Treatment Of Food Refusal Research Articles

Therapy of Food Refusal and Anorexia Nervosa in German-Language Psychiatry Textbooks of the Past 200 Years

The aim of this study was to describe how the therapy of anorexia nervosa (AN) and food refusal have been discussed in leading textbooks used in German-speaking academic psychiatry over the past 200 years. For this purpose, 18 textbooks of important school psychiatrists were selected. These were analyzed in a structured way to determine the content of the subject taught at universities in German-speaking countries at a given period. We found that AN was not taught as a distinct disorder until the end of the 20th century, although great attention had been paid to food refusal as a symptom and manifold therapeutic concepts had been developed much earlier. Whereas at the beginning of the 19th century forced feeding using feeding tubes was established, in the following years pharmacotherapies and special diets were developed. It is noteworthy that since the beginnings of academic psychiatry, some early forms of psychotherapy have been developed; for instance, special kinds of behavior were recommended when dealing with the patient, as the therapist was supposed to serve as a role model to encourage patients to eat. Treatment of food refusal by means of structured psychotherapeutic approaches were not established before AN was generally accepted as a distinct disease entity. The understanding of etiological factors that might lead to AN as well as potential psychotherapeutic interventions have changed fundamentally over the past decades.

Evaluation of an Individualized Levels System to Increase Consumption for an Adolescent with Food Refusal

A levels system is an intervention that uses a combination of behavioral principles, such as differential reinforcement and response cost, in order to increase appropriate behaviors and simultaneously decrease problem behaviors. Within a levels system, an individual must meet a pre-determined behavioral criterion in order to gain access to various levels of reinforcement. For example, engaging in higher rates of inappropriate behavior will result in access to highly preferred items or activities, while higher rates of inappropriate behavior will access to lesser preferred activities. Although levels systems have been applied in group settings, as well as in the individual treatment of severe problem behavior, their use has not been explored in the treatment of food refusal. The current study implemented a levels system to target increasing the variety and volume of food consumed by a 12-year-old female diagnosed with fetal alcohol spectrum disorder (FASD) effects, mild intellectual disability, and attention-deficit/hyperactivity disorder (ADHD). At the end of her admission, the participant had increased her variety consumed at an age-appropriate volume significantly, as well as the volume of food consumed.

A systematic review of the novel applications of cannabinoids in dementia care: food refusal and neuropsychiatric symptoms

<h3>Introduction</h3> In recent years, there has been increased research interest investigating the novel use of cannabinoids in the treatment of patients living with dementia. Early clinical research suggests that cannabinoids may be beneficial in a variety of areas, including pain, sleep, weight loss, and behavioral aggression. In particular, cannabinoids may be especially valuable in dementia care in areas where there are currently limited therapies, including food refusal and neuropsychiatric symptoms (NPS) such as agitation and sleep disruption. Pharmacologic interventions for disordered eating in dementia are limited. And although atypical antipsychotics are commonly used to treat NPS, they are associated with an increased risk of serious adverse events and all-cause mortality in older patients. Thus, this study aims to review the current literature on the potential applications of cannabinoids in the treatment of food refusal and neuropsychiatric symptoms in dementia populations. <h3>Methods</h3> A systematic literature review was performed utilizing six major electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, Google Scholar, Cochrane CENTRAL) for articles published from database inception to November 2020. Search strings including keywords and Medical Subject Headings (MeSH terms) related to cannabinoids, dementia, food refusal, weight loss, agitation, and neuropsychiatric symptoms were used to identify relevant articles. <h3>Results</h3> A total of 23 relevant articles were identified that examined the use of cannabinoids including tetrahydrocannabinol, dronabinol, and nabilone in dementia patients. Regarding treatment of NPS in dementia, numerous studies found that use of cannabinoids was associated with potential benefits including reduced nighttime motor activity, improved sleep duration, reduced agitation, and lower Neuropsychiatric Inventory scores. With regards to food refusal, multiple articles documented use of cannabinoids being associated with increased percentage of meals consumed, with one crossover placebo-controlled trial finding increased overall body weight in dementia patients on dronabinol. Documented potential side effects include possible worsening of psychosis and anxiety, although overall, the literature appears to show cannabinoids to be generally well-tolerated. <h3>Conclusions</h3> Use of cannabinoids as potential treatments for food refusal and neuropsychiatric symptoms in dementia populations is an ongoing area of research. Completed clinical studies done on the subject to date have been small in scale, but have shown cannabinoids to be relatively well-tolerated and have yielded positive results. Thus, cannabinoids may have potential as a therapeutic intervention in dementia care, and these findings warrant further investigation. <h3>Funding</h3> Not applicable

Examining extinction bursts in the treatment of pediatric food refusal

AbstractEscape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly. Considerations for using escape extinction in interventions will be discussed.

