2016 Gatlinburg Conference Poster
PS-79
Title: Using Brief Intensive Feeding Treatment to Decrease Maladaptive Behavior and Parent Stress
Authors: Sharnita D. Grays-Harris, Jessica F. Scherr, Jonathan Wilkins, Micheline Silva, Megan Stone, Tyler A. Hassenfeldt,
Elizabeth Kryszak, Lindsay McGuirk
Introduction: Although deficits in communication, social interaction, and behavior are the defining characteristics of Autism
Spectrum Disorder (ASD), feeding problems are also a major concern. Forty-six to 89% of children with ASD exhibit feeding
difficulties, including inadequate intake, food refusal, food selectivity, texture sensitivity, and vomiting and rumination (Ledford
& Gast, 2006). Feeding problems adversely impact children's nutrition and are correlated with high rates of parental stress
(Curtin, et al., 2015). Thus, effective treatment focusing on mealtime behavior and mastery of feeding strategies through parent
training is essential for decreasing inappropriate mealtime behavior, mastering feeding strategies, and reducing parent stress.
Escape extinction is an empirically validated behavioral procedure used to increase preferred behaviors of acceptance of the
spoon or cup and decrease interfering behaviors (Kodak & Piazza, 2008). Researchers have examined the effects of evidencebased treatment; however, studies have not specifically investigated the combination of brief intensive feeding treatment and
parent training on maladaptive feeding behavior and caregiver stress reduction in ASD.
Methods: Participants include children with ASD referred for intensive outpatient treatment by a clinical provider. In this fourweek program, three participants are seen for 30 minutes of brief, intensive feeding intervention three days per week.
Treatment is going with 15 participants diagnosed with ASD. The intervention includes a combination of clinician-implemented
behavioral feeding intervention with parent education and training so that parents become the primary feeders by the end of
the program. Pre and post-treatment data on maladaptive feeding behaviors and parent stress are measured via the Brief
Assessment of Mealtime Behavior in Children (BAMBIC; Hendy, Seiverling, et al., 2013) and the Parenting Stress Index, Fourth
Edition Short Form (PSI-4; Abidin, 2012), respectively. Sessions are conducted by a team of psychologists and psychology
trainees trained in implementation of behavioral procedures and data collection. Interobserver agreement is measured 20% of
treatment sessions.
Results: At this point, one participant has completed the brief, four week intensive feeding program. This participant is four
years of age; has diagnoses of ASD, Jacobsen syndrome, and Global Developmental Delay; and was referred for treatment due to
low feeding acceptance rates. Participant 1's rates of food acceptance increased from 23% to 100% within nine 30 minute
sessions in response to a protocol that implemented exposure, escape extinction, and parent training.
Discussion: ASD is a neurodevelopmental disorder often accompanied by feeding difficulties. Feeding problems in children are
positively associated with parental stress, which negatively influences child development. It is critical to treat behavioral
difficulties related to feeding problems as well as empower and educate parents. In order to maximize developmental outcomes
and learning in children with ASD, feeding treatments must offer family-centered care that takes into account both child and
parental factors.
References/Citations:
• Abidin, R. R. (2012). Parenting stress index (4th ed.). Lutz, FL: PAR.
• Curtin, C., Hubbard, K., Anderson, S. E., Mick, E., Must, A., & Bandini, L. G. (2015). Food selectivity, mealtime behavior
problems, spousal stress, and family food choices in children with and without autism spectrum disorder. Journal of
Autism and Developmental Disorders, 45(10), 3308-3315.
• Hendy, H. M., Seiverling, L., Lukens, C. T., & Williams, K. E. (2013). Brief assessment of mealtime behavior in children:
Psychometrics and association with child characteristics and parent responses. Children's Health Care, 42(1), 1-14.
• Kodak, T., & Piazza, C. C. (2008). Assessment and behavioral treatment of feeding and sleeping disorders in children with
autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17(4), 887-905.
• Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on
Autism and Other Developmental Disabilities, 21(3), 153-166.