| |

Received: 12 December 2019    Revised: 12 May 2020    Accepted: 18 May 2020

DOI: 10.1111/apa.15372

REGULAR ARTICLE

Controlled case series demonstrates how parents can be

trained to treat paediatric feeding disorders at home

Tessa Taylor1,2  | Neville Blampied2  | Nikolas Roglić1

1
Paediatric Feeding International, Sydney,
NSW, Australia
2
Department of Psychology, and the
School of Health Sciences, University of
Canterbury/Te Whare Wānanga o Waitaha,
Christchurch, New Zealand
Correspondence
Tessa Taylor, Department of Psychology,
Speech & Hearing, and the School of Health
Sciences, University of Canterbury/Te
Whare Wānanga o Waitaha, Private Bag
4800, Christchurch 8140, New Zealand.
Email: DrTaylor@PaediatricFeedingIntl.com
Abstract
Aim: Paediatric feeding disorders are normally managed by specialist clinics. We ex-
amined whether treatment gains were maintained when trained parents continued
the programme at home and during meals out.
Methods: This controlled consecutive case series recruited 26 children (22 boys) with
avoidant/restrictive food intake disorder, from a private paediatric feeding disorders
practice in New South Wales, Australia. Their mean age was six (2-13) years. All had
severe feeding problems and mealtime skill deficits, and most had autism and de-
velopmental delays or intellectual disabilities. The children received intensive, indi-
vidualised, behaviour-analytic treatment for 11 (6-21.5) days, and the parents were
trained to continue it at home. The primary treatment outcomes included the range
and amount of food eaten and mealtime behaviour.
Results: The children met all of the therapeutic goals agreed at the treatment out-
set. They ate a mean of 92 different foods and improved how they ate, drank and
behaved during mealtimes. The mean differences before and after treatment were
clinically and statistically significant, and the gains were maintained during follow-up
at a mean of 2.3 years. Parental satisfaction and treatment acceptability were high.
Conclusion: Specially trained parents successfully continued paediatric eating disor-
der treatment at home and maintained treatment gains.

KEYWORDS
avoidant/restrictive food intake disorder, home treatment, inappropriate mealtime behaviour
paediatric feeding disorders, parental training

1 |  I NTRO D U C TI O N
Chronic and severe paediatric feeding disorders can include being
dependent on a gastrostomy tube or liquids, refusing food and only
eating certain items. Feeding problems occur in wide-ranging popu-
lations, including children with typical development, medical com-
plications, such as food allergies and reflux,1 and developmental
Abbreviations: ARFID, avoidant/restrictive food intake disorder; ES, effect size; CI,
confidence interval.
disabilities. 2,3 Many meet the criteria for avoidant/restrictive food
intake disorder (ARFID), which includes failure to thrive, nutritional
deficiencies, dependence on artificial feeding methods and, or, di-
etary supplements and marked impairment in psychosocial function-
ing.4 When this occurs during critical neuro-developmental periods,
numerous adverse effects on behaviour, cognition, emotion and
health may occur and persist into adulthood.3-7
Over the past 40 years, treatment for paediatric feeding disor-
ders has been based on behaviour analysis principles and research

© 2020 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

Acta Paediatrica. 2020;00:1–9.  |

wileyonlinelibrary.com/journal/apa     1
 |
2       TAYLOR et al.

has delivered a range of empirically supported, effective treatments.

