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

vidually identified feed<strong>in</strong>g skill deficits us<strong>in</strong>g
the SOMA scor<strong>in</strong>g sheet descriptions <strong>and</strong> a
written description of normal development of
feed<strong>in</strong>g skills (Guerra & Vaughn, 1994). The
PI <strong>and</strong> additional SLP <strong>in</strong>dividually listed feed<strong>in</strong>g
skill deficits that each identified as primary
for each participant. These two <strong>in</strong>dividuals
met <strong>and</strong> compared their lists of primary
feed<strong>in</strong>g skill deficits. When a feed<strong>in</strong>g skill deficit
was identified by both the PI <strong>and</strong> the
additional SLP, it was added to a list of potential
feed<strong>in</strong>g skill goals for that participant. The
PI <strong>and</strong> additional SLP reviewed tapes together
<strong>and</strong> discussed potential goals until the two
came to an agreement regard<strong>in</strong>g the primary
feed<strong>in</strong>g skill deficit for each participant. The
SOMA evaluation was used as a structured
method for assist<strong>in</strong>g <strong>in</strong> identification of feed<strong>in</strong>g
skill deficits only. SOMA scores were not
computed because the test was devised for
<strong>in</strong>fants <strong>and</strong> young children.
Behavior goals were identified by <strong>in</strong>terviews
with teachers, related services staff, <strong>and</strong> parents/caregivers
of the participants. Follow<strong>in</strong>g
<strong>in</strong>terviews, the PI completed <strong>in</strong>formal observations
of mealtimes to confirm presence of
behaviors. Next, a list of potential behavior
goals was created for each participant. The PI
<strong>and</strong> Co-PI (a university Department of Special
<strong>Education</strong> faculty member <strong>and</strong> behavior specialist)
used the list to determ<strong>in</strong>e a primary
positive mealtime behavior goals for each participant.
Design
An A-BC-C-BC2-BC multiple treatment design
across three groups of three participants
(Baer, Wolf, & Risley, 1968) with brief withdrawal
conditions (Birnbrauer, Peterson, &
Solnick, 1974; Herson & Barlow, 1976) was
used to evaluate the effectiveness of an <strong>in</strong>tervention
package (B – a dysphagia treatment
program <strong>and</strong>C–aPRBMP) on the dependent
variables (<strong>in</strong>dividually identified feed<strong>in</strong>g skill
<strong>and</strong> positive mealtime behavior goals) of <strong>in</strong>dividuals
with moderate, severe, or multiple disabilities.
Consider<strong>in</strong>g the ethical implications
of a withdraw<strong>in</strong>g all treatments for children
with severe feed<strong>in</strong>g problems, the researchers
chose to implement a brief withdrawal of one
of the two <strong>in</strong>terventions dur<strong>in</strong>g the withdrawal
conditions. With<strong>in</strong> this design, the dependent
variables were measured under basel<strong>in</strong>e con-
ditions, <strong>and</strong> the <strong>in</strong>terventions were <strong>in</strong>troduced
<strong>in</strong> a counterbalanced sequence to three
groups of children <strong>and</strong> youth. The multiple
treatment design was chosen as it has been
reported as useful <strong>in</strong> ask<strong>in</strong>g, “Would X <strong>in</strong>tervention
work better than Y <strong>in</strong>tervention” (Holcombe,
Wolery, & Gast, 1994). Individual performance
data were recorded for each
<strong>in</strong>tervention session. Individual <strong>and</strong> comparative
group results were obta<strong>in</strong>ed across each
study condition.
Each participant group was exposed to six
conditions. Basel<strong>in</strong>e condition (A) consisted
of a SOMA evaluation <strong>and</strong> pre-<strong>in</strong>tervention
observations. The BC condition <strong>in</strong>volved a
dysphagia treatment program comb<strong>in</strong>ed with
a PRBMP. For the B <strong>and</strong> C conditions, either
the dysphagia treatment program alone or the
PRBMP alone was implemented (i.e., either B
or C was withdrawn). The B <strong>and</strong> C conditions
were counterbalanced across groups. The BC2
condition <strong>in</strong>volved a return to the dysphagia
treatment program comb<strong>in</strong>ed with the
PRBMP. The BC condition <strong>in</strong>volved the dysphagia
treatment program comb<strong>in</strong>ed with the
PRBMP implemented by the tra<strong>in</strong>ed classroom
staff <strong>and</strong> personnel.
Basel<strong>in</strong>e Condition
The PI <strong>and</strong> graduate students with<strong>in</strong> a university
Department of Speech Pathology <strong>and</strong> Audiology
charted basel<strong>in</strong>e percentages of accurate
responses. Dur<strong>in</strong>g basel<strong>in</strong>e condition,
participants were fed by the same school staff
as dur<strong>in</strong>g the SOMA evaluations. The graduate
students were tra<strong>in</strong>ed <strong>in</strong> the use of a plus ()
<strong>and</strong> m<strong>in</strong>us (-) system to chart accurate performance
of target skills <strong>and</strong> behaviors. In this
system, graduate students recorded a plus ()
sign if participants performed the target skill
or behavior <strong>and</strong> a (-) sign if participants did
not perform the target behavior for each bite
or opportunity. Graduate students demonstrated
a functional underst<strong>and</strong><strong>in</strong>g of the
<strong>and</strong> – system prior to <strong>in</strong>itiation of the first
basel<strong>in</strong>e session. One of Denver’s goals required
an <strong>in</strong>terval record<strong>in</strong>g method. For this
method, graduate students were <strong>in</strong>structed to
use a stopwatch <strong>and</strong> make a slash mark for
number of events that occurred dur<strong>in</strong>g each
<strong>in</strong>terval. At the end of each session, marks
were tallied <strong>and</strong> divided by the number of
m<strong>in</strong>utes <strong>in</strong> the session to yield the rate of
Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors / 85