Increasing In-School Food Consumption of an Elementary Student with Emotional/Behavioral Disorders: A Case Study.

Many children experience meal related problem behaviors at some point in childhood; however, the behaviors are usually temporary and do not pose a serious health risk (O'Brien, Repp, Williams, & Christophersen, 1991). For children who do not improve, chronic food refusal or other feeding related challenging behaviors could adversely affect families (Hagekull & Dahl, 1987) and children's health. Persistent food refusal, if not treated, can eventually lead to malnourishment and require medical intervention (Kedesdy & Budd, 1998).Several comprehensive reviews of the literature documented the effectiveness of behavior analytic techniques in treating food refusal and suggest it may be the only discipline with empirical support in this area (Kerwin, 1999; Sharp, Jaquess, Morton, & Herzinger, 2010; Williams, Field, & Seiverling, 2010). Sharp et al. (2010) indicated that nearly 90% of the studies reviewed combined a number of behavior analytic techniques into multicomponent intervention packages to treat a variety of feeding issues. Common intervention components included antecedent adjustments, differential reinforcement, physical or verbal prompts, shaping, and extinction procedures. Further, researchers demonstrated treatment packages that include varied combinations of these elements are easily implemented with a variety of young children in clinic (Kerwin, 1999; Sharp, et al., 2010) and home (Gale, Eikeseth, & Rudrud, 2011) settings. There are however, a limited number of studies that assess the use of therapeutic feeding interventions to address chronic food refusal in school settings. Specifically, there is a lack of studies on the use of treatment packages to increase the food consumption of children who readily consume meals at home and refuse food and liquids at school.Researchers conducted the present case study to address the immediate need of a student who consumed food at home and refused all food and drinks in her school setting. In order to increase in-school food consumption, researchers developed a multi-component treatment package that included antecedent adjustments (time and place food was offered), contingent reinforcement (access to highly preferred item following consumption of lunch item), and shaping procedures to adjust the weight of highly preferred and less preferred food items. The purpose of this case study was to assess the effectiveness of a therapeutic feeding intervention on the in-school food refusal of an elementary student with emotional/behavioral disorders.MethodParticipant and SettingMichelle was an eight-year-old third grader who was diagnosed with Severe Anxiety Disorder and Mood Disorder by her treating psychiatrist. She received a Full Scale IQ of 91 on the Wechsler Intelligence Scale for Children®-4th edition (WISC®-IV; Wechsler, 2003). Michelle's WISC-IV scores were considered an underestimate of her ability by the school psychologist, due to "emotional agitation," which resulted in substantial variability on the subtests. At the time of the study, Michelle took Zoloft® (3.5 ml) and Abilify® (2 tsp.) and received special education services under the category emotional disturbance. The majority of her instruction occurred in an emotional support classroom. Prior to her placement in the emotional support setting, Michelle attended both inpatient and partial-hospital ization programs two times consecutively following an apparent acute decline in adaptive functioning. During her hospitalization, Michelle lost six pounds due to food refusal.At the onset of the study, Michelle spent her lunch period in the lunchroom monitored by teaching assistants. She did not eat or drink anything during this or any other time of the school day and often refused food and drinks in the morning before school. Michelle occasionally accepted food items in the presence of her mother and ate at home. Once home from school, Michelle binged on a limited variety of unhealthy preferred food items. …