The findings indicate caution about encouragement of maximal self-care autonomy among youth with IDDM and suggest that families who succeed in maintaining parental involvement in diabetes management may have better outcomes.

To date, no standardized measures have been developed to evaluate the mealtime behavior of children with autism. The Brief Autism Mealtime Behavior Inventory (BAMBI) was designed to measure mealtime behavior problems observed in children with autism. Caregivers of 40 typically developing children and 68 children with autism completed the BAMBI, the Behavioral Pediatric Feeding Assessment Scale (BPFAS), the Gilliam Autism Rating Scale (GARS), the Youth/Adolescent Questionnaire (YAQ), and a 24-hour recall interview. The BAMBI demonstrated good internal consistency, high test-retest reliability, a clear factor structure, and strong construct and criterion-related validity in the measurement of mealtime behavior problems in children with autism.

The effectiveness of behavioral interventions for pediatric feedings problems has been well documented. However, the application of these procedures in the real world is often more complex and difficult than research reports reveal. Multiple factors such as the child's medical condition and history, medical monitoring requirements, and the need to adjust treatment procedures as intervention progresses make it difficult to follow the best-laid plans developed from reading structured and highly controlled experimental applications. This article details factors to be considered in the actual clinical-based application of behavioral procedures in the treatment of pediatric feeding problems. A description of how referrals are generated and initial assessment is conducted, and a model for inpatient treatment is presented. In addition, the need for efficient and effective treatment in the real world is stressed.

Although preschool-aged children with diabetes might be at increased risk for both general and disease-specific psychological adjustment difficulties, this issue has not been investigated. We evaluated both general and diabetes-related adjustment of 20 preschool-aged children and their mothers. The mothers completed the Child Behavior Checklist, Parenting Stress Index, Parents' Diabetes Opinion Survey, and the Preschool Diabetes Behavior Checklist. The latter measure was constructed specifically for this study to measure the frequency of oppositional and avoidance behaviors of children regarding diabetes management tasks. Mothers reported that their children displayed significantly more internalizing behavior problems (anxiety, depression, withdrawal) and were a significantly greater source of parental stress compared with corresponding nondiabetic normative group samples. Also, certain maternal attitudes about diabetes and its treatment were correlated with the children's disease-specific behavior problems. The children's general psychological adjustment, however, was not predictive of these diabetes-specific behavior problems.

Background and objectives Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy. Methods Twenty dysphagic neonates (mean gestation ± standard deviation [SD] = 30.9 ± 4.9 weeks; median 31.1 weeks; range = 23.7–38.6 weeks) with abnormal VSS results were evaluated at 49.9 ± 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding. Results At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P <0.05) between the primary oral feeders versus the chronic tube feeders for swallow frequency, swallow propagation, presence of adaptive peristaltic reflexes, oral feeding challenge test results, and upper esophageal sphincter tone. VSS results or disease characteristics had little effect on the feeding outcomes (P = NS). Conclusions Swallow-integrated esophageal motility studies permit prolonged evaluation of swallowing reflexes and responses to stimuli under controlled conditions at cribside. The dysfunctional neuromotor mechanisms may be responsible for neonatal dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs.

Five cases involving the treatment oflongstanding, severe, and previously unmanageable self-injurious behavior are presented. In each case, the behavior was forceful contact with the head or face, and treatment consisted of mild and brief contingent electrical stimulation, delivered automatically or by a therapist, via the Self-Injurious Behavior Inhibiting System. Results of reversal and/or multiple baseline designs, in which sessions ranged in duration from 10 min to all day across a variety of settings, showed that the effects of the system were immediate and produced almost complete elimination of the self-injurious behavior. Controlled and anecdotal follow-up data for four of the five cases suggest continuing benefits and the absence of detrimental side effects associated with treatment. Potential applications of the device, as well as extensions and limitations, are discussed.DESCRIPTORS: self-injurious behavior, electrical stimulation, punishmentWe express our deepest appreciation to the parents and guardians of those who participated as subjects in this study for their support and cooperation. We also thank the following individuals for their invaluable work on the development of SIBIS (Robert Fischell, Leslie and Mooza Grant, Arnold Newman, and Gary Pace) and their assistance in conducting various aspects of the research

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We report a case in which a Self-Injurious Behavior Inhibiting System (SIBIS) device and a conditioned punisher were utilized to decrease and maintain suppression of severe head hitting/banging in a preschool child. After an experimental evaluation conducted at the hospital, SIBIS was implemented at home. The originality of this particular SIBIS case study is that programmed and systematic effort at establishing conditioned punishment was included in the intervention. Results indicate that a zero-level response was rapidly reached, and that the conditioned punisher (i.e. verbal prompt þ movement towards the place where SIBIS was kept) was sufficient to maintain treatment effects. Continuous assessment after treatment and formal observation session at 7 months follow-up revealed that SIBIS could be removed from the natural environment of the child while maintaining a therapeutic effect. These results were interpreted as the effects of the explicit pairing between the delivery of electric stimulations and previously neutral stimuli, which were initially ineffective to elicit any response, or to suppress SIB. Close and extended monitoring during and after treatment failed to reveal the presence of negative side effects associated with SIBIS, whereas a number of positive effects were observed.