However, these have only been generally available from specialised
multidisciplinary, hospital-based research clinics served by staff with
high levels of expertise in the treatment methods.4,8-11 Most children
do not have access to this treatment.7,12 In general, conventional
treatment methods do not have a high-quality evidence base world-
wide.4,12-17 Thus, lack of awareness of, and access to, effective treat-
ment may lead to continuing suffering and distress for children and
their families. Repeated treatment failure can also waste healthcare
resources and time.7 Translational research 18 is urgently needed to
demonstrate the feasibility of adapting specialist, in-hospital treat-
12,19,20
ment so that it can be delivered at home and in the community.
We also need research to evaluate treatment outcomes and show
that gains can be maintained over time and in different settings.
Our primary aim was to demonstrate what could be achieved
when effective behaviour-analytic treatment was translated from
specialist hospital settings and adapted so that specially trained par-
ents could use it at home and during meals out. It presents the first
analysis of the overall outcomes achieved with a consecutive, con-
trolled case series that received in-home, behaviour-analytic feeding
treatment without any additional food-related therapy.
2 |  M E TH O DS
The intensive, individualised treatments used in this translational
effectiveness trial study were adapted from Taylor et al19 The
study took place from May 2016 to March 2019 at a private clini-
cal practice specialising in treating paediatric feeding disorders in
New South Wales, Australia. It was performed in accordance with
the Declaration of Helsinki and the relevant ethical standards for
psychologists and behavioural analysts. The parent provided writ-
ten, informed consent for the therapy and the subsequent use of the
de-identified data.
Key Notes
• This study examined whether treatment gains were
maintained when specially trained parents treated pae-
diatric feeding disorders at home.
• We recruited 26 children aged 2-13 years with avoidant/
restrictive food intake disorder, and most had autism
and developmental delays or intellectual disabilities.
• Some 2 years after the programme started, the chil-
dren were eating a mean of 92 different foods and
had improved how they ate, drank and behaved during
mealtimes.
experienced unsuccessful treatment for a mean of 3.5 ± 3.0 years, and
the maximum was 11 years. Multiple treatment experiences were com-
mon, with a mean of 5 ± 4 treatments and a maximum of 12. Most chil-
dren were receiving ongoing services and monitoring, but these were
paused during the intensive behavioural treatment programme and the
previous feeding targets did not continue after the programme. The
therapists and parents agreed on a mean of 11 treatment goals (range
7-17), which were used to provide individualised treatment. The ses-
sions were held in settings with the necessary seating, equipment and
supplies. The primary setting was at home, and the other settings were
cafes, restaurants, day care centres and schools.
2.2 | Measurement, reliability, integrity and
acceptability
A trained observer computer-coded the children and therapists'
behaviours using specialised real-time data collection software
(BDataPro, Kennedy Krieger Institute; 21). The frequency keys
recorded the frequency of responses, including acceptance,

2.1 | Patients TA B L E 1   Characteristics of the 26 children in the study cohort

n (%)
We reviewed 29 consecutive cases and reported the outcomes re-
ported for 26 children who were diagnosed with ARFID by a registered Male 22 (85%)
clinical psychologist and doctoral-level certified behavioural analyst Autism, developmental delay 20 (77%)
with specialist training in paediatric feeding disorders. Three cases Growth impairments 14 (54%)
were excluded because they were receiving other therapies. Each Constipation 11 (42%)
child's physician approved their participation and provided medical in- Nutritional deficiencies 8 (31%)
formation, such as prior screening, growth and medical history, food Formula or baby bottle dependence 8 (31%)
allergies and any multidisciplinary specialist and testing referrals. The
Genetic/chromosomal abnormalities 5 (19%)
detailed patient characteristics can be found in Table 1, and the meth-
History of nasogastric tube 3 (12%)
odology is summarised here and described in more detail in Appendix
Eczema 3 (12%)
S1. The average age of the 26 children was six (range 2-13) years: 15
Gastrostomy tube 2 (8%)
were Caucasian Australian and the others were of Asian, Arabic and
Parenteral nutrition 1 (4%)
European ethnicities and nationalities. Most of the families had high so-
cio-economic status. At their initial assessment, the children displayed a Coeliac disease 1 (4%)

range of severe feeding problems and mealtime skill deficits.7 They had Note: Other factors not detailed here were prematurity and reflux.
TAYLOR et al. |
      3

