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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).
TABLE 1 Participant Demographic Characteristics <strong>and</strong> Target Goals: Groups 1, 2, <strong>and</strong> 3 Target Goals <strong>and</strong> Codes Feed<strong>in</strong>g Goals (FG) Mealtime Behavior Goals (MBG) Level of Cognitive Function Feed<strong>in</strong>g Supports Participant <strong>and</strong> Group Number Diagnosis Age Gender Fragile X Syndrome 15 M Moderate Supervision 1. Take small bites (MBG) 2. Swallow between bites (FG) Down Syndrome 17 M Moderate to Severe Supervision 1. Use napk<strong>in</strong> with request (MBG) 2. Swallow between bites (FG) Unknown, Seizure Disorder 14 M Moderate Supervision 1. No spills on self or tray (MBG) 2. Close lips with chew<strong>in</strong>g (FG) 6 M Severe Staff feeds; PEG-tube; wheel 1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon (MBG) chair with head supports; 2. Rhythmic sequence of 2 or more jaw pureed diet; thick liquids movements with chew<strong>in</strong>g (FG) 7 F Severe Staff feeds; pureed diet; adaptive 1. Open mouth <strong>in</strong> anticipation of spoon spoon; PEG-tube; wheel chair, (MBG) position<strong>in</strong>g supports 2. Close lips with spoon<strong>in</strong>g (FG) 4 F Severe Staff feeds; pureed diet; wheel 1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon (MBG) chair with head supports; soft 2. Active lips with spoon<strong>in</strong>g (FG) spoon, tra<strong>in</strong><strong>in</strong>g cup; thick liquids 11 M Severe Supervision 1. Eat a non-preferred food. (MBG) 2. Clean face with no request. (FG) Trisomy 13 Seizure Disorder Visual Impair-ment Cerebral Palsy Seizure Disorder Unknown Bl<strong>in</strong>d Seizure Disorder Group 1 Participant 1 Brett Group 1 Participant 2 Jason Group 1 Participant 3 Denver Group 2 Participant 4 Nate Group 2 Participant 5 Stacy Group 2 Participant 6 Jessica Seizure at birth; effects of encephalitis 1. Assist <strong>in</strong> self-feed<strong>in</strong>g with spoon<strong>in</strong>g. (MBG) 2. Active lips with spoon<strong>in</strong>g. (FG) Group 3 Participant 7 Dust<strong>in</strong> Group 3 Participant 8 Kyle 1. Eat a non-preferred food. (MBG) 2. Clean face without request. (FG) Cerebral Palsy 4 M Severe Staff spoons; bottle for liquids; adaptive bowl, spoon; diced food; wheel chair with head, chest supports Unknown 13 F Severe Staff feeds; pureed diet; thick liquids; adaptive cup, spoon Group 3 Participant 9 Anna Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors / 83
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