Education and Training in Developmental Disabilities - Division on ...

<strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>, 2005, 40(1), 80–96
© <strong>Division</strong> on <strong>Developmental</strong> <strong>Disabilities</strong>
Improv<strong>in</strong>g Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors <strong>in</strong> Children
<strong>and</strong> Youth with <strong>Disabilities</strong>
Rita L. Bailey <strong>and</strong> Maureen E. Angell
Ill<strong>in</strong>ois State University
Abstract: A s<strong>in</strong>gle-subject multiple treatment design counterbalanced across n<strong>in</strong>e participants with moderate to
severe <strong>and</strong> multiple disabilities was used to determ<strong>in</strong>e the efficacy of a school-based multi-treatment package (a
comb<strong>in</strong>ed dysphagia treatment <strong>and</strong> positive re<strong>in</strong>forcement behavior management program) for children <strong>and</strong>
youth (ages 4-17) with feed<strong>in</strong>g problems as compared to use of a dysphagia treatment program or a positive
re<strong>in</strong>forcement behavior management program alone. While results found improvement <strong>in</strong> development of feed<strong>in</strong>g
skills <strong>and</strong> positive mealtime behaviors with all <strong>in</strong>tervention programs, the comb<strong>in</strong>ed <strong>in</strong>tervention package was
the most effective <strong>in</strong>tervention strategy. These results may help professionals establish best practices for treatment
of feed<strong>in</strong>g problems <strong>in</strong> schools.
Problematic mealtime behaviors are a common
f<strong>in</strong>d<strong>in</strong>g <strong>in</strong> children diagnosed with feed<strong>in</strong>g
<strong>and</strong>/or swallow<strong>in</strong>g problems collectively
known as dysphagia (Arvedson, 1997; Kerw<strong>in</strong>,
1999; Logemann, 2000; Munk & Repp, 1994).
These behaviors may develop for a variety of
reasons <strong>and</strong> range from those that are socially
<strong>in</strong>appropriate to those that have a detrimental
effect on nutrition <strong>and</strong> health. These challenges
often make mealtimes unpleasant.
Many problems that children experience <strong>in</strong>
the areas of feed<strong>in</strong>g, growth, <strong>and</strong> food acceptance
have been attributed to a comb<strong>in</strong>ation
of the medical or physical condition of the
child, <strong>in</strong>appropriate food selection, <strong>and</strong>/or
<strong>in</strong>appropriate dynamics dur<strong>in</strong>g feed<strong>in</strong>g (Satter,
1990). Inappropriate caregiver-child <strong>in</strong>teractions
that have been found to precipitate
problems may <strong>in</strong>clude attention for negative
behaviors, responses to attempts at forced
feed<strong>in</strong>g, <strong>and</strong> reduction of feed<strong>in</strong>g choices due
to food selectivity preferences <strong>in</strong> children
(Christophersen & Hall, 1978).
Children with dysphagia may f<strong>in</strong>d mealtimes
stressful <strong>and</strong> unpleasant. If children
have experienced airway compromise such as
occurs with aspiration <strong>and</strong> chok<strong>in</strong>g, they may
associate these negative experiences with the
Correspondence concern<strong>in</strong>g this article should
be addressed to Rita L. Bailey, Department of Special
<strong>Education</strong>, Ill<strong>in</strong>ois State University, Campus
Box 5910, Normal, IL 61790-5910.
act of eat<strong>in</strong>g. Medically fragile children are
often subjected to medically necessary but <strong>in</strong>trusive
<strong>and</strong> aversive oral/facial sensory <strong>in</strong>puts.
Suction<strong>in</strong>g, oral <strong>and</strong> nasal gastric tube placement,
<strong>and</strong> the use of facial tape to secure
tubes may lead to tactile defensiveness <strong>and</strong>
oral hypersensitivity (Comrie & Helm, 1997).
Early experiences with oral sensory stimuli are
often limited for children with neurological
<strong>and</strong>/or physical impairments, especially for
those who experience extensive episodes of
hospitalization. This may limit new <strong>and</strong> repeated
exposure to foods. This lack of oral
sensory experiences may lead to food aversions
<strong>and</strong> refusals, a common f<strong>in</strong>d<strong>in</strong>g <strong>in</strong> children
with eat<strong>in</strong>g disturbances (Pelchat &
Pl<strong>in</strong>er, 1986). Early experience <strong>and</strong> repeated
exposure to new foods contributes to development
of food acceptance patterns <strong>and</strong> control
of food <strong>in</strong>take. In fact, most children are likely
to reject new foods <strong>in</strong>itially, but they learn to
like them with time <strong>and</strong> repeated neutral exposure
(Birch, Johnson, & Fisher, 1995; Birch
& Marl<strong>in</strong>, 1982). It is clear that eat<strong>in</strong>g does
not exist <strong>in</strong> isolation from the context <strong>in</strong>
which it takes place. Caregiver <strong>in</strong>fluences,
physical conditions, social, psychological factors,
<strong>and</strong> the feed<strong>in</strong>g environment impact the
development of feed<strong>in</strong>g.
Statement of the Problem
80 / <strong>Education</strong> <strong>and</strong> <strong>Tra<strong>in</strong><strong>in</strong>g</strong> <strong>in</strong> <strong>Developmental</strong> <strong>Disabilities</strong>-March 2005
Children with comb<strong>in</strong>ed dysphagia <strong>and</strong> problematic
mealtime behaviors present a particu-