Using a Novel Variant of Stimulus Fading in the Treatment of Food Refusal and Co-Morbid Challenging Behaviour in a Child with Autism

Using a Novel Variant of Stimulus Fading in the Treatment of Food Refusal and Co-Morbid Challenging Behaviour in a Child with Autism

A Comparison of Two Variations of the High-Probability Instructional Sequence with a Child with Autism

Abstract Children who engage in low rates of compliance can be at a serious disadvantage relative to peers in important areas of learning, and also be at risk for more restrictive placements and long-term dependence on others more generally. One intervention, the high-probability (high-p) instructional sequence, has involved a variety of results. There is still much to learn about the mechanisms responsible for behavior change in high-p sequences. The present study compared two variations of the high-p sequence: maintenance and leisure high-p tasks, on the compliance of a young child with autism. Results indicated that compliance with low-p tasks was higher in the leisure high-p condition relative to the maintenance high-p condition across all three tasks. Implications for understanding the mechanisms responsible for behavior change in high-p sequences are provided. KEYWORDS: Autism, Compliance, High-Probability Instructional Sequence, Non-Compliance, Behavioral Momentum Children with autism have a variety of skill deficits that can interfere with their learning and socialization across the lifespan. A relatively common problem pertains to non-compliance, where children fail to complete tasks for which they are asked. Noncompliance may result in increased dependence on others, more restrictive educational placements, and impaired socialization and development more generally. It isn't surprising, then, that a range of interventions to improve compliance have been studied by behavioral researchers (e.g., guided compliance, high-probability instructional sequences; Wilder, 2011). These interventions often involve both antecedent and consequent manipulations; however, little is known about the mechanisms responsible for behavior change in various antecedent interventions for non-compliance. The high-probability (high-p) instructional sequence is an antecedent intervention which involves presenting 3-5 tasks for which there is a high-probability of compliance just prior to presenting a task for which there is a low-probability of compliance. Studies on the high-p sequence have focused on multiple topographies of behavior, including task transitioning (Ardoin, Martens, & Wolfe, 1999), social initiations (Davis, Brady, Hamilton, McEvoy, & Williams, 1994), food refusal (Dawson et al., 2003) and more. Importantly, the high-p sequence has not only been used to increase compliance, but also as a means to treat problem behavior more specifically (e.g., Mace & Bel-fiore, 1990). Prior research on the high-p sequence has produced varied results. For example, some researchers have found that the high-p sequence did not correspond to an increase in compliance (e.g., Rortvedt & Miltenberger, 1994). Others have highlighted the necessity of extinction in the treatment of non-compliance (Zarcone, Iwata, Hughes, & Vollmer, 1993; Zarcone, Iwata, Mazaleski, & Smith, 1994). Along these lines, Wilder, Zonneveld, Harris, Marcus, and Reagon (2007) found that the high-p sequence was only effective towards increasing compliance with 1 of the 3 children in their study, whereas extinction (repeating the instruction after 10 s and providing hand-over-hand guidance) was required for the other two children. Similarly, Dawson et al. (2003) found that the high-p sequence was not effective in the treatment of food refusal, but that bite acceptance increased when escape extinction (non-removal of the spoon and re-presenting expelled bites) was used. Still others have found that compliance to low-p requests only increased after high levels of reinforcement were added to each high-p request (Bullock & Normand, 2006; Mace, Mauro, Boya-jian, & Eckert, 1997; Zuluga & Normand, 2008). Normand, Kestner, and Jessel (2010) further evaluated factors that influence the success of the high-p sequence, and found that the presence of stimuli related to the low-p task decreased compliance with high-p instructions. …

The Use of Descriptive Analysis to Identify and Manipulate Schedules of Reinforcement in the Treatment of Food Refusal

The feeding behaviors of a child diagnosed with failure to thrive were assessed using descriptive analysis methodology to identify the schedules of reinforcement provided by the child's parents. This analysis revealed that the child's appropriate feeding behaviors (i.e., bite acceptance, self-feeding) were on a lean schedule of positive reinforcement and that the child's refusal behaviors (e.g., non-acceptance, expulsion) were on a rich schedule of negative reinforcement. A treatment package consisting of differential positive reinforcement for bite acceptance with and without escape extinction was evaluated by manipulating the schedules of reinforcement that were identified to be used by the child's parents. The results showed a reduction of the child's inappropriate mealtime behaviors and increases in the child's acceptance of offered food items. The results also suggested that the differential reinforcement component appeared to be most responsible for ongoing effectiveness of the treatment. These results are discussed in terms of treating the food refusal behavior of children diagnosed with failure to thrive as a preventive measure for later development of developmental disabilities.

Psychological Treatment of Food Refusal in Young Children.

Feeding and eating problems in young children are the result of a complex aetiology that often combines biological and psychological factors. The aim of this review is to describe psychological techniques of intervention used in the management of eating problems in young children that draw on a number of theoretical approaches and should be applied within a developmental framework.

Treatment of food refusal by the overcorrective functional movement training method

A procedure involving overcorrective functional movement training was used in the treatment of severe food refusal by a severely retarded, quadriplegic boy. The effect of the treatment was validated through an ABAB design. The dependent variables of the procedure were the number of overcorrection trials and the cubic centimeters of food intake. Follow-up measures are reported at 4 and 6 months.

Treatment of food refusal in a two-year-old child

This article presents a case study of the successful modification of solid food eating in a two-year old child. The treatment paradigm rested on the pairing of a high incidence behavior (liquid ingestion) with a low incidence behavior (solid food ingestion). The mother of the child was also seen during the treatment period for directive instruction in behavior modification and for supportive counseling. The entire treatment period spanned 13 weeks, and was managed in a psychiatric inpatient milieu. Follow-up weights at one, two and three months, and at two years are reported.