Treating Chronic Food Refusal in Young Children: Home‐based Parent Training

Abstract

We evaluated the effects of behavioral parent training program on parent and child feeding-related behaviors in the home. We trained mothers to initiate regular offerings of previously rejected (target) foods and to provide contingent attention (i.e., specific prompts, positive reinforcement) to increase their child's acceptance of nonpreferred foods. For 1 subject, we also directed training at increasing self-eating. Results of a nonconcurrent multiple baseline design across 3 mother-child dyads demonstrated that, with training, all mothers increased offerings of target foods and use of specific prompts, and 2 mothers increased levels of positive attention. In turn, children increased their acceptance of target foods and self-eating, thus demonstrating the functional effects of parent training on in-home meal times. Temporary increases in food refusals occurred when treatment was initiated but declined as treatment continued. We discuss the results in terms of the potential benefits and limitations of a home-based treatment model.

Feeding and eating disorders in childhood

“…In current clinical practice, some of these presentations receive a diagnosis of eating disorder not otherwise specified (EDNOS); yet, it is far from clear whether this is appropriate as they are not characterized by weight and/or shape concerns. Terms used to describe such presentations include the following: food avoidance emotional disorder 79,80 ; restrictive eating 81 ; selective eating 40,82,83 ; choosy eating 84 ; perseverant eating 85,86 ; sensory food aversions 21 ; chronic food refusal 87 ; food neophobia 88,89 ; functional dysphagia 90 ; and childhood phobias leading to compromised intake 91 (e.g., fear of vomiting, fear of defecating, fear of bathroom, etc.). Careful reading of the clinical descriptions in the existing literature suggests that it might be possible to distinguish three main subtypes within these childhood restrictive/avoidant eating disturbances that are distinct from childhood presentations of an eating disorder in that there is no evidence of weight/shape concerns.…”

Functional Assessment and Behavioural Intervention for Eating Difficulties in Children with Autism: A study Conducted in the Natural Environment Using Parents and ABA Tutors as Therapists

“…However, if food selectivity results in the child failing to eat a sufficient variety of foods, the child will not maintain nutritional status required to grow; in these cases food selectivity may present a more serious health risk . Research on feeding problems has focused on increasing acceptance and reducing inappropriate behaviour during meal times, demonstrating that behavioural interventions are effective in increasing food consumption in children who demonstrate Functional Assessment and 7 selectivity or eat too little (e.g., Ahearn, Kerwin, Eicher, Shantz, & Swearingin, 1996;Coe et al, 1997;Patel, Piazza, Martinez, Volkert, & Santana, 2002;Riordan, Iwata, Finney, Wohl, & Stanley, 1984;Werle, Murphy, & Budd, 1993).…”

“…Increases in oral acceptance of food were seen, demonstrating the effectiveness of parent and teacher led intervention in the natural setting. Werle, Murphy and Budd (1993) utilised a non-concurrent multiple baseline design to investigate the effects of parent training on parent and child feeding related problem behaviours during meal times in three boys with developmental delay and their mothers.…”

“…Werle, Murphy & Budd, 1993;Najdowski et al, Functional Assessment and 31 general, studies have often focused on clinic treatment delivered by therapists. The current study demonstrated functional assessments and treatments can be conducted in the children's homes when parents are included as part of the therapy team.…”

Combining Stimulus Fading, Reinforcement, and Extinction to Treat Food Refusal

“…This is an important limitation that needs to be addressed in the future. Unfortunately, there is a dearth of research evaluating treatment protocols implemented in home and community settings, a notable exception being a study conducted by Werle, Murphy, and Budd (1993) in which the authors evaluated a home-based treatment for feeding problems. Despite their successes, more work needs to be done to assess the factors that result in successful treatment in typical settings.…”