attempts to identify predictors of later feeding problems. Objectives: Children (N = 236) with disordered feeding, who refrained from behavioral treatment after consultation at a tertiary treatment center for feeding and eating problems were followed-up after, on average, 6 years and 3 months (timepoint 2). Method: Logistic regressions were carried out with characteristics taken at intake (timepoint 1)-sex, pre/dysmaturity, gastro-intestinal disease, history of age-adequate feeding, syndrome/developmental impairment, autism spectrum disorder, comorbidity, age, and several variables of a restrictive- and selective food intake-and duration between timepoint 1 and 2, as predictor variables, and age-appropriate food intake at t2 as the dependent variable. Results: Despite improvement over time, 63% did not reach an age-adequate food intake at t2. Predictors of age-inadequate food intake were: (a) older age; (b) sex (male), (c) longer duration between timepoint 1 and timepoint 2; (d) autism spectrum disorder; (e) selective texture choices and (f) lack of varied nutritional intake. Conclusion: This study shows that most untreated young children's feeding problems do not improve over years. Besides the advice to seek help at an early age, it seems especially recommended to treat (male) children with autism spectrum disorder and selective feeding patterns.

Heart rate and the role of the active receiver during contingent electric shock for severe self-injurious behavior.

Five individuals, who were treated for severe self-injurious behaviors with contingent electric shock, participated. Hereby, each occurrence of the target response was followed by a remotely administered aversive consequence. Participants' heart rates were compared at times when the active device of the equipment for the above procedure was attached to their body and when the active device was detached. Although typical response patterns emerged across the participants results demonstrated that heart rates were lower when the active device was attached, tentatively supporting the notion that anxiety and stress may be collateral to participants' SIB.

Establishing diurnal bladder control with the response restriction method: extended study on its effectiveness.

In this study, the effect of response restriction as a method to establish diurnal bladder control was assessed with 40 participants with moderate and severe levels of mental handicap. Being an extension of a previous study [Am. J. Mental Retard. 106 (2001) 209], the significant decrease of the mean number of toileting accidents in function of initiating the procedure offers a further contribution to the validity of response restriction as a method for toilet training. A significant positive relationship between number of training hours and participants' chronological age and between number of toileting accidents during baseline and number of training hours was revealed. Advantages of the present procedure are that administering aversive consequences for toileting accidents (e.g., restitutional overcorrection) is to be omitted and the relatively short period of training time.

Effects of single and repeated shock on perceived pain and startle response in healthy volunteers.

Contingent shock (CS) has been used in a number of studies to suppress health-threatening self-injurious behavior of individuals with mental retardation and autism. As sustained suppression is an issue of concern, research into procedural variables of CS is needed. In this study, clinical evidence was used to infer a variable that might be of relevance for the application of clinical contingent shock, that is, to assess the effect of single versus repeated shock at a specific location on the body. With pain intensity and startle response as dependent variables, shocks were administered to 48 healthy volunteers. Electric shocks were identical to those that used in clinical practice. The second shock in succession to the same location of the body produced higher pain intensity ratings than the first shock and that the third shock in succession to the same location of the body produced higher pain intensity ratings than the second shock in succession. Startle responses, however, failed to be affected in this direction. The latter result is consistent with a previous study. Our data suggest that repeated shock to the same location is likely to be more effective to establish suppression than repeated shock to different locations.