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Pleasing the Picky Eater

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Picky eating is a prevalent problem for children with developmental disorders (DDs) (Silbaugh et al., 2016). The lack of nutrients and energy resulting from a picky diet can add additional complexities to their life and treatment. The "picky" variable takes many forms. The color, brand, texture, or taste may contribute to a child's selection of food (i.e., a child will only eat foods of a specific color or of a specific brand). Others will eat a variety of foods but will only consume small amounts of food or drinks.

Try a Food Diary

Recording the foods consumed, the time of consumption, and the amount consumed is a good place to begin. In a few cases, tracking such variables alleviated many concerns allowing everyone to have a clear idea of the child's current eating habits, which serves as an important baseline. It also revealed what the remaining issues were.

Call Upon Your Behavior Analyst

From there, it is helpful to stick to basic behavior analytic techniques, such as forming a functional hypothesis – (i.e., hypothesizing why the child is engaging in picky eating behaviors) - and treating the behavior accordingly (Piazza et al., 2015). However, Silbaugh et al., (2016) pointed out that direct assessments by behavior analysts and the formation of a functional hypothesis for the treatment of food selectivity is not occurring enough. Ask your behavior analyst to directly observe your child during meals in multiple settings (at the clinic, home, restaurant, etc.). This can be done using video recording or live.

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Extinction

Many of the functional hypotheses that have been formed in published literature have hypothesized that food refusal has an escape function (e.g., children refuse food to avoid eating less preferred foods). This can be treated by ceasing to remove the foods following refusal (Penrod et al., 2012). This is called extinction. Extinction alone is not recommended and should be paired with reinforcement. Many researchers have used escape extinction and reinforcement (rewards) to successfully treat the picky eating paradigm.

Sometimes additional elements are also needed, such as:

· Modeling (Fu, Penrod, Fernand, Whelan, Griffith, & Medved, 2015)

· If-then statements

· Praise

· High probability sequences (e.g., give the child 3 bites of something preferred before giving 1 bite of a less preferred edible) (Ewry & Fryling, 2015)

· Physical prompts

· Desensitization

· Conditioning

· Shaping (gradually increasing the amount of food your child is expected to eat – aka stimulus fading) (Freeman & Piazza, 1998)

· Token economy

If-then Statements

Others have also found that picky eating behaviors are occurring because they result in preferred items, usually preferred foods. Sometimes, when problem behaviors occur, children are given promises of preferred items (e.g., "If you eat three bites of peas, then you can play outside") (Penrod, Gardella, & Fernand, 2012). If-then statements are great; however, if they are only occurring after problem behavior, like food refusal, the child may engage in the problem behavior simply to gain access to such promises. This can be avoided by consistently giving if-then statements prior to problem behaviors. If this occurs, creating a plan to fade out the if-then statements will also be needed.

Token Economy and Visual Menus

With so many treatment options, selecting the right one can be daunting. To narrow the options, try looking at what your child already responds well to. For example, some children may already be very responsive to tokens so the use of a simple token economy at the table may be appropriate and effective. The procedure might look like this: a child is required to take one bite of a less preferred food before earning a token and after receiving a designated number of tokens he will then be allowed to remove the less preferred foods and/or receive preferred foods. Also, some children may be very visual and benefit from visual schedules. For such kiddos, it may be appropriate to create a visual menu of food items and allow the child to choose what foods are prepared for him.

Have a Plan

When treating behaviors, it is vital to have a clear plan. Before introducing an intervention, clearly defining the problem AND the goal will give the intervention direction, as well as a way to measure efficacy and progress. Simply saying, "He needs to eat more" is too vague. What foods need to be introduced? How much food needs to be consumed in a day? What is the normal range for this child's age, height, and weight? The child's pediatrician may need to be consulted to guide some of these answers. Once these vital questions are answered, how are you going to get from the current situation, to the end goal? Will the child work on one food at a time? How many bites of food will be required before moving onto the next food? When and how can the intervention be faded out?

At the end of the day, your child's health and development is the focus. Having a clear plan based on behavior analytic technology will help you recognize if progress, even when it is slow, is being made. Also, if you have a clear plan, then it can be shared with the babysitter, grandparent, etc. This will allow consistency and ensure that your child knows what to expect and is expected to him/her at meal times. Further, that the improvments are the result of the treatment that you are using. Pleasing the picky eater can take a lot of time, but through behavior analysis there is a lot of hope.

References

Ewry, D. M., & Fryling, M. J. (2015). Evaluating the high-probability instructional sequence to increase the acceptance of foods with an adolescent with autism. Behavior Analysis in Practice. 9(4), 380-383.

Freeman, K. A., & Piazza, C. C. (1998). Combining stimulus fading, reinforcement, and extinction to treat food refusal. Journal of Applied Behavior Analysis, 31, 691-694.

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, 39,771-784.

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, 527-537.

Piazza, C. C., Milnes, S. M., & Shalev, R. A. (2015). A behavior-analytic approach to the assessment and treatment of pediatric feeding disorders. In Roane, H. S., Ringdahl, J. L., & Falcomata, T. S. (Eds), Clinical and organizational applications of applied behavior analysis. Elsevier.

Silbaugh, B. C., Penrod, B., Whelan, C. M., Hernandez, D. A., Wingate, H. V., Falcomata T. S., Lang R. (2016). A systematic synthesis of behavioral interventions for food selectivity of children with autism spectrum disorders. Review Journal of Autism and Developmental Disorders, 3(4), 345-357.

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Stephanie Bewley received her Bachelor of Science in Psychology from Northern Arizona University and her Master of Education in Curriculum and Instruction with an emphasis in Teaching and Learning and a specialization in Applied Behavior Analysis from Arizona State University. She has experience implementing ABA services in clinics, schools (including inclusion), social groups, communities, homes, and vocations. Stephanie has provided ABA Therapy since in 2011 and has been with The Shape of Behavior since 2014 when the San Angelo, TX Clinic was opened.

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Guest Sunday, 20 May 2018
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