Simultaneous Presentation to Decrease Packing in a Child With a Feeding Disorder

Abstract

Children with feeding disorders may pack food (i.e., hold food in the mouth for a prolonged period of time). Treatments to target packing exist, including reinforcement contingencies, redistribution, and chasers, but these strategies are not always effective. Simultaneous presentation has also been used to reduce packing; however, it has not been faded out. The current study expanded this literature by using a treatment package, which included simultaneous presentation, to decrease packing in a 4-year-old boy with autism and food selectivity who packed nonpreferred foods. The simultaneous presentation component was then systematically faded out until generalization occurred. Keywords Fading. Feeding disorder. Packing. Simultaneous presentation Food selectivity is a common referral for children with feeding disorders (Piazza et al., 2002), and multiple behavioral treatment approaches have been evaluated to successfully increase acceptance of a variety of foods and decrease food refusal (Bachmeyer, 2009). However, once acceptance for nonpreferred foods increases, new problem behaviors may emerge (Gulotta, Piazza, Patel, & Layer, 2005). Eating is a complex process involving a chain of behaviors, including sitting and remaining seated during mealtimes, placing the food in the mouth as either a self-feeder or non-self-feeder,

The Role of Occupational Therapy in Managing Food Selectivity of Children with Autism Spectrum Disorder: A Scoping Review

“…Specifically, in Peterson's study, this association was only observed in children who received applied behavioral analysis (ABA) therapy [41]. In addition, included studies showed that the interventions increased the number of foods (food variety) accepted by children [31,[41][42][43][44][45][46][47], decreased inappropriate mealtime behaviors [41,43,45,46], and reduced challenging attitudes during mealtime [47].…”

“…The eight selected studies were conducted in different countries: the USA (n = 6), Mexico (n = 1), and Japan (n = 1). One of the studies included is a randomized clinical trial [41], one is a non-randomized clinical trial [31], one is a pilot study [42], three are case reports [43][44][45], and two are case series [46,47]. All children who participated in the interventions described in the included articles were diagnosed with ASD.…”

“…The diagnosis of ASD was confirmed by an interdisciplinary team (n = 2) [41,47] using different methods such as the Autism Diagnostic Observation Schedule (ADOS) [41,42], ICD-10 checklist [47], DSM-5 checklist [42], interviews with the children's parents [41] and review of medical records [46]. In three articles, there is no information on where or how the diagnosis of ASD was made [43][44][45].…”

“…The main limitation reported regarding the articles included in this scoping review was the small sample size (n = 4) [42,44,45,47]. In addition, articles indicate results difficult to generalize (n = 2) [42,47], did not evaluate the long-term effects of the interventions (n = 2) [46,47], did not provide training for parents after the intervention in order to continue the food presentation at home (n = 1) [41], food presentation differed during the intervention (n = 1) [41], dietary selectivity was difficult to assess (n = 1) [31], a lack of a control group [42], and there could be a carry-over effect of continued sessions (n = 1) [46].…”

“…Finally, Whipple et al [45] developed a program in 2019 to decrease food selectivity related to packing in order to reduce inappropriate behaviors during mealtime and food selectivity. This study is based on the simultaneous presentation of preferred foods alongside non-preferred foods.…”