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

A functional relationship was established
between use of a comb<strong>in</strong>ed <strong>in</strong>tervention package
<strong>and</strong> development of feed<strong>in</strong>g skills. Across
all participants <strong>and</strong> feed<strong>in</strong>g skills, a mean ga<strong>in</strong>
of 15% was made <strong>in</strong> the BC condition <strong>and</strong> 7%
<strong>in</strong> the BC2 condition. This is remarkable
progress, given the developmental nature of
feed<strong>in</strong>g skill acquisition (Guerra & Vaughn,
1994). Several participants (i.e., Brett, Jason,
Denver, <strong>and</strong> Stacy) exhibited ga<strong>in</strong>s of more
than 20% <strong>in</strong> the BC condition. A functional
relationship was also found between use of the
comb<strong>in</strong>ed <strong>in</strong>tervention package <strong>and</strong> development
of positive mealtime behaviors. A mean
ga<strong>in</strong> of 25% was recorded for all participants
<strong>and</strong> across positive mealtime behavior goals <strong>in</strong>
the BC condition. An additional mean ga<strong>in</strong> of
4% was recorded <strong>in</strong> the BC2 condition. Several
participants (i.e., Brett, Jason, Denver,
<strong>and</strong> Stacy) exhibited mean ga<strong>in</strong>s above 20% <strong>in</strong>
the BC condition. Dust<strong>in</strong> <strong>and</strong> Anna exhibited
mean ga<strong>in</strong>s above 20% <strong>in</strong> the BC2 condition.
A stronger relationship was found between
improvement of feed<strong>in</strong>g skills <strong>and</strong> positive
mealtime behaviors with use of the comb<strong>in</strong>ed
<strong>in</strong>tervention package (BC) than with use of
the dysphagia treatment program (B) alone
or the PRBMP (C) alone. Across all participants
<strong>and</strong> goals, the comb<strong>in</strong>ed <strong>in</strong>tervention
package yielded the greatest improvements
(20%). Ga<strong>in</strong>s recorded <strong>in</strong> the BC were greater
than ga<strong>in</strong>s made <strong>in</strong> the B condition (8%) or <strong>in</strong>
the C condition (6%). Greater mean ga<strong>in</strong>s
were recorded <strong>in</strong> improvement of positive
mealtime behaviors (25% <strong>in</strong> BC) with the
comb<strong>in</strong>ed <strong>in</strong>tervention approach than <strong>in</strong> development
of feed<strong>in</strong>g skills (15% <strong>in</strong> BC)
across all participants. These results may <strong>in</strong>dicate
that development of feed<strong>in</strong>g skills may be
a more difficult process than changes <strong>in</strong> behavior.
These results support use of a comb<strong>in</strong>ed
<strong>in</strong>tervention package for treatment of
both feed<strong>in</strong>g skill deficits <strong>and</strong> problematic
mealtime behaviors across a variety of disability
conditions <strong>and</strong> ages. While significant evidence
exists that feed<strong>in</strong>g problems often
<strong>in</strong>volve a comb<strong>in</strong>ation of physical <strong>and</strong> behavioral
issues (e.g., Arvedson, 1997; Gisel, Birnbaum,
& Schwartz, 1997; Logemann, 2000),
the efficacy of dysphagia <strong>and</strong> PRBMP treatment
<strong>in</strong>terventions has not been previously
evaluated <strong>in</strong> a way that determ<strong>in</strong>es the effects
of each <strong>in</strong>tervention separately <strong>and</strong> <strong>in</strong> comb<strong>in</strong>ation
to isolate the effects of the <strong>in</strong>terven-
tions. This <strong>in</strong>vestigation used a multiple treatment
design across n<strong>in</strong>e participants with
moderate to severe <strong>in</strong>tellectual disabilities, a
wide range of ages, diagnoses, <strong>and</strong> feed<strong>in</strong>g
skill <strong>and</strong> mealtime behavior deficits <strong>in</strong> three
school sett<strong>in</strong>gs.
A mean decrease of 7% <strong>in</strong> feed<strong>in</strong>g skills was
recorded across all participants <strong>in</strong> the BC
condition, although results varied across participants
(see Table 2). This f<strong>in</strong>d<strong>in</strong>g underscores
the need for advanced tra<strong>in</strong><strong>in</strong>g <strong>and</strong>
support for school staff members work<strong>in</strong>g with
children <strong>and</strong> youth with feed<strong>in</strong>g problems. No
participant returned to pre<strong>in</strong>tervention levels
as a result of staff implemented <strong>in</strong>terventions.
A positive f<strong>in</strong>d<strong>in</strong>g was that a mean ga<strong>in</strong> of 10%
occurred across groups <strong>in</strong> behavior goals
when school staff members provided <strong>in</strong>terventions
<strong>in</strong> the BC condition. Further research
is needed to confirm f<strong>in</strong>d<strong>in</strong>gs of this study <strong>and</strong>
to determ<strong>in</strong>e effects of additional <strong>in</strong>tervention
comb<strong>in</strong>ations that will enhance the nutrition
<strong>and</strong> health of children <strong>and</strong> youth with disabilities.
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