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.

Self-management and supervisory feedback improves trainer implementation of communication rehabilitation programmes.

OBJECTIVE: This study investigated the differential effects of self-management and supervisory feedback on the acquisition and maintenance of accurate use of response prompts by five trainers who provided communication training to individuals with severe intellectual disability. METHODS: A counterbalanced design was used. For three trainers the self-management condition was first in effect followed by the supervisory feedback condition. For the two other trainers this order was reversed. RESULTS: Results revealed that for three trainers there was a statistically significant difference between the two conditions, favouring supervisory feedback. For the other two trainers, self-management and supervisory feedback were equally effective in establishing accurate use of response prompts. Acceptability ratings from trainers suggest a preference for self-management over supervisory feedback. CONCLUSION: For three out of five trainers supervisory feedback was more effective in improving implementation of the communication intervention (i.e. response prompting) than self-management.

Professional development improves staff's implementation of rehabilitation programmes for children with severe-to-profound intellectual disability.

OBJECTIVE: To evaluate the effectiveness of supervisory feedback and self-management on the acquisition and generalization of correct implementation of rehabilitation training programmes implemented by direct care staff. DESIGN: A non-concurrent multiple baseline design across three trainer-trainee dyads was used. METHODS: Three staff members were trained in how to implement one-to-one teaching programmes with four children with profound-to-severe intellectual disability. Staff received feedback and were taught to self-manage their (in)correct trainer behaviour. RESULTS: Supervisory feedback and self-management increased the mean percentage correct entry behaviour and reinforcement during training. Trainer's use of entry behaviour and reinforcement generalized across settings and trainees. As levels of response prompting for three trainers were already high during baseline, no firm statements could be made concerning its acquisition and generalization. CONCLUSION: Staff can improve the accuracy of training as a result of feedback and/or self-management procedures in the rehabilitation of children with severe disabilities.

Instruction and video feedback to improve staff's trainer behaviour and response prompting during one-to-one training with young children with severe intellectual disability.

We investigated the effectiveness of instruction and video feedback on correct trainer behaviour and the use of prompt sequences of 10 direct-care staff during one-to-one training with 10 young children with severe intellectual disability. Following baseline, trainers received instruction (written and verbal) concerning (in)correct trainer behaviour and response prompting. Then, video feedback was implemented and consisted of (a) interrupting a video presentation if an error occurred, (b) providing positive feedback, and (c) prompting the trainer to avoid errors or omissions. Data were collected in a non-concurrent multiple baseline design. The results showed that instruction and video feedback were highly effective in improving correct trainer behaviour. During baseline, trainers were inconsistent in their use of prompt sequences (21 correct prompt sequences were used as well as 17 incorrect prompt sequences). The intervention was effective in decreasing the number of incorrect prompt sequences. The trainers rated instruction and video feedback as an acceptable and effective intervention.

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.