The case study provides a clinical example of incorporating adaptive feeding equipment into behavioral treatment programming to increase mealtime independence for a child with puree-dependence and vision difficulties. We used an ABCA design to evaluate a treatment package that included graduated guidance, escape extinction, noncontingent reinforcement with attention and a tangible item, and differential negative reinforcement to increase independent feeding. The results demonstrated increased independent feeding from an adaptive puree pouch holder for a 3-year-old boy diagnosed with global developmental delay, pediatric feeding disorder, and a vision impairment. Independent feeding generalized to the home setting and maintained at a 12-month follow-up.
CarruthB. R.SkinnerJ. D. (2002). Feeding behaviors and other motor development in healthy children (2-24 months). Journal of the American College of Nutrition, 21(2), 88–96. https://doi.org/10.1080/07315724.2002.10719199
2.
DemchukN. C.BighamM. H.HansenB. A. (2024). Clinical application and fading of synchronous reinforcement for increasing self-feeding for a child with autism spectrum disorder and history of trauma. Clinical Case Studies, 23(5), 363–378. https://doi.org/10.1177/15346501241244755
3.
EstremH. H.ParkJ.ThoyreS.McComishC.McGlothen-BellK. (2022). Mapping the gaps: A scoping review of research on pediatric feeding disorder. Clinical Nutrition ESPEN, 48, 45–55. https://doi.org/10.1016/j.clnesp.2022.04.006
4.
GalaiT.FriedmanG.MosesM.ShemerK.GalD. L.Yerushalmy-FelerA.LubetzkyR.CohenS.Moran-LevH. (2022). Demographic and clinical parameters are comparable across different types of pediatric feeding disorder. Scientific Reports, 12(1), 8596. https://doi.org/10.1038/s41598-022-12562
5.
GeigerK. B.CarrJ. E.LeblancL. A. (2010). Function-based treatments for escape-maintained problem behavior: A treatment-selection model for practicing behavior analysts. Behavior analysis in practice, 3(1), 22–32. https://doi.org/10.1007/BF03391755
6.
GodayP. S.HuhS. Y.SilvermanA.LukensC. T.DodrillP.CohenS. S.DelaneyA. L.FeulingM. B.NoelR. J.GiselE.KenzerA.KesslerD. B.Kraus de CamargoO.BrowneJ.PhalenJ. A. (2019). Pediatric feeding disorder: Consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124–129. https://doi.org/10.1097/MPG.0000000000002188
7.
HaneyS. D.IbañezV. F.KirkwoodC. A.PiazzaC. C. (2023). An evaluation of negative reinforcement to increase self-feeding and self-drinking for children with feeding disorders. Journal of Applied Behavior Analysis, 56(4), 757–776. https://doi.org/10.1002/jaba.1013
8.
HansenB. A.AndersenA. S. (2020). Behavior-analytic treatment progression for a child with tube dependence: Reaching age-typical feeding. Clinical Case Studies, 19(6), 403–417. https://doi.org/10.1177/1534650120950525
9.
HegdeV.JainR.BappalA.ShambhuR. (2021). Ocular manifestations in children with developmental delay at a tertiary center in South India. Saudi journal of ophthalmology: Official Journal of the Saudi Ophthalmological Society, 35(1), 1–4. https://doi.org/10.4103/1319-4534.325773
10.
IvyS.HattonD. D.WehbyJ. H. (2018). Using graduated guidance to teach spoon use to children with severe multiple disabilities including visual impairment. Research and Practice for Persons with Severe Disabilities, 43(4), 252–268. https://doi.org/10.1177/1540796918808519
PatelM. R.PiazzaC. C.MartinezC. J.VolkertV. M.SantanaC. M. (2002). An evaluation of two procedures for increasing food acceptance. Journal of Applied Behavior Analysis, 35(4), 363–374. https://doi.org/10.1901/jaba.2002.35-363
13.
PhippsL. E.PetersonK. M.PiazzaC. C. (2022). Indices of happiness and unhappiness during treatment of pediatric feeding disorders. Behavioral Interventions, 37(3), 568–593. https://doi.org/10.1002/bin.1863
14.
PiazzaC. C.FisherW. W.HagopianL. P. (2010). Behavioral interventions for food refusal in children with feeding disorders: A review of the literature. Journal of Applied Behavior Analysis, 43(3), 379–391. https://doi.org/10.1901/jaba.2010.43-379
15.
PutnickD. L.BellE. M.GhassabianA.RobinsonS. L.SundaramR.YeungE. (2022). Feeding problems as an indicator of developmental delay in early childhood. The Journal of Pediatrics, 242, 184–191. https://doi.org/10.1016/j.jpeds.2021.11.010
16.
RubioE. K.PichardoD.BorreroC. S. W. (2018). Using backward chaining and a physical guidance delay to teach self-feeding. Behavioral Interventions, 33(1), 87–92. https://doi.org/10.1002/bin.1504
17.
SainiV.AndersenA. S.JesselJ.VanceH. (2022). On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis. Journal of Applied Behavior Analysis, 55(2), 513–528. https://doi.org/10.1002/jaba.901
18.
SharpW. G.EstremH. H.RomeoC.PedersonJ.ProctorK. B.GillespieS.DuC.MarshallJ.RaolN. (2023). Assessing the U.S. treatment landscape for pediatric feeding disorder: A survey of multidisciplinary providers. Child: Care, Health and Development, 50(1), Article e13198. https://doi.org/10.1111/cch.13198
19.
SharpW. G.JaquessD. L.MortonJ. F.HerzingerC. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13(4), 348–365. https://doi.org/10.1007/s10567-010-0079-7
20.
SimioneM.HarshmanS.Cooper-VinceC. E.DaigleK.SorboJ.KuhlthauK.FiechtnerL. (2023). Examining health conditions, impairments, and quality of life for pediatric feeding disorders. Dysphagia, 38(1), 220–226. https://doi.org/10.1007/s00455-022-10455-z
21.
TaylorT. (2024). Mealtime skill Independence: From pouch-to-spoon fading to using chopsticks. Journal of Developmental and Physical Disabilities, 37(4), 633–651. https://doi.org/10.1007/s10882-024-09968-2
22.
TereshkoL.WeissM. J.GranfieldA. (2023). Increasing food consumption with an antecedent and reinforcement-based treatment generalized via telehealth. Clinical Case Studies, 22(4), 403–419. https://doi.org/10.1177/15346501221149974
23.
Van ArsdaleA.IbañezV. F.VollmerT. R. (2024). Noncontingent reinforcement in the treatment of pediatric feeding disorder: A concise review. Journal of Applied Behavior Analysis, 57(3), 798–802. https://doi.org/10.1002/jaba.1073
24.
VolkertV. M.SharpW. G.ClarkM. C.OrmandH.RubioE. K.McCrackenC.BryanL. (2019). Modified-bolus placement as a therapeutic tool in the treatment of pediatric feeding disorders: Analysis from a retrospective chart review. Journal of Speech, Language, and Hearing Research: Journal of Speech Language Hearing Research, 62(9), 3123–3134. https://doi.org/10.1044/2019_JSLHR-S-18-0268
25.
World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). World Health Organization. https://icd.who.int/
