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Packing involves not swallowing solids or liquids in the mouth. It is a significant mealtime behaviour to treat. Research has shown effectiveness of redistribution, but only two studies in highly specialised hospital settings in the United States have evaluated the use of a chaser. We extended this literature by conducting treatment in the home setting, and comparing a liquid and puree chaser separately to infant gum brush redistribution and a move-on to the next bite presentation component. A 4-year-old male with autism spectrum disorder and gastrostomy tube dependence participated in his home. We used a multielement single-case experimental design. With the liquid chaser, consumption increased to 100%. Swallowing latency was significantly lower with the liquid chaser compared to other packing treatments.

Research has shown effectiveness of redistribution procedures for decreasing packing and increasing swallowing. Redistribution has been done using lower manipulated-texture foods on an infant gum brush in specialized U.S. hospitals. We extended this by using regular texture bites of food in a short-term (1-2 weeks) home-based program in Australia, showing decreased then absent use of the procedure, and following up. Two children with autism spectrum disorder participated. We used a modified withdrawal/reversal design. Latency to swallow decreased. Participants increased variety to 90 and 122 regular texture foods across food groups. All goals were met including increasing independence in self-feeding. Both parents were trained. Gains maintained to 6 months and redistribution was no longer needed.

Behavior analysts typically rely on visual inspection of single-case experimental designs to make treatment decisions. However, visual inspection is subjective, which has led to the development of supplemental objective methods such as the conservative dual-criteria method. To replicate and extend a study conducted by Wolfe et al. (2018) on the topic, we examined agreement between the visual inspection of five raters, the conservative dual-criteria method, and a machine-learning algorithm (i.e., the support vector classifier) on 198 AB graphs extracted from clinical data. The results indicated that average agreement between the 3 methods was generally consistent. Mean interrater agreement was 84%, whereas raters agreed with the conservative dual-criteria method and the support vector classifier on 84% and 85% of graphs, respectively. Our results indicate that both objective methods produce results consistent with visual inspection, which may support their future use.

Packing involves not swallowing solids or liquids in the mouth. It is a significant mealtime behaviour to treat. Research has shown effectiveness of redistribution, but only two studies in highly specialised hospital settings in the United States have evaluated the use of a chaser. We extended this literature by conducting treatment in the home setting, and comparing a liquid and puree chaser separately to infant gum brush redistribution and a move-on to the next bite presentation component. A 4-year-old male with autism spectrum disorder and gastrostomy tube dependence participated in his home. We used a multielement single-case experimental design. With the liquid chaser, consumption increased to 100%. Swallowing latency was significantly lower with the liquid chaser compared to other packing treatments., Author(s): Tessa Taylor [sup.1] [sup.2] Author Affiliations: (1) Paediatric Feeding International, , Double Bay, Sydney, NSW, Australia (2) grid.21006.35, 0000 0001 2179 4063, University of Canterbury/Te Whare Wananga o Waitaha, [...]

Saliva packing can be one of the most severe life-threatening and challenging behaviours to treat. A 9-year-old male with autism spectrum disorder and intellectual disability had 100% nasogastric (NG) feeding tube dependence and significant adaptive behaviour regression (in speaking, using the toilet and his hands, school attendance, sleep). He participated in an intensive behaviour-analytic paediatric feeding treatment programme. Saliva packing, as an automatically-maintained undifferentiated behaviour that persisted in all waking contexts despite high engagement in activities, warranted an additional outside of meal approach. He began swallowing, met 100% of his 21 goals, gained weight, and eliminated tube dependence. He reached a variety of 94 across all food groups, drinks, and supplements. Caregivers were trained and reported high social validity, and gains generalised and maintained in 1-month follow-up. This is the first case to our awareness in Australia of an in-home solely behaviour-analytic intervention to eliminate tube dependence, and it was conducted without hunger provocation, weight loss, or limited nutritional variety. [ABSTRACT FROM AUTHOR]

A small but growing body of research in pediatric feeding disorders asserts the importance of comprehensively measuring social significance of goals, procedures, and effects of intervention, and incorporating social validity into practice to inform treatment. This report sought to extend this literature by detailing procedures to measure and improve social validity during a clinical case of a 3.5‐year‐old during a home‐based intensive feeding program. A multiple baseline design demonstrated effectiveness of nonremoval and re‐presentation added to a treatment package. Repeated choice via direct child preference assessments informed demand fading and gradual progression across six feeding skill domains (medication, cup drinking, independence, texture, volume, variety) and arrangements of response effort (preference, skill) with layers of reinforcer parameters (quality, magnitude, rate, immediacy). Indices of happiness definitions were modified, and extinction bursts examined. Fostering a collaborative approach, caregivers provided detailed input on social validity measures pretreatment, at discharge, and long‐term follow‐up (6‐month, 1‐year), inclusive of both qualitative and quantitative responses, written and verbal communication, and permanent product data. Further implications for practitioners included detailing the process for caregiver training and generalization to family meals with siblings and community settings, and providing adaptable full‐text guidelines for free access/choice contexts. [ABSTRACT FROM AUTHOR]

