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Biomedical subjects

Cathleen C Piazza

Publications and source records attributed to Cathleen C Piazza.

16 recordsLinked to original sources
PubMed2005

An evaluation of a high-probability instructional sequence to increase acceptance of food and decrease inappropriate behavior in children with pediatric feeding disorders.

We evaluated the effects of escape extinction with and without a high-probability (high-p) instructional sequence on food acceptance and inappropriate behavior for children diagnosed with feeding problems. The high-p sequence consisted of three presentations of a response that was similar topographically (i.e., presentations of an empty nuk, liquid on a spoon, and a preferred liquid on a spoon) to the low-p response (i.e., presentation of a nuk with food, liquid from a cup, and presentation of a nonpreferred food). Acceptance of food increased in the presence and not the absence of the high-p sequence during initial withdrawals for two of the three children. In addition, the high-p sequence plus escape extinction was associated with reduced levels of inappropriate behavior relative to escape extinction alone for two children. Data are discussed in relation to behavioral momentum, motivating operations, and the relative contributions of the high-p instructional sequence and escape extinction in the treatment of feeding problems.

Child↗
PubMed2005

A systematic evaluation of food textures to decrease packing and increase oral intake in children with pediatric feeding disorders.

This study examined packing (pocketing or holding accepted food in the mouth) in 3 children who were failing to thrive or had inadequate weight gain due to insufficient caloric intake. The results of an analysis of texture indicated that total grams consumed were higher when lower textured foods were presented than when higher textured foods were presented. The gram intake was related directly to levels of packing. That is, high levels of packing were associated with higher textured foods and low gram intake, and low levels of packing were associated with lower textured foods and high gram intake. All participants gained weight when texture of foods was decreased. Packing remained low during follow-up for 2 participants even when the texture of food was increased gradually over time. These data are discussed in relation to avoidance, response effort, and skill deficit.

Behavior Therapy↗
PubMed2005

Using food redistribution to reduce packing in children with severe food refusal.

Positive- and negative-reinforcement-based procedures typically have targeted acceptance for children with severe food refusal; however, these procedures do not always result in successful swallowing. Once acceptance is achieved, some children expel the food repeatedly or pack (hold or pocket) it in their mouths for extended periods of time. This study evaluated the effects of using food redistribution with a bristled massaging toothbrush to reduce packing and increase consumption in 4 children with severe feeding disorders. Packing was reduced for all children. In addition, latency to clean mouth (the duration of time from acceptance to food no longer being present in the child's mouth in the absence of expulsion) for 2 children decreased when the food-redistribution procedure was used. Results are discussed in terms of the potential operant functions of the food-redistribution procedure.

Behavior Therapy↗
PubMed2005

On the effectiveness of and preference for punishment and extinction components of function-based interventions.

The current study describes an assessment sequence that may be used to identify individualized, effective, and preferred interventions for severe problem behavior in lieu of relying on a restricted set of treatment options that are assumed to be in the best interest of consumers. The relative effectiveness of functional communication training (FCT) with and without a punishment component was evaluated with 2 children for whom functional analyses demonstrated behavioral maintenance via social positive reinforcement. The results showed that FCT plus punishment was more effective than FCT in reducing problem behavior. Subsequently, participants' relative preference for each treatment was evaluated in a concurrent-chains arrangement, and both participants demonstrated a dear preference for FCT with punishment. These findings suggest that the treatment-selection process may be guided by person-centered and evidence-based values.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2004

Increasing variety of foods consumed by blending nonpreferred foods into preferred foods.

UNLABELLED: A treatment with differential or noncontingent reinforcement and nonremoval of the spoon increased the acceptance of one or two of 16 foods for 2 participants with severe food refusal. These differential levels of acceptance were demonstrated empirically in an ABAB design in which A was the presentation of the accepted (preferred) foods and B was the presentation of foods the participants refused (nonpreferred foods). Subsequently, we implemented a blending treatment that consisted of mixing (blending) nonpreferred foods into preferred foods in various ratios (e.g., 10% nonpreferred/90% preferred, 20% nonpreferred/80% preferred). We then presented nonpreferred foods that had been exposed to blending to determine if consumption of nonpreferred foods would increase following the blending treatment. We also conducted periodic reversals in which we presented nonpreferred foods that had not been exposed to the blending treatment. Following initial implementation of the blending treatment, consumption was high for nonpreferred foods that had been blended and low for nonpreferred foods that had not been blended. Consumption increased for all foods (i.e., foods that had been exposed to blending and foods that had not been exposed to blending) after seven or eight foods had been exposed to the blending treatment. Thus, the variety of foods consumed by the participants increased from one or two to 16. These results are discussed in terms of stimulus fading, conditioned food preferences, and escape extinction. DESCRIPTORS: conditioned food preferences, food refusal, negative reinforcement, stimulus fading

Child, Preschool↗
PubMed2004

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal.

