A Multi-Component Treatment to Reduce Packing in Children With Feeding and Autism Spectrum Disorders

Abstract

Despite the high prevalence and potential negative consequences of feeding disorders in children with autism spectrum disorder (ASD), there are surprisingly few studies that examine the efficacy of treatment exclusively with these children. Children with feeding disorders also frequently exhibit packing (holding or pocketing food without swallowing). Investigators have evaluated procedures in the general pediatric population to treat packing, and some have shown that procedures need to be combined to form an effective treatment. Although investigators have evaluated the efficacy of re-distribution, swallow facilitation, and a chaser, these procedures have not been evaluated specifically with children with ASD. Prior to the current investigation, we successfully used nonremoval procedures to increase acceptance of pureed foods and liquids and decrease the inappropriate mealtime behavior of two children diagnosed with ASD and feeding problems; however, in each case, packing emerged during initial treatment. We then used different combinations of re-distribution, swallow facilitation, and chaser treatments to decrease packing for both children.

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

“…Thus, diets lacking in important nutrients could lead to additional learning or behavior problems for children with ASD (Rosales et al, ). Fortunately, there are studies showing that we can improve the diet variety of children with ASD using applied behavior analysis (e.g., Ahearn, ; Kadey, Roane, Diaz, & Merrow, ; Laud, Girolami, Boscoe, & Gulotta, ; Levin, Volkert, & Piazza, ; Luiselli, Ricciardi, & Gilligan, ; Tarbox, Schiff, & Najdowski, ; Valdimarsdóttir, Halldórsdóttir, & SigurÐardóttir, ; Wood, Wolery, & Kaiser, ). For example, Kadey et al () expanded the diet variety of two participants diagnosed with ASD who were admitted to an intensive outpatient feeding program for treatment of food selectivity, using nonremoval of the spoon, noncontingent reinforcement, and a physical‐guidance procedure.…”

Further Manipulations in Response Effort or Magnitude of an Aversive Consequence to Increase Self-Feeding in Children with Feeding Disorders

“…For Ezra, we had to combine the above protocol components with blending (Mueller, Piazza, Patel, Kelley, & Pruett, 2004) to increase consumption of nonpreferred foods. For Mickey, once we began introducing variety beyond apple sauce, he continued to pack and we then implemented redistribution combined with swallow facilitation which was not effective (Levin, Volkert, & Piazza, 2014). To re-establish consumption, we implemented escape extinction, differential reinforcement of mouth clean, and a flipped spoon presentation with only apple sauce and then again generalized this treatment to other foods, but it was still difficult to increase the bolus beyond 0.2 cc.…”

“…In addition, the therapist used redistribution and swallow facilitation if Ezra was packing at the 30-s mouth check. That is, the therapist collected the food in Ezra's mouth with a nuk brush (i.e., a plastic utensil that is approximately 12.5 cm long with soft rubbery bristles at one end) and then placed the nuk brush with the food onto the posterior of his tongue while applying gentle pressure to deposit the food (Levin, Volkert, & Piazza, 2014). We used redistribution and swallow facilitation because Ezra began packing the avoidance food.…”

Pocketing of food in cheeks during eating in an adolescent with CHARGE syndrome

“…Pocketing of food in cheeks or food packing has been described in the current literature as holding accepted food in the mouth without swallowing. 2,3 This eating behaviour has previously been described in children with autism. 3 Feeding and swallowing problems are seen in many (>70%) infants with CHARGE syndrome, and of these, the majority have to be tube fed at some point.…”

“…2,3 This eating behaviour has previously been described in children with autism. 3 Feeding and swallowing problems are seen in many (>70%) infants with CHARGE syndrome, and of these, the majority have to be tube fed at some point. Many feeding issues seen in CHARGE syndrome such as problems with chewing, swallowing, reflux and aspiration may be due to cranial nerve dysfunction 1,4 .…”