swallowing, inappropriate mealtime behaviour and expulsion. The
duration keys measured delays in seconds before acceptance and
swallowing occurred and the duration of negative vocalisation.
Frequency of swallowing was divided by the number of therapist-
programmed bite presentations during the session to provide an
overall measure of the percentage of food consumed. The last
three data points in the initial phases, namely baseline one and
treatment one, were averaged, as were the repeated baseline two
and treatment two phases. The plates were photographed to re-
cord the variety of the food eaten, and the food was measured
before and after eating to determine the volume consumed. All
19
parents were provided with a questionnaire at the end of the
programme, and the responses to the five-point Likert scale items
were averaged to assess the 23 programme satisfaction items and
the 16 items on social acceptability of the treatment. All the ses-
sions were video-recorded to assess the interobserver agreement
and reliability, which was 96%. 21 The mean responses per minute
for lapses in procedural integrity for each minute were 0.1 lapses
for the therapist and 0.2 for the parents, and the mean interob-
server agreement was 99.5%.
2.3 | Experimental design and data analysis
The study included all cases that met the inclusion criteria, regard-
22
less of outcome, to reduce selection and publication bias. This
was consistent with the consecutive, controlled case series experi-
mental design. All the 26 cases also demonstrated experimental
control, using within-subjects, single-case experimental designs,
where each case served as its own control. 23 The most frequently
used design, for more than 80% of the children, was a reversal, or
withdrawal, design. This involved taking the treatment out, namely
baseline two, and putting it back in when needed, namely treat-
ment two. This was because replication showed that the treatment
was needed and was the reason for the improvement in eating.
The outcomes were examined using a combination of graphic tech-
niques24 and effect size estimation, using Cohen's dav, where the
standardiser was the average of the standard deviations before
and after treatment. 25 The graphs were predominantly modified
Brinley plots (Figure 1;26). These are scatterplots that display indi-
vidual changes over time, with each data point representing coor-
dinates of an individual's score at time one on the x-axis and time
two on the y-axis.
2.4 | Procedure
The mean waiting time for treatment was 3.5 (range 1-10) months.
Once it had started, the children received intensive continuous treat-
ment, which was provided for about 6 days per week for 2-4 weeks
during which they received treatment for an average of 11 (6-21.5)
days. The first author was the principal therapist and conducted the
sessions for approximately 7-8 hours per day with a trained assistant.
The involvement of the therapist reduced as the parents developed
the skills they needed and the responsibility for the intervention was
gradually transferred to them.

Modified Brinley plot interpretaon

Reducon = improvement Increase = improvement

Deterioriation Improvement
Final Treatment

ge
ch f
o
an
ne
Li
no

Improvement
Deterioriation

Baseline Baseline

F I G U R E 1   Illustrates the key features of modified Brinley plots and the interpretation of the graph space when a reduction in score
indicated clinical improvement (left panel) and when an increase indicated improvement (right panel). The + shows the coordinates of the
baseline and final treatment means for the lowest data points. Data points that fall near, or on, the 45° diagonal line of no change represent
individuals who showed little or no change between time one and time two. The magnitude of individual change is displayed by points lying
at greater distances above and below the line. Depending on the direction of the clinical and desired change for the measure, any change can
be classified as an improvement or deterioration. To aid interpretation, 26 the group mean coordinate is shown by a plus sign and the Cohen's
dav effect size 25 is displayed along with the 95% confidence Interval (95% CI), calculated using ESCII software developed by Cumming, La
Trobe University, Melbourne, Australia 28
4       | TAYLOR et al.