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.

Escape Reaction↗
PubMed2003

Functional analysis of inappropriate mealtime behaviors.

The purpose of the current investigation was to apply the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) to the inappropriate mealtime behaviors of 15 children who had been referred to an intensive program for the assessment and treatment of severe feeding disorders. During Study 1, we conducted descriptive assessments of children and parents during meals. The results of Study 1 showed that parents used the following consequences for inappropriate mealtime behaviors: coaxing and reprimanding, allowing the child to periodically take a break from or avoid eating, and giving the child preferred food or toys following inappropriate behavior. The effects of these consequences were tested systematically in Study 2 when we conducted analogue functional analyses with the children. During alternating meals, one of the consequences typically used by parents consistently followed inappropriate child behavior. Results indicated that these consequences actually worsened behavior for 10 of the 15 children (67%). These results suggested that the analogue functional analysis described by Iwata et al. may be useful in identifying the environmental events that play a role in feeding disorders.

Behavior Therapy↗
PubMed2003

On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal.

We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. However, the addition of positive reinforcement to escape extinction was associated with beneficial effects (e.g., greater decreases in negative vocalizations and inappropriate behavior) for some participants.

Ambulatory Care↗
PubMed2003

Training parents to implement pediatric feeding protocols.

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.

Behavior Therapy↗
PubMed2002

Assessment and treatment of vocal tics associated with Tourette's syndrome.

A functional analysis suggested that a young man's vocal tics were maintained by automatic reinforcement. A preference assessment was conducted to identify stimuli that effectively competed with the occurrence of vocal tics. When used as components of a reinforcement-based intervention, however, these stimuli were ineffective at reducing the occurrence of vocal tics. Observations conducted in a naturalistic context led to the hypothesis that variations in tics were associated with body positioning. Thus, an additional analysis was conducted to determine if vocal tics occurred less when the participant was lying down versus when he was seated upright. Results suggested that a combination of procedures might be useful in developing idiosyncratic interventions for automatically reinforced problem behavior, such as vocal tics.

Adult↗
PubMed2002

Varying response effort in the treatment of pica maintained by automatic reinforcement.

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.

Adult↗
PubMed2002

An evaluation of simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity.

In the current investigation, we compared two methods of food presentation (simultaneous vs. sequential) to increase consumption of nonpreferred food for 3 children with food selectivity. In the simultaneous condition, preferred foods were presented at the same time as nonpreferred food (e.g., a piece of broccoli was presented on a chip). In the sequential condition, acceptance of the nonpreferred food resulted in presentation of the preferred food. Increases in consumption occurred immediately during the simultaneous condition for 2 of the 3 participants. For 1 participant, increases in consumption occurred in the simultaneous condition relative to the sequential condition, but only after physical guidance and re-presentation were added to treatment. Finally, consumption increased for 1 participant in the sequential condition, but only after several sessions. These results are discussed in terms of possible mechanisms that may alter preferences for food (i.e., establishing operations, flavor-flavor conditioning).

Autistic Disorder↗
PubMed2002

An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal.

Consumption of solids and liquids occurs as a chain of behaviors that may include accepting, swallowing, and retaining the food or drink. In the current investigation, we evaluated the relative effectiveness of differential reinforcement of the first behavior in the chain (acceptance) versus differential reinforcement for the terminal behavior in the chain (mouth clean). Three children who had been diagnosed with a feeding disorder participated. Acceptance remained at zero when differential reinforcement contingencies were implemented for acceptance or mouth clean. Acceptance and mouth clean increased for all 3 participants once escape extinction was added to the differential reinforcement procedures, independent of whether reinforcement was provided for acceptance or for mouth clean. Maintenance was observed in 2 children when escape extinction was removed from the treatment package. The mechanism by which consumption increased is discussed in relation to positive and negative reinforcement contingencies.

Child, Preschool↗