No abstract

Parents play an important role in the treatment of their children's symptoms of autism spectrum disorder (ASD); thus, developing effective, efficient, socially acceptable, and accessible procedures for training parents to implement applied-behavior-analysis (ABA) interventions is critically important. One potential approach involves delivering training via a virtual private network (VPN) over the internet (Fisher et al., 2014). In this study, we conducted a randomized clinical trial to evaluate a virtual parent-training program with e-learning modules and scripted role-play via a VPN. We evaluated parent implementation of ABA skills using direct-observation measures in structured-work and play-based training contexts. Parents in the treatment group showed large, statistically significant improvements on all dependent measures; those in the waitlist-control group did not. Parents rated the training as highly socially acceptable. Results add to the growing literature on the efficacy and acceptability of virtually delivered training in ABA.

Functional analyses of inappropriate mealtime behavior typically include conditions to determine if the contingent delivery of attention, tangible items, or escape reinforce food refusal. In the current investigation, descriptive analyses were conducted for 25 children who had been admitted to a program for the assessment and treatment of food refusal to determine if the consequences commonly delivered during functional analyses were observed during parent-conducted meals. The conditional probabilities for the delivery of attention, tangible items, and escape following food refusal and acceptance were compared to the unconditional probabilities of each event. Results showed that attention and escape most frequently followed refusal and differed depending on the topography of refusal. Implications for further evaluations of food refusal using similar methods are discussed.

Introduction Avoidant and restrictive food intake disorder (ARFID) is characterized by restrictions in oral intake and does not include concerns related to body image. Despite the evidence-based medical and behavioral treatments, there is limited research as they apply to ARFID, but the extant research supports hospital-based behavioral therapy. Individuals with ARFID may have comorbidities that can affect treatment, which requires multidisciplinary treatment to provide effective care. Supplementary sources of nutrition may be required for individuals with this diagnosis to ensure they maintain proper nutritional status (eg, enteral feeding). Methods A record review from 2015 to 2019 identified 16 participants admitted to an inpatient hospital. Of the sample, 75% of participants had a psychiatric diagnosis and 88% of participants experienced an acute event that preceded their feeding difficulties. Each participant received medical oversight, and instead of a standard treatment approach, behavioral treatment components were individualized based on each participants’ presentation. Results All participants met at least 80% of their admission treatment goals, and 92% of participants who completed their admission consumed 100% of their nutritional needs orally. Follow-up data indicate sustained progress for several months following discharge. Conclusion Our results suggest that a multidisciplinary, medical, and behavioral treatment model is effective for a variety of clinical presentations of ARFID. More research is needed on triggering events that precede restricted food and liquid intake. In addition, the extent to which these treatment components are preferred should be assessed in an effort to maintain treatment gains after discharge.