Percentage consumpon from baseline to final treatment

Baseline 1 vs Treatment 1 Baseline 1 vs Baseline 2 Baseline 2 vs Treatment 2

100

Treatment 2
Perc ent of bites c ons um ed

80 Treatment 1

Baseline 2 Baseline 2
60

40

20
Baseline 1

0
0 3 6 9 12 15 18 21 24 27 0 3 6 9 12 15 18 21 24 27 0 3 6 9 12 15 18 21 24 27
Parcipants (in order of case number)

F I G U R E 2   Horizontal dot plots show the percentage of bites consumed by each child in initial baseline one compared to initial treatment
one (left panel), replication of baseline two compared to initial baseline one (middle panel) and replication of final treatment two compared
to replicated baseline two (right panel). Pairs of data points are shown for each child in consistent case-number order from child one on the
extreme left of the x-axis to child 26 on the extreme right of each panel. Pairs of percentages (one above the other) are displayed for each
case sequentially for case one to case 26 in the same order over the three figure panels

2.5 | Assessment and treatment
The review of the intake assessment included the physician's report
and reports from other disciplines and service providers, meal obser-
vations, intake questionnaires, parental interviews, three-day diet
records, functional assessment, case-conceptualisation and therapy
goal specification. We directly assessed each child's food and reward
preferences.19,27 Foods from each food group were targeted and the
spoon size and food texture matched individual needs. Treatments
were individualised and data-driven, with components selected from
8-10,12
well-established, empirically supported treatments.
involved changing the mealtime environment, such as providing
incentives for swallowing and praising appropriate mealtime be-
haviour. Treatment also involved setting achievable mealtime re-
quirements, such as continuing to present food and liquids despite
rejection, replacing food or liquid that was spat out and providing
prompting instructions and guidance. We also taught the skills
needed to achieve goals, such as chewing, using utensils, self-feed-
ing and drinking, drinking with an open cup, biting from whole food
portions rather than pre-cut bite sizes and taking medicine. As the
treatment progressed, intensive parental behavioural skills training
was provided and we varied the cutlery and crockery provided, how
the children were placed at family meals and the setting where they
ate19 to ensure generalisation of therapy gains.
2.6 | Maintenance and follow-up
To help the children maintain their treatment gains, the parents were
given specific maintenance instructions. For two weeks after the
end of the programme, they were asked to offer their child the foods
on the discharge food list, record mealtime data, take photographs
of the plates and video the meals. The data were returned to the
first author for review and follow-up. The parents were contacted
2-3 years after treatment, at a mean of 2.3 years, and asked to com-
plete a five-point Likert satisfaction survey, which ranged from one
for worse than pre-treatment to five for resolved.
3 | R E S U LT S
Treatment
Figure 2 presents the primary outcome data, which was consump-
tion, and demonstrates the experimental control as horizontal dot
plots. Food consumption was very low at the initial baseline meas-
ure, baseline one, with most children not consuming any of the food
presented. At the end of the first treatment phase, treatment one,
children were completing 100% of the programmed bites consist-
ently, within a mean of 46 (2-134) minutes of treatment starting.
When treatment was withdrawn as a replication procedure, at base-
line two, consumption decreased for all children. When treatment
resumed in the second treatment phase, namely treatment two, con-
sumption increased again for all children, with no overlap of points
with the baseline, thus replicating the treatment effect. At the end
of the programme, the children were consuming an average of 158
(52-292) grams of solids per meal.
The number of foods the children ate increased from an av-
erage of six, mainly starch, to a mean of 92 from all food groups,
which equated to a very large Cohen dav effect size of about four
(Figure 3). One child could only eat 30 different foods due to aller-
gies and was awaiting tests because of vomiting (Figure 3). Examples
TAYLOR et al. |
      5

