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

Method
Sett<strong>in</strong>g
The sett<strong>in</strong>g was an elementary <strong>and</strong> a junior
high school with<strong>in</strong> a public school district,
located with<strong>in</strong> a town of approximately 45,000
people, with 10,416 students mak<strong>in</strong>g up the
district’s population. Of this number, 1470
students received special education <strong>and</strong> related
services. Three participants ate their
meals <strong>in</strong> the lunchroom with peers, while six
participants were fed by school personnel <strong>in</strong>
their classrooms, due to safety concerns, need
for proximity to healthcare personnel, <strong>and</strong>/or
perceived negative effects of the distract<strong>in</strong>g
lunchroom environment.
Participants
Participants were n<strong>in</strong>e children <strong>and</strong> youth
with moderate to severe/profound cognitive
disabilities between the ages of 4 <strong>and</strong> 17. All
participants received special education services
<strong>and</strong> had been previously identified with
feed<strong>in</strong>g impairments to the extent to which
they were fed, assisted <strong>in</strong> feed<strong>in</strong>g, or supervised
dur<strong>in</strong>g self-feed<strong>in</strong>g <strong>in</strong> the school environment.
Categories of cognitive <strong>and</strong> physical
disability were established <strong>in</strong> compliance with
the criteria stated <strong>in</strong> the Individuals with <strong>Disabilities</strong>
<strong>Education</strong> Act (P.L. 101-476). Licensed
psychologists <strong>and</strong> students’ eligibility
teams had made a determ<strong>in</strong>ation of participants’
classification through use of appropriate
measures of general <strong>in</strong>tellectual function<strong>in</strong>g
<strong>and</strong> adaptive behavior. See Table 1 for
participant demographic characteristics <strong>and</strong>
goal targets. Two participant groups (1 <strong>and</strong> 2)
were formed by convenience, that is, they
were grouped by classroom <strong>and</strong> schedules.
Group 3 was formed with one participant
from one classroom <strong>and</strong> two participants from
another classroom to achieve equal numbers
<strong>in</strong> each group.
Brett, Participant 1, was a 15-year-old male
diagnosed with Fragile X syndrome <strong>and</strong> associated
developmental delays. His cognitive disability
was estimated at moderate/severe. Observation,
<strong>in</strong>terviews, <strong>and</strong> the Schedule for Oral
Motor Assessment (SOMA) (Skuse, Stevenson,
Reilly, & Mathisen, 1995) evaluation revealed
the follow<strong>in</strong>g feed<strong>in</strong>g characteristics: (a) stuff<strong>in</strong>g
his mouth with large bites of food, (b)
82 / <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
often not swallow<strong>in</strong>g between bites, <strong>and</strong> (c)
apparent decreased awareness of food on his
face as evidenced by lack of appropriate napk<strong>in</strong>
use. Brett was considered at risk for chok<strong>in</strong>g
due to the large bites of food <strong>in</strong> his mouth
prior to swallow<strong>in</strong>g. Additionally, these mealtime
behaviors were not considered to be socially
acceptable. Two primary goals were
identified for Brett (see Table 1).
Jason, Participant 2, was a 17-year-old male
diagnosed with Down syndrome <strong>and</strong> associated
developmental delays. His level of cognitive
disability was estimated at moderate/severe.
Observation, <strong>in</strong>terviews, <strong>and</strong> the SOMA
evaluation revealed the primary feed<strong>in</strong>g characteristics:
(a) stuff<strong>in</strong>g his mouth with large
bites of food, (b) often not swallow<strong>in</strong>g between
bites; (c) decreased chew<strong>in</strong>g ability, (d)
severe tongue thrust, <strong>and</strong> (e) apparent decreased
awareness of food on his face as evidenced
of lack of appropriate napk<strong>in</strong> use.
Two primary goals were identified for Jason
(see Table 1).
Denver, Participant 3, was a 14-year-old
male diagnosed with seizure disorder <strong>and</strong> developmental
delays of unknown orig<strong>in</strong>. His
level of cognitive disability was estimated at
moderate. Observation, <strong>in</strong>terviews, <strong>and</strong> the
SOMA evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) many food spills from
the spoon <strong>and</strong> the mouth while eat<strong>in</strong>g <strong>and</strong> (b)
open mouth/lips with chew<strong>in</strong>g. While these
characteristics did not place him at a high risk
for chok<strong>in</strong>g, they were determ<strong>in</strong>ed to decrease
social acceptability. Therefore, two
goals were identified for Denver (see Table 1).
Nate, Participant 4, was a 6-year-old male
diagnosed with Trisomy 13, a secondary seizure
disorder, <strong>and</strong> m<strong>in</strong>imal vision. The level
of Nate’s cognitive disability was estimated at
severe. Although Nate had a percutaneous
endoscopic gastronomy (PEG) tube, it was reportedly
used only when he was ill. Nate exhibited
sensory defensiveness by cry<strong>in</strong>g or
mov<strong>in</strong>g away when touched around or <strong>in</strong> the
mouth. Observation, <strong>in</strong>terviews, <strong>and</strong> the
SOMA evaluation revealed the follow<strong>in</strong>g feed<strong>in</strong>g
characteristics: (a) a passive oral manipulation
of food for “textured” pureed consistency
<strong>and</strong> (b) total dependence on the feeder
for the provision of food, although Nate had
the physical ability to br<strong>in</strong>g his h<strong>and</strong> toward
his face <strong>in</strong> other circumstances. Two primary
goals were identified for Nate (see Table 1).