Food Selectivity

Children who develop an unhealthy relationship with eating often experience short and long-term implications (Gale, Eikeseth, & Rudrud, 2010). Generally, children progress through a predictable sequence of feeding skills (Vaz, Volkert, & Piazza, 2011); however, children who are selective or picky eaters will only consume certain foods and no other variations (Ahearn, 2003). Feeding difficulties, such as food selectivity, are common among children with developmental disabilities (Cooper, Heron, & Heward, 2014, p. 317), and are estimated to develop in about one third of this population (Palmer, Thompson, & Linscheid, 1975). Bandini and colleagues (2010) noted that a standardised definition of food selectivity was absent in current literature. Consequently, they operationalised food selectivity to include three components: 1) food refusal; 2) limited food repertoire; and 3) high frequency single food intake (Bandini et al., 2010, p. 2).

Food selectivity is often exhibited by children with developmental disabilities and can be a major concern for caregivers (Bandini et al., 2010). Positively, research shows much promise in ameliorating parental concerns as well as improving the lives of those who exhibit such eating disorders. In children with ASDs, the literature suggests that food selectivity can be successfully treated with a multitude of intervention strategies such as: stimulus fading (Koegel et al., 2012), taste exposure and behavioural skills training (Seiverling et al., 2012), antecedent manipulations (Najdowski et al., 2012), differential reinforcement and non-contingent reinforcement (Allison et al., 2012), high-p request sequences (Penrod et al., 2012), modeling (Fu et al., 2015), and escape extinction (Allison et al., 2012; Fu et al., 2015). Escape extinction is not always a necessary supplement for positive outcomes (Najdowski et al., 2012; Penrod et al., 2012). Moreover, caution should be advised if utilising an escape extinction procedure as it can lead to extinction bursts (Najdowski et al., 2012) and aggression (Allison et al., 2012).

Food selectivity covers a wide range of problematic eating behaviours (Bandini et al., 2010). Therefore, the intervention strategies above could possibly be applied to client’s presenting with many topographies of feeding disorders. Considering that maladaptive feeding behaviours may be the product of environmental factors (Penrod et al., 2012), observing others (Bandura, 1965; Fu et al., 2015), or even sensory functions (Koegel et al., 2012), challenges lie in selecting interventions that best match the individual’s learning history. Despite these interventions showing promise for treating food selectivity, the literature is relatively recent and the subjects relatively young. Longitudinal follow-ups on such clients may ultimately be the illuminating factor on the efficacy of the current plethora of interventions available.

Selected readings:

Ahearn, W. H. (2003). Using simultaneous presentation to increase vegetable consumption in a mildly selective child with autism. Journal of Applied Behavior Analysis, 36(3), 361–365.

Allison, J., Wilder, D. A., Chong, I., Lugo, A., Pike, J. & Rudy, N. (2012). A comparison of differential reinforcement and noncontingent reinforcement to treat food selectivity in a child with autism. Journal of Applied Behavior Analysis, 45(3), 613-617.

Bandini, L. G., Anderson, S. E., Curtin C., Cermak, S., Evans, E. W., Scampini, R., Maslin, M., & Must, A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. The Journal of Pediatrics, 157(2), 259-264.

Bandura, A. (1965). Influence of models’ reinforcement contingencies on the acquisition of imitative responses. Journal of Personality and Social Psychology, 1, 589-595.

Cooper, J., Heron, T., & Heward, W. (2014). Applied Behavior Analysis (Pearson New International Edition, 2nd Ed.) UK: Pearson Education.

Fu, S. B., Penrod, B., Fernand, J. K., Whelan, C. M., Griffith, K., & Medved, S. (2015). The Effects of Modeling Contingencies in the Treatment of Food Selectivity in Children With Autism. Behavior Modification, 39(6), 771-784.

Gale, C. M., Eikeseth, S., & Rudrud, E. (2011). Functional assessment and behavioural intervention for eating difficulties in children with autism: a study conducted in the natural environment using parents and ABA tutors as therapists. Journal of Autism and Developmental Disorders, 41(10), 1383-96.

Koegel, R. L., Bharoocha, A. A., Ribnick, C. B., Ribnick, R. C., Bucio, M. O., Fredeen, R. M., & Koegel, L. K. (2012). Using individualized reinforcers and hierarchical exposure to increase food flexibility in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(8), 1574-1581.

Najdowski, A. C., Tarbox, J., & Wilke, A. E. (2012). Utilizing antecedent manipulations and reinforcement in the treatment of food selectivity by texture. Education and Treatment of Children, 35(1), 101-110.

Palmer, S., Thompson, R. J., & Linscheid, T. R. (1975). Applied Behavior Analysis in the Treatment of Childhood Feeding Problems. Developmental Medicine & Child Neurology, 17(3), 333.

Penrod, B., Gardella, L., Fernand, J. (2012). An evaluation of a progressive high-probability instructional sequence combined with low probability demand fading in the treatment of food selectivity. Journal of Applied Behavior Analysis, 45(3), 527-537.

Seiverling, L. Williams, K., Sturmey, P., & Hart, S. (2012). Effects of behavioral skills training on parental treatment of children’s food selectivity. Journal of Applied Behavior Analysis, 45(1), 197-203.

Vaz, P. C. M., Volkert, V. M., & Piazza, C. C. (2011). Using negative reinforcement to increase self-feeding in a child with food selectivity. Journal of Applied Behavior Analysis, 44(4), 915– 920.

The Formative Years of Life

All children develop at different speeds. Popcorn is prepared in the same pot, in the same heat, in the same oil, and yet the kernals do not pop at the same time. Don’t compare your child to other children. Their turn to pop is coming!

299.00 (F84.0)

Autism is a lifelong neuro-developmental disability that affects the development of the brain in areas of social interaction and communication. People with autism have difficulties in communicating and forming relationships with people, in developing language and in using abstract concepts. It also impacts on their ability to make sense of the world around them. It was first described by Leo Kanner in 1943. The following year in 1944, a German scientist named Hans Asperger describes a "milder" form of autism now known as Asperger's Syndrome. It wasn't until 1994 that Asperger's Syndrome was added to the DSM, expanding the autism spectrum to include milder cases in which individuals tend to be more highly functioning.

 

Over the years, the definition, classification and diagnostic specifics of autism have undergone many significant changes. In 2013 the DSM-5 folded all subcategories of the condition into one umbrella diagnosis of autism spectrum disorder (ASD). Asperger's Syndrome is no longer considered a separate condition. The severity levels for Autism Spectrum Disorder, 299.00 (F84.0) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are outlined below.

Level 3: "Requiring very substantial support"

Social communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.

Restricted, repetitive behaviours: Inflexibility of behaviour, extreme difficulty coping with change, or other restricted / repetitive behaviours markedly interfere with functioning in all spheres. Great distress / difficulty changing focus or action.

Level 2: "Requiring substantial support"

Social communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or  abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited  to narrow special interests, and how has markedly odd nonverbal communication.

Restricted, repetitive behaviours: Inflexibility of behaviour, difficulty coping with change, or other restricted / repetitive behaviours appear frequently enough to be obvious to the casual observer and interfere with functioning in  a variety of contexts. Distress and / or difficulty changing focus or action.

Level 1: "Requiring support"

Social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

Restricted, repetitive behaviours: Inflexibility of behaviour causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

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'If they can't learn the way we teach, we teach the way they learn' ~ O. Ivar Lovaas