Addressing Feeding Disorders Using High-Probability Sequencing for Children and Adolescents with Developmental Disabilities

Abstract

Feeding disorders exhibited by children with developmental disabilities, which include limiting food intake or refusing to consume solid foods, often result in poor health consequences. Interventions for feeding disorders vary in terms of their acceptability to children with disabilities and their families. One specific procedure, the high-probability sequence, is a nonrestrictive approach where requests with which a child has a history of compliance are presented prior to requests associated with noncompliance. This article reviewed research concerning the application of high-probability sequencing for feeding disorders among children and adolescents with developmental disabilities. Experimental studies published between 1970 and 2018 in English as either peer-reviewed articles or dissertations were eligible for descriptive review. Identified articles ( N = 15) evaluated high-probability sequencing using various single-case experimental designs. Participants ( N = 21) were generally preschool-aged children (mean age = 5.7 years) diagnosed with autism spectrum disorder (ASD; n = 9) or other developmental disabilities ( n = 12). Subsequent analysis of articles that met quality indicators of the What Works Clearinghouse ( n = 12) suggests that research does not support the effectiveness of the procedure for increasing food acceptance. Implications for practice and future studies involving high-probability sequencing follow a discussion of findings.

Blending as a treatment for feeding disorders: A review of the literature

“…Blending required postimplementation alterations in order to succeed in two studies (e.g., simultaneous presentation; Najdowski et al, 2012;escape extinction;Shore et al, 1998) and did not result in criterion levels of consumption in a single study (Leadley, 2018). In general, child participants appeared to exhibit more severe disabilities and feeding disorders than children featured in literature concerning other nonrestrictive interventions (e.g., high-probability sequencing; King et al, 2019). Rather than unhealthy eating habits (e.g., refusal to eat vegetables; Penrod, Gardella, & Fernand, 2012), many of the children in the blending literature received clinic-based intervention for either refusing to consume solid food or for severe selectivity.…”

“…The WWC guidelines (2017) define the case as the unit of analysis for determining the relationship between an independent variable and changes in outcomes. We identified and defined cases in accordance with the explicit procedures described by King et al (2019). Cases, defined as designs with the potential to demonstrate at least two replications within or across participants (e.g., ABA design) of the effect of blending relative to a single comparison data path, did not include AB phase contrasts unless such a comparison represented the only analysis presented by the researchers.…”

“…Deriving the total PND for each case involved averaging comparison values across conditions. In accordance with the procedures employed by King et al (2019), we associated the PND values with small (<50%), moderate (values of 50%–70%), or large (values of >70%) effects.…”

“…Additional nonrestrictive intervention involves altering the presentation of food. High-probability sequencing increases food acceptance by presenting preferred food items prior to nonpreferred foods (King, Johnson, Burch, & Chitiyo, 2019). Similarly, simultaneous presentation involves presenting preferred and nonpreferred foods together (e.g., placing a nonpreferred food on the same spoon as a preferred food; Volkert et al, 2016).…”