of the meals consumed are shown in Figure 4. Figure 5 shows that
for all children, inappropriate mealtime behaviour, expulsion and
negative vocalisation at the end of treatment were low or reduced.
The overall effects sizes for all three measures were large (Cohen's
dav −1.4 to −2.35). Before treatment, there were long delays to tak-
ing and swallowing bites which decreased after treatment (Figure 6).
Individual differences in the nature and texture of the food and how
skilled the children were at chewing and swallowing accounted for
the considerably lower Cohen's dav effect size for swallowing, of
about −1, than for accepting food when presented (−2.6).
The Cohen's dav effect sizes were large to very large (range
1.4-4) across the different measures and in no instance did the 95%
confidence interval (95% CI) indicate that the effect size was close
to zero, as the associated mean change was always statistically sig-
nificant (P < .05). When we measured the treatment effect, based on
the average percentage reduction from baseline to the end of the
treatment, it was 98% for non-consumption. Delays in acceptance
fell by 97% and 75% for delays to an empty mouth, but the figure
was 89% when we excluded the five children who had reached these
goal levels at baseline. Other reductions were 99% for food refusal,
97% for food expulsion and 97% for negative vocalisation. All the
children met 100% of the treatment goals, including learning to take
medication, chewing, feeding themselves with utensils, drinking
from a cup and sitting for meals.
At discharge, 20 parents (77%) completed the questionnaire.
They reported high satisfaction (mean 4.9, range 4.6-5, maximum
5.0) and social acceptability of the treatment (mean 4.9, range
4.6-5, maximum 5.0). During the immediate follow-up period of
two weeks, 17 parents reported on a mean of 25 (4-135) meals.
They reported high and stable consumption of the food presented
(mean 99%, range 90%-100%). Anecdotally, families reported im-
provements in other areas of life and well-being, for example in
height, weight and body mass index, bloodwork for nutritional
deficiencies, hair quality and growth, toothbrushing, sleeping
and toileting. They also reported improvements in their child's
behaviour, such as being able to change between activities and
follow instructions. Improvements in learning were also reported,
such as progress in therapy and school. Other benefits were

Variety of foods consumed from before treatment to final treatment

160
150 Number of Foods Consumed
Fi nal Treatment - Total Number of Foods

140
130
120
110
100
90
80
70
60
50
40
dav = 4.2 [3.1, 5.7]
30
20
10
0
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160

Baseline - Total Number of Foods

45
Protein Starch Veges Fruit Combo
40
Final Treatment - Number consumed

35

30

25

F I G U R E 3   Modified Brinley plots 20

showing total number of foods consumed

15
before and at the end of treatment (top
figure) and truncated modified Brinley 10
plots showing the range of different
food groups consumed after treatment 5

compared to before treatment (bottom

0
figure). The diagonal line in every plot 0123456789 0123456789
0123456789 0123456789 0123456789
indicates the line of no change from
before treatment to the end of treatment Baseline - Number consumed
 |
6       TAYLOR et al.

Sample pictures of plates children consumed

F I G U R E 4   Sample pictures of meals the children consumed

related to energy, sports and social participation, travel, immunity,
skin colour and decreased dependence on items like supplements,
formulas and laxatives. One example of growth improvement was
an 11-year-old child who was overweight and had stunted growth
with a blood analysis that revealed 18 significant deficiencies and
abnormalities. After he was discharged, his parents reported that
he had rapidly grown 25 cm in height and this was confirmed by
his therapist.
At follow-up, 21 parents reported that their child's feeding prob-
lem was much better than before treatment and five said it had com-
pletely resolved. The mean Likert score was 4.12 (2-5). No parents
reported the problem was worse. All but one of the parents reported
that their children were eating from all food groups. The exception
was a child who had similar before and after results as moving home
meant their parents did not maintain the protocol.
4 | D I S CU S S I O N
The data analysis used in this study showed both individual and over-
all group patterns of change following therapy. The consistently large
size of change seen in the figures was confirmed by the standardised
mean difference effect size and 95% CI estimation, with Cohen's dav
values that were large to very large and statistically significant. This
TAYLOR et al. |
      7

Inappropriate mealme behaviour, expulsion, F I G U R E 5   Modified Brinley plots comparing before treatment
and negave vocalisaons from before treatment with the end of treatment. These show changes in the frequency
to final treatment of inappropriate mealtime behaviour (top panel), the rate at which
food was expelled by each child (middle panel) and the percentage
of sessions with negative vocalisations (bottom panel). The diagonal
Inappropriate Mealtime
35 line in every plot indicates the line of no change from before
Final Treatment - Refusals/minute