Medication administration can be a significant issue in pediatric populations, and especially with patients with developmental disabilities and comorbid feeding disorders. Research has focused largely on consumption of solids rather than medication and liquids in pediatric feeding programs, with most studies being conducted within specialized hospital settings in the United States. No studies to our knowledge have detailed treatment evaluations for medication administration in pediatric feeding except for a few studies on pill swallowing. We report results of treatment protocols for medication administration using empirically-supported treatments in a short-term intensive home-based behavior-analytic program in Australia. Two males with autism spectrum and pediatric feeding disorders participated. We used a multiple baseline single-case experimental design for medication administration conducted concurrently with a treatment evaluation for solid foods. Consumption increased in number (9; supplements, laxatives, pain relievers), flavors (8; chocolate, blackcurrent and apple, strawberry, lemon-lime, orange, chocolate-vanilla, cherry, apple), forms (4; thin and thick liquids, chewables, gummies), and delivery methods (5; finger-fed, spoon, cup, medicine spoon, medicine cup) within the first treatment session. For one participant, we taught open cup drinking for a variety of liquids (milk, juices, medications). For both participants, we taught self-feeding with utensils for thick liquid medications. Treatment results were similar for solids and participants increased food variety to over 160 across food groups. All goals were met including training parents to maintain gains at home. [ABSTRACT FROM AUTHOR]

Practitioners in pediatric feeding programs often rely on single-case experimental designs and visual inspection to make treatment decisions (e.g., whether to change or keep a treatment in place). However, researchers have shown that this practice remains subjective, and there is no consensus yet on the best approach to support visual inspection results. To address this issue, we present the first application of a pediatric feeding treatment evaluation using machine learning to analyze treatment effects. A 5-year-old male with autism spectrum disorder participated in a 2-week home-based, behavior-analytic treatment program. We compared interrater agreement between machine learning and expert visual analysts on the effects of a pediatric feeding treatment within a modified reversal design. Both the visual analyst and the machine learning model generally agreed about the effectiveness of the treatment while overall agreement remained high. Overall, the results suggest that machine learning may provide additional support for the analysis of single-case experimental designs implemented in pediatric feeding treatment evaluations. [ABSTRACT FROM AUTHOR]

Social validity is often defined as the degree to which an intervention has value to the community that it effects, but it is seldom reported in the literature. Most social validity questionnaires are purposely created by the authors of the study and often lack a description of scale development process. The purpose of this study was to evaluate methods for the development of a Likert‐type social validity scale. Caregivers of children who took part in a study on behavioral treatments for pediatric feeding disorders were part of an initial interview to inform scale development. We analyzed interviews using thematic (qualitative) analysis and textual (quantitative) analysis, and used the resulting themes to generate items for two social validity questionnaires. We examined the inter‐rater reliability of the questionnaire development process and evaluated the content validity of the questionnaires resulting from each method. Textual analysis had higher inter‐rater reliability for producing themes that could be converted to questionnaire items. The textual analysis method produced a questionnaire with content validity equal to that of the thematic analysis method. The study demonstrates the successful use of a quantitative approach to the development of social validity questionnaires for behavioral interventions. [ABSTRACT FROM AUTHOR]

Research from specialised hospital feeding programmes in the United States has shown effectiveness of a variety of treatments for packing (not swallowing food or liquid in the mouth) to increase swallowing and consumption. One potential component used in clinical practice has not been evaluated in the literature to our knowledge. This component is move-on and involves moving on to the next bite presentation rather than waiting for swallowing (i.e., clean mouth). A 5-year-old female with autism spectrum disorder and avoidant/restrictive food intake disorder participated in a home setting in Australia. We used a withdrawal/reversal single-case experimental design for a move-on component added to a treatment package. With move-on added, latency to clean mouth decreased and consumption increased to 100%. After the treatment evaluation, additional procedures (interspersal, redistribution) were needed in full plate and portion meals. Food variety was increased to 116 regular texture foods across all food groups. All (100%) of admission goals were met. Parents were trained to high procedural integrity, and the protocol was generalised to the community. Gains maintained to 1-month follow-up. [ABSTRACT FROM AUTHOR]

Aim: Paediatric feeding disorders are normally managed by specialist clinics. We examined whether treatment gains were maintained when trained parents continued the programme at home and during meals out.Methods: This controlled consecutive case series recruited 26 children (22 boys) with avoidant/restrictive food intake disorder, from a private paediatric feeding disorders practice in New South Wales, Australia. Their mean age was six (2-13) years. All had severe feeding problems and mealtime skill deficits, and most had autism and developmental delays or intellectual disabilities. The children received intensive, individualised, behaviour-analytic treatment for 11 (6-21.5) days, and the parents were trained to continue it at home. The primary treatment outcomes included the range and amount of food eaten and mealtime behaviour.Results: The children met all of the therapeutic goals agreed at the treatment outset. They ate a mean of 92 different foods and improved how they ate, drank and behaved during mealtimes. The mean differences before and after treatment were clinically and statistically significant, and the gains were maintained during follow-up at a mean of 2.3 years. Parental satisfaction and treatment acceptability were high.Conclusion: Specially trained parents successfully continued paediatric eating disorder treatment at home and maintained treatment gains. [ABSTRACT FROM AUTHOR]