A systematic review of functional analysis in pediatric feeding disorders.

We conducted a systematic review of the functional analysis of inappropriate mealtime behavior in peer-reviewed studies in PsycINFO, ERIC, PubMed, and the Journal of Applied Behavior Analysis between 2000-2016. We identified 18 studies involving 86 functional analyses. We coded descriptive data and calculated summary statistics in addition to conducting a quality appraisal of the literature. We identified escape, exclusively or in part, as the maintaining reinforcer for inappropriate mealtime behavior in 92% of cases. Results indicate that differentiated functional analyses of inappropriate mealtime behavior can be obtained, and outcomes are consistent with etiological theories of food refusal behavior. We discuss procedural differences across studies as well as directions for future research.

Evaluation of word recognition following typing produced through facilitated communication.

The extant literature on facilitated communication suggests facilitator control rather than independent communication. We used a novel assessment to evaluate a participant's correct identification of words produced during facilitated communication sessions. The participant was unable to recognize common words that she was being facilitated to type, with correct responding varying as a function of the number of distracter stimuli available. These findings are discussed in relation to behavior-analytic evaluations for alternative medical treatments for autism and related disorders.

Analysis of self-feeding in children with feeding disorders.

In the current investigation, we evaluated a method for increasing self-feeding with 3 children with a history of food refusal. The children never (2 children) or rarely (1 child) self-fed bites of food when the choice was between self-feeding and escape from eating. When the choice was between self-feeding 1 bite of food or being fed an identical bite of food, self-feeding was low (2 children) or variable (1 child). Levels of self-feeding increased for 2 children when the choice was between self-feeding 1 bite of food or being fed multiple bites of the same food. For the 3rd child, self-feeding increased when the choice was between self-feeding 1 bite of food or being fed multiple bites of a less preferred food. The results showed that altering the contingencies associated with being fed increased the probability of self-feeding, but the specific manipulations that produced self-feeding were unique to each child.

Effects of access to a stimulating object on infant behavior during tummy time.

Placing infants in a prone position for "tummy time" often is recommended to ensure appropriate infant development and to combat the effects associated with infants spending extended periods of time in a supine position. However, tummy time may be associated with inappropriate infant behavior such as crying and noncompliance. We provided continuous access to a preferred stimulus to decrease negative vocalizations and to increase the duration of an infant's head being elevated during tummy time.

Sequential treatment of a feeding problem using a pacifier and flipped spoon.

Parents may be reluctant to treat the feeding disorder of a chronically ill child who exhibits distressed behavior during feeding. In this study, we identified a child with chronic medical problems and a feeding disorder who cried during feedings. We introduced treatment components sequentially to address parental concerns about crying. First, we used a pacifier to reduce crying, and then we used a flipped spoon to increase mouth clean. The results showed that a sequential approach to treatment can be effective for children with complex medical and behavioral problems.

Functional analysis and treatment of multiply controlled inappropriate mealtime behavior.

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.

Preference for reinforcers under progressive- and fixed-ratio schedules: a comparison of single and concurrent arrangements.

Progressive-ratio (PR) schedules were used to identify the break point (i.e., the last schedule value completed) for 2 reinforcers under single and concurrent schedules. After the respective break points were established, the same reinforcers were presented under concurrent fixed-ratio (FR) schedules that were yoked to the break points obtained with the PR schedules. Results suggested that the participants responded more for the high-preference item than for the low-preference item, regardless of the presentation arrangement (single or concurrent presentations). This pattern of responding was maintained when the reinforcers were presented under dissimilar FR schedules. The results suggest that responding for differentially preferred stimuli may vary as a function of differences in schedule requirements.