Behaviour
treatment to the end of treatment
(IMB)
30

dav = –2.1 highly positive outcome of the treatment was firstly the result of
25
matching the treatment to each child and, second, continuing with
[–2.85, –1.275]
20 treatment until all target goals were met. Confidence in conclusions
was enhanced because the interobserver agreement and procedural
15
integrity measurements showed that the therapy data were accu-

10 rately recorded and that the therapists accurately followed the pro-
tocol, as the data quality and treatment fidelity were high.
5 It was also a strength of this study that the parents were trained
to a high standard so that they could continue to use the meal pro-
0
tocols independently, rather than needing long-term professional
0 5 10 15 20 25 30 35 services. Treatment was tailored by directly working with each
Baseline - Refusals/minute child rather than adopting a generic approach. Parents were then
thoroughly trained on precisely established procedures that were
11 Rate of Food Expels specifically designed for their child and had already been shown
10
Final Treatment - Expels/minute

to work. The treatment was safe, ethical and posed no risks to the
9 dav = –1.44 [–2.1, –.79] child's health, as none of the therapy involved depriving children of
8 preferred foods, drinks or formula. It also encouraged children to
7 eat various nutritious foods from all food groups. Furthermore, the
6 children were taught the mealtime skills they needed for age-appro-
5 priate independence and so that they would accept different food
4 textures.

3 A limitation of this study was the lack of observational and sys-

2 tematic, standardised data during the follow-up period and the lack
of intake data while children were on the waiting list for treatment.
1
Another limitation was that their body mass index could not be cal-
0
culated during these two periods. However, the children increased
0 1 2 3 4 5 6 7 8 9 10 11 their consumption quickly, on the first day, so there were no con-
Baseline - Expels/minute cerns about any further weight loss during treatment, except for one
child with malabsorption and diarrhoea due to a genetic condition
100
Negative Vocalisations and vomiting. Future studies should include multi-method, multi-
90 trait measures that are comparable from the time of intake through
Final Treatment - % of Sessions

80 dav = –2.35 [–3.1, –1.5] to follow-up periods. More research is also needed on younger age

70 groups and early intervention and prevention methods. The current

study was carried out with mostly high socio-economic status fami-
60
lies, due to lack of government funding in this treatment, so it is not
50 clear whether the training and follow-up results would be the same
40 for low status families.

