Using Behavior-Analytic Treatment to Teach Tongue Lateralization Skills to Children With Avoidant/Restrictive Food Intake Disorder

Abstract

Oral-motor skills needed for efficient consumption of table-textured foods (e.g., tongue lateralization) often develop as children are exposed to food at increasingly higher textures (e.g., soft meltable, crunchy, and chewy; Volkert et al., 2014). For children with avoidant/restrictive food intake disorder (ARFID; American Psychiatric Association, 2013; World Health Organization, 2019), these oral-motor skills may not develop without intervention. We review case studies of three children diagnosed with ARFID who did not display the skills necessary for efficient consumption of regular table-textured food. We collaborated with a speech-language pathologist to identify oral-motor targets and used a behavior-analytic treatment to teach tongue lateralization skills necessary for safe and effective chewing. We used a treatment package consisting of nonremoval of the utensil with prompting and differential reinforcement to shape functional tongue movements. We discuss considerations for practitioners and the importance of individualized treatment and collaboration with other disciplines while teaching oral-motor skills necessary for chewing and consuming table-textured food.

A Scoping Review of Psychological Interventions and Outcomes for Avoidant and Restrictive Food Intake Disorder (ARFID)

“…as providing attention for a desired behavior and not giving attention for undesirable eating and mealtime behaviors. Several studies involved escape extinction, in which the patient is not allowed to "escape" the feeding demand through re-presenting the food or not removing a spoonful of food (e.g.,McMahon et al, 2022;Phipps et al, 2022;Sharp et al, 2016). Working closely with parents was central to behavioral interventions, including didactic instruction, in vivo therapist feedback, modeling, and role-play with parents (e.g.,Bloomfield et al, 2019;Taylor et al, 2019).…”

A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID)

“…Differential reinforcement was also common, such as providing attention for a desired behavior and not giving attention for undesirable eating and mealtime behaviors. Several studies involved escape extinction, in which the patient is not allowed to “escape” the feeding demand through re‐presenting the food or not removing a spoonful of food (e.g., McMahon et al, 2022; Phipps et al, 2022; Sharp et al, 2016). Working closely with parents was central to behavioral interventions, including didactic instruction, in vivo therapist feedback, modeling, and role‐play with parents (e.g., Bloomfield et al, 2019; Taylor et al, 2019).…”

Assessment of Chewing in Children With Down Syndrome

“…This finding is problematic as existing research indicates that a lack of appropriate early experience with high-texture foods contributes to delays in the development of chewing, thus, emphasizing the critical role of practice in the development of rotary chewing ( Beckett et al, 2002 ). Similarly, Phipps et al (2022) also advocated for practice with increasingly higher texture foods in order to develop the basic skills necessary to consume regular texture foods.…”

“…In addition, they reported that adaptation of jaw control to different food consistencies was an important component in the development of rotary chewing. Phipps et al (2022) suggested that the components involved with chewing develop only when children are exposed to higher texture foods.…”

“…However, the KCPS does not provide a clear level of functioning of the separate chewing components which could better guide intervention. In this regard, Phipps et al (2022) assessed tongue lateralization with and without food present in the mouth. This method of assessment allowed for the observation of tongue movements (left, right, as well as movements to the lower and upper lip) required to perform tongue lateralization.…”