Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
The likely function of the behavior becomes clear when an ABC chart is used. At this
point we have a strong hypothesis that attention is one of the reinforcing variables.
The fact that Mom did not remove the spoon suggests that escape may not be the
primary function of the behavior. However, when Charlotte turned her head, she
did in fact avoid taking a bite. The hypothesis of escape as one of the functions of
her refusal behavior is supported by her medical and developmental history. There
was reported information that indicated sensory and motor problems that have the
potential to make feeding unpleasant. That which is unpleasant is often avoided. Her
behavior resulted in both escape and attention. On a practical level, we must operate
as though both reinforcers are helping to maintain the behavior and our intervention
would address both escape and attention (1).
Since several reinforcers may be operating, an appropriate intervention will address
all functions suggested by the data. For example, an intervention for Charlotte would
need to include components from the protocols for internal events, attention, and
escape. Below are several examples of interventions based on the hypothesized
function of the food refusal. Because escape is a likely function in almost all feeding
dysfunction, the most complete sample intervention is included under its heading.
Developing Intervention Plans
Intervention plans are developed with data gathered during the functional
assessment process. The interventions are based on teaching and reinforcing
replacement behaviors so that, theoretically, the child drops the old behavior
because it no longer works as efficiently and effectively as the replacement behavior
(1). Steps 1-4 below are included in all interventions.
1. Baseline data must be collected to identify the tasks and the duration of trials
that a child can tolerate without becoming distressed. Task analysis is then
used to break the goal behavior down into many smaller steps, called subskills.
Individual intervention is begun at a subskill that is easy for the child
and unlikely to trigger severe escape behaviors.
2. Seating, positioning, food selection, oral-motor skill development, medication,
and other components specific to the child must be addressed to reduce the
aversive (punishing) elements of the mealtime setting.
3. An assessment must be conducted to identify highly preferred reinforcers (8).
When reinforcers are varied and rotated randomly, their effectiveness is enhanced.
Identified reinforcers, on a random rotation basis, are used to reward
behaviors already in the child’s repertoire. This builds behavioral momentum
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