This information is provided for reference only. The content is not intended to advertise specific outcomes or create unreasonable expectations. Therapeutic decisions should be made in consultation with a registered health practitioner.

On average, children went from eating 6 to 94 foods across all food groups.

Children had previously received up to 11 years of prior failed interventions by up to 12 different disciplines/treatment types (sensory/play, speech, physician (developmental paediatrician, GI, ENT, etc.), OT, dietitian, interdisciplinary feeding hospitals, hunger provocation/starvation, behavioural, medications (appetite, psychiatric, etc.), psychology/eating disorders, other (chiro, telehealth, equipment, hypnosis, research study), special diet). 

• *Note: Each child and family are unique and the programme is individualised. Outcomes experienced by one person do not necessarily reflect the processes and results that other people may experience or guarantee the same outcomes. Outcomes can vary based on individual circumstances. 

These are only published cases from Australia and only selected feeding relevant diagnoses and conditions are listed for each case. The focus is on the specific individualised feeding needs/goals rather than diagnosis. In the hospital at Johns Hopkins/Kennedy Krieger, many diverse, severe, and complex feeding cases and issues were supported (Taylor, Kozlowski, & Girolami, 2017). In Australia, cases have had autism, developmental delay, intellectual disability, chromosomal abnormalities, coeliac disease, William’s syndrome, prematurity, constipation, anemia, nasogastric and gastrostomy tubes, failure to thrive, reflux, and dyspraxia, as well as typical development and no diagnoses at all. 

Home-Based Behavioural Intervention across Skill Domains for a Child with Tube Dependency (Mann, S.A. Taylor, T. Taylor, & Zhang, 2023)*

Prolonged tube feeding has a multitude of negative outcomes. The transition to oral feeding is essential for child and family quality of life. Behaviour-analytic interventions are effective for paediatric feeding disorders, but information is lacking regarding the treatment process and outcomes. This study evaluated a home-based behavioural intervention for a 19-month-old child dependent on tube feeding. An intensive period was followed by caregiver support to advance feeding skills. We applied differential reinforcement and volume fading within a multiple probe design. Results showed clinically significant behavioural and nutritional outcomes, the cessation of tube feeding, and a process valued by the family. *Note: Conducted by Dr. Sarah Ann Taylor in New Zealand. 

Treatment of Avoidant/Restrictive Food Intake Disorder for a Teenager with Typical Development Within the Home Setting (Taylor, Haberlin, & Haberlin, 2019)

ARFID can occur in children with typical development and persist past childhood. This significantly impacts most areas of children’s lives, but may become more evident in teenage years, especially socially. There is an empirically supported treatment for ARFID with 40 years of research backing, this being behaviour-analytic feeding interventions. However, application to individuals over age 12 is lacking, and needs to be investigated for effectiveness. This is important as the addition of ARFID (formerly called feeding disorders) to the DSM-V has seen an increase in new treatments for ARFID by attempting to apply eating disorder treatments to this population including children. More research is needed to identify if already established behavioural intervention procedures are effective for ARFID in individuals with selectivity, without disabilities, older ages, and in settings outside of intensive specialised feeding hospital admissions in the United States. A 13-year-old female with ARFID and years of failed treatment attempts participated in her home in Australia. She consumed no vegetables or fruits. Her diet was limited to 5 specific starches, 1 protein, and 1 combo. She was motivated to change her diet because of social and health (never feeling full, low energy, spikes/crashes) impact. Socially, this posed a significant problem at school, with friends and family, and during occasions and travel. Previous treatment attempts since the age of 2 years included psychologists, eating disorders specialists, dietitians, speech/occupational therapists, gastroenterologist, anxiety medications (with side effects), hypnosis, sensory treatment (SOS), play therapy, rewards, removal of privileges, withholding food, etc. We conducted multiple stimulus without replacement preference assessments and used a changing criterion design with multiple baseline probes. Treatment consisted of demand fading, choice, differential attention, and contingent access. We did not use cognitive or family based treatment. Consumption increased to 100%. Variety reached 61 foods across all food groups. She met 100% of goals and ate at a restaurant. Caregivers reported high satisfaction and social acceptability. Gains were maintained at 9 months. This brief, behaviour-analytic in-home treatment was effective in increasing food group variety consumption.

Brief Report: Packing Treatment Comparison and Use of a Chaser to Increase Swallowing for a Clinical Case (Taylor, 2021)

Packing involves not swallowing solids or liquids in the mouth. It is a significant mealtime behaviour to treat. Research has shown effectiveness of redistribution, but only two studies in highly specialised hospital settings in the United States have evaluated the use of a chaser. We extended this literature by conducting treatment in the home setting, and comparing a liquid and puree chaser separately to infant gum brush redistribution and a move-on to the next bite presentation component. A 4-year-old male with autism spectrum disorder and gastrostomy tube dependence participated in his home. He also had a history of prematurity (24 weeks), ventilator, CPAP, oxygen, and failure to thrive. He ate custard and soup as a nonself-feeder at a certain temperature. If a minuscule lump was in the soup, he would gag and vomit. He had never chewed or used his teeth or swallowed any texture. He might accept 2 other specific foods, but would pack for hours or expel. He consumed chocolate milk mix via spoon feeding as a nonself-feeder. He used an adaptive water bottle that squirted water into his mouth with prompting and assistance. He did not take medications orally (via G-tube). Previous treatment attempts included multiple years since birth with a hospital feeding team, various therapies, and a 10-day hospitalisation for tube weaning (resulting in some small oral intake of custard, liquid soup, and chocolate milk mix). His parents persisted in oral feeding and volume and decreased tube nutrition dependence on their own. We used a multielement single-case experimental design. With the liquid chaser, consumption increased to 100%. Swallowing latency was significantly lower with the liquid chaser compared to other packing treatments. His variety reached over 124 foods at any temperature. He learned self-feeding and scooping, including holding the container, and using a fork. He learned drinking independently from a full cup including sipping, a regular water bottle, and regular straw. Liquid variety was increased to multiple flavours of formula and water in a regular open cup. He learned to eat independently from pouch and take medications orally rather than via tube. He learned to bite off, chew with his molars, lateralize, masticate, and swallow a wide variety of regular texture foods, including meats and raw fruit/vegetables. Refusal, expulsion, packing (not swallowing), emesis (vomit), and gagging/coughing all decreased to low/zero levels, and independence, chewing/texture, and swallowing increased significantly. He transitioned from a highchair to a booster at the family dinner table. His parents were trained to implement the protocol. He met all 22 of his goals in 15 days.

Use of an Exit Criterion for a Clinical Paediatric Feeding Case In-Home (Taylor, 2020)

There are well-established empirically-supported treatments for paediatric feeding disorders (avoidant/restrictive food intake disorder; ARFID); however, more research is needed on their sole use, outside of specialised multidisciplinary feeding hospitals, and with older ages. Additionally, there is little research on the use of an exit criterion treatment. An 11-year-old male with autism participated in a 2-week in-home programme. He ate no fruits or vegetables, rarely used utensils, did not drink out of a cup, and had constipation and laxative dependence. He engaged in inappropriate mealtime behaviour (IMB) if foods were near him (other’s eating), gagged at the smell, and requested his mum to wash her hands before touching his water bottle if she cut vegetables. Previous treatment attempts include 18 months with an OT from a multidisciplinary feeding team and speech therapy. Treatment was solely behaviour-analytic and consisted of demand fading, choice, differential attention, contingent access, and exit criterion. We conducted repeated edible preference assessments and used a changing criterion single-case experimental design across three food variety groups of decreasing preference. Variety reached 79 foods across food groups and 100% of goals were met (including utensils and cup drinking). He ate at a restaurant and with his sibling. Caregivers reported high social acceptability and at 2-year follow-up the problem still resolved.   

Intensive Paediatric Feeding Treatment and the Use of a Side Deposit for a Clinical Case Within the Home Setting in Australia (Taylor, 2018) 

Researchers have shown the effectiveness of physical guidance procedures in highly specialised hospital settings. We replicated use of a side deposit in a treatment package using a reversal design. We extended by translating to a home setting in Australia. We also evaluated the frequency and necessity of use over time to 13 months, choice and positive reinforcement alone prior, and food preferences before and after exposure. A 9-year-old boy with autism and history of nasogastric tube (NG tube) at birth ate no fruits, vegetables, or meat and did not drink water, and was dependent on laxatives and formula. He had years of attempted treatments with multiple disciplines and therapists, including medications and participation in an intensive research study at a hospital. Choice and contingent access, differential attention, nonremoval, and re-presentation were ineffective in increasing consumption, but it increased to 100% when the side deposit was added. Variety increased to 57 regular texture foods and water from a cup. He met 100% of goals. His parents reported high satisfaction and acceptability. Treatment gains maintained over a year in the absence of protocol implementation.

Assessment and Treatment of Pica Within the Home Setting in Australia (Taylor, 2020) 

Pica is one of the most serious, life-threatening topographies of self-injurious behavior because a single instance can result in death. Despite this, there is a need for more research on teaching adaptive skills to replace pica, particularly outside of intensive specialized hospital admissions and with younger children. We present a case history of a 4-year-old male with autism spectrum disorder, pica, food selectivity, food stealing, and history of iron deficieny in which assessment and treatment occurred in the family’s home for 9 days. Pica was significantly impacting his life and restricting his location, daily activities, independence, and adaptive functioning. He could not go outside freely because he ate dirt, bark, grass, rocks, rubbish, etc. He also ate academic materials such as glue, crayons, plastic, paper, paint, etc. He mouthed and bit many dangerous household objects (e.g., extension cord, cleaning products) and toys which had visible teeth marks and bits missing. Food stealing impacted his daily life and social engagement, significant others, and community and social settings. Cupboards and outdoors were locked. He did not consume any vegetables separately and only ate 3 fruits. A functional analysis suggested pica was maintained by automatic reinforcement. A competing stimulus assessment showed pica was highest without competing stimuli, lowest with highly preferred edibles, and lower with highly preferred tangibles. Response interruption and redirection with differential reinforcement was effective with and without competing stimuli across contexts. The participant learned to independently throw away pica material and rubbish, put away objects he previously engaged in pica and mouthing with, and use appropriately some materials (academic, leisure, therapy), and to refrain from touching other items he previously consumed inappropriately (dangerous, inappropriate, or belonging to others such as food, electronics, and household items). Pica decreased by 97%, independent discards increased by 100%, and 100% of admission goals were met. He independently accepted, chewed, and swallowed 25 new foods including 12 vegetables and 8 fruits. His mother and therapist were trained