30 It should be noted that most of the children in our study were

not dependent on tube feeding. The severity of typical presenta-
20
tions would probably be higher in hospital settings than in our pri-
10 vate practice, because such clinics may have more patients with
0 long-term gastrostomy tubes and higher levels of more severe med-
0 10 20 30 40 50 60 70 80 90 100 ical complications and developmental issues. Future studies might
Baseline - % of Sessions replicate this treatment model with children who depend on tube
feeding, as they may need longer treatment, especially to teach
them to chew and drink from a cup and to accept different food
 |
8       TAYLOR et al.
Time taken (seconds) to accept and swallow bites comparing before treatment to final treatment
Latency to Acceptance
Final Treatment
180
Latency (sec)
120 dav = –2.59 [–3.5, –1.7]
60
0
0 60 120 180 240 300 360 420 480 540 600 0
Baseline Latency (sec)
F I G U R E 6   Truncated modified Brinley plots showing latency, in seconds, to food acceptance into the mouth upon presentation and
latency to showing a clean mouth, namely swallowing, on inspection following acceptance before treatment and at the end of treatment.
The diagonal line represents the line of no change
textures following tube weaning. Also, certain children may require
hospitalisation and multidisciplinary teams if they have swallowing
problems, severe food allergies, breathing issues, seizures and blood
sugar issues, such as glycogen storage disease. Treatment intensity
and duration needs to be individually calibrated to the severity of
cases and decisions about treatment should be data-driven and
based on progress towards goals. If not, there is a risk of iatrogenic
worsening of the feeding disorder.4,11,19 It is important to note that
the current study was not conducted in the same way as a conven-
tional outpatient service, as we provided continuous sessions for full
consecutive days. However, this intensive treatment produced rapid
improvements in feeding compared to typical, conventional outpa-
tient treatment. Finally, we note that proper expertise, notably years
of training at the hospital where this treatment was developed, is
needed to run this treatment programme.4,11,19
Another strength of the study was that quick improvements
were shown, even though many children had unsuccessful prior
treatment, often involving a range of disciplines and approaches.
In addition, no families withdrew because the parents thought the
feeding disorder had improved while they were on the waiting list.
On the contrary, parents typically reported that the feeding problem
had worsened. Feeding disorders become harder to treat as children
get older and treatment options become limited and more difficult.
That is why early, effective intervention is very important, both for
the well-being of the child and their family and to avoid wasting lim-
ited health system resources.7
5 |  CO N C LU S I O N
This study clearly demonstrated that an intensive, empirically valid
treatment for paediatric feeding disorders could be provided by
properly trained clinicians and continued by trained parents at home
or during meals out. The success of our programme is highly encour-
aging, as it suggests that these empirically valid behaviour-analytic
treatments can be used outside the few specialist settings where
they were developed. We demonstrated that specially trained par-
ents were able to continue the programme and continue to achieve
treatment outcomes several years after they took over responsibil-
ity for the programme. This could improve access to treatment and
Latency to Swallow (Mouth Clean)
dav = –1.3 [–1.95, –.65]
60 120 180 240 300 360 420 480 540 600
help many more families coping with severe and chronic paediatric
feeding disorders.
C O N FL I C T O F I N T E R E S T
The authors have no conflicts of interest to declare.
ORCID
Tessa Taylor  https://orcid.org/0000-0001-8643-3955
Neville Blampied  https://orcid.org/0000-0002-0158-4904
REFERENCES
1. Yeung KA, Taylor T, Scheimann A, et al. The prevalence of food al-
lergies in children referred to a multidisciplinary feeding program.
Clin Pediatr. 2015;54(11):1081-1086.
2. Taylor T, Kozlowski AM, Girolami PA. Comparing behavioral treat-
ment of feeding difficulties and tube dependence in children with
cerebral palsy and autism spectrum disorder. NeuroRehabilitation.
2017;41(2):395-402.
3. Kozlowski AM, Taylor T, González ML, Girolami PA. Feeding dis-
orders. In: Matson JL, Matson ML, eds. Comorbid Conditions in
Individuals with Intellectual Disabilities. Cham, Switzerland: Springer;
2015.
4. González ML, Mulderink TD, Girolami PA. Avoidant restrictive food
intake disorder. In: Maragakis A, O'Donohue WT, eds. Principle-
Based Stepped Care and Brief Psychotherapy for Integrated Care
Settings. Cham, Switzerland: Springer; 2018.
5. Zucker N, Copeland W, Franz L, et al. Psychological and psycho-
social impairment in preschoolers with selective eating. Pediatrics.
2015;136(3):e582-e590.
6. Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition
in the first 1000 days to support childhood development and adult
health. Pediatrics. 2018;141(2):e20173716.
7. Taylor T, Taylor S. Let's not wait and see: the substantial risks of
paediatric feeding problems. Manuscript submitted for publication;
2020.
8. Kerwin MLE. Empirically supported treatments in pediatric psychol-
ogy: severe feeding problems. J Pediatr Psychol. 1999;24(3):193-214.
9. Volkert VM, Piazza CC. Pediatric feeding disorders. In: Sturmey
P, Hersen M, eds. Handbook of Evidence-Based Practice in Clinical
Psychology. Hoboken, NJ: John Wiley & Sons; 2012.
10. Sharp WG, Jaquess DL, Morton JF, Herzinger CV. Pediatric feed-
ing disorders: a quantitative synthesis of treatment outcomes. Clin
Child Fam Psychol Rev. 2010;13(4):348-365.
11. Piazza CC, Milnes SM, Shalev RA. A behavior-analytic approach to
the assessment and treatment of pediatric feeding disorders. In:
Roane HS, Ringdahl JE, Falcomata TS, eds. Clinical and Organizational
TAYLOR et al.
Applications of Applied Behavior Analysis. Cambridge, MA: Academic
Press; 2015.
12. Sharp WG, Volkert VM, Scahill L, McCracken CE, McElhanon B. A
systematic review and meta-analysis of intensive multidisciplinary
intervention for pediatric feeding disorders: how standard is the
standard of care? J Pediatr. 2017;181:116-124.
13. Peterson KM, Piazza CC, Volkert VM. A comparison of a modified
sequential oral sensory approach to an applied behavior-analytic
approach in the treatment of food selectivity in children with au-
tism spectrum disorder. J Appl Behav Anal. 2016;49(3):485-511.
14. Addison LR, Piazza CC, Patel MR, et al. A comparison of sensory in-
tegrative and behavioral therapies as treatment for pediatric feed-
ing disorders. J Appl Behav Anal. 2012;45(3):455-471.
15. Lukens CT, Silverman AH. Systematic review of psychological
interventions for pediatric feeding problems. J Pediatr Psychol.
2014;39(8):903-917.
16. Taylor SA, Virues-Ortega J, Anderson R. Transitioning children from
tube to oral feeding: a systematic review of current treatment ap-
proaches. Speech Language Hearing. 2019;22:1-14.
17. Gosa MM, Carden HT, Jacks CC, Threadgill AY, Sidlovsky TC.
Evidence to support treatment options for children with swallowing
and feeding disorders: a systematic review. J Pediatr Rehabil Med.
2017;10(2):107-136.
18. Lerman DC. From the laboratory to community application:
translational research in behavior analysis. J Appl Behav Anal.
2003;36(4):415-419.
19. Taylor T. Intensive paediatric feeding treatment and the use of a
side deposit for a clinical case within the home setting in Australia.
Eur J Behav Anal. 2018;19(2):208-227.
20. Taylor SA, Purdy SC, Jackson B, Phillips K, Virues-Ortega J.
Evaluation of a home-based behavioral treatment model for chil-
dren with tube dependency. J Pediatr Psychol. 2019;44(6):656-668.
21. Bullock CE, Fisher WW, Hagopian LP. Description and validation of
a computerized behavioral data program: “BDataPro”. Behav Anal.
2017;40(1):275-285.
|
      9
22. Hagopian LP. The consecutive controlled case series: design, da-
ta-analytics, and reporting methods supporting the study of gener-
ality. J Appl Behav Anal. 2020;53(2):596-619.
23. Cooper JO, Heron TE, Heward WL. Applied behavior analysis.
Hoboken, NJ: Pearson; 2020.
24. Wilkinson L. Graphic displays of data. In: Cooper H, ed. APA
Handbook of Research Methods in Psychology. Washington, DC:
American Logical Association; 2012.
25. Lakens D. Calculating and reporting effect sizes to facilitate cu-
mulative science: a practical primer for t-tests and ANOVAs. Front
Psychol. 2013;4:863.
26. Blampied NM. Analyzing therapeutic change using modified
Brinley plots: History, construction, and interpretation. Behav Ther.
2017;48(1):115-127.
27. Kunkel KR, Kozlowski AM, Taylor T, González ML. Validating a food
avoidance assessment for children with food selectivity. Behav Dev.
2018;23(2):89-105.
28. Cumming G. Understanding the new statistics: Effect sizes, confidence
intervals, and meta-analysis. New York, NY: Routledge; 2012.
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section.
How to cite this article: Taylor T, Blampied N, Roglić N.
Controlled case series demonstrates how parents can be
trained to treat paediatric feeding disorders at home. Acta
Paediatr. 2020;00:1–9. https://doi.org/10.1111/apa.15372