| Pediatric Feeding Autism Case Study |
Behavioral Feeding
Therapy Case Study on Randomizing Meals to Facilitate Intake with an Autistic
Child
Michael was a 4-year-old child diagnosed with autism. He had
an unremarkable medical history. Prior to coming to Los Altos Feeding Clinic he
would only consume bottles of formula.
He would drink 6-8 bottles per day of concentrated formula. He would not
drink from other containers nor would he drink other liquids. He also did not
consume any solids.
He was seen for four weeks in total. Treatment was three
times per day, five days per week.
The first week consisted of introducing solids to him. It
was decided to use purees for two reasons. First, he had never chewed on a
solid, which could make sessions dangerous because poorly chewed solids can be
a choking hazard. Second, more trials can occur per session because time is not
wasted on chewing. Four foods, chicken, green beans, macaroni and cheese, and
applesauce, were randomized throughout the meals and week.
Introducing solids consisted of presenting a bite, while simultaneously
verbally prompting him to take a bite. Initially the bite was presented to the
top lip until there was a mouth opening, and then the bite was deposited in the
mouth. The bite would not be deposited in cases of gagging, coughing or
vomiting, but were put in during all other openings. Each meal had a time cap
of twenty-five minutes, and volume of ten ounces of food. The session would end
when either the time cap had elapsed or the volume was consumed, whichever
occurred first.
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| Week 1 |
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The chart above shows how the time between presentation of
food and the bite being taken decreased. During the first session bites were
taken an average of ten seconds after food presentation. By session three bites
were taken on average after three seconds, and by session five they were stable
at about one second.
Week
two of treatment involved the introduction of new foods. Bites were presented with
the same protocol as in week one. Four novel foods were presented in each
session. Volumes of each food were held constant at three ounces each,
including all food groups in the meal. Randomizing foods in this way, instead
of focusing on one or just a few foods helped to generalize eating across all
foods, as can be seen in the next graph.
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| Graph Week 2 |
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There was a general trend in latencies dropping over time.
By the tenth session of week two, latencies were stable at or near one second. This
graph shows that eating was conditioned to occur at short latencies across all
foods.
Generalizing
meals to other settings serves the function of not only strengthening eating
behaviors, but also ensuring that eating would take place across all settings
(no matter the food), including the child’s own home environment. Week three
consisted of randomizing nine settings across the fifteen meals throughout the
week. All other variables were held constant, including randomizing the same
foods used in week two. Settings included the park, playroom, different
treatment rooms, hotel room, and hotel lobby.
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| Graph Week 3 |
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There was an initial spike of refusal, which was followed by
a sharp downward trend. By session 35 latencies were at or near one second.
Week
four consisted of training primary caregiver to feed with random foods and
random settings. This would ensure that feedings across settings and foods
would not only take place in the context of the therapist, but also ensure that
feedings take place with the primary care giver.
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| Graph Week 4 |
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There was a downward trend after session 47. Most meals
thereafter were at one or two seconds, except for a spike in latency for
sessions 52 and 53. Primary caregiver reported that eating continues at low
latencies across foods and settings. This was reported four months subsequent
to completion of treatment.
Data was collected by videotaping all sessions. Two data
collectors independently took data while viewing video footage at separate times.
Inter-observer reliability was measured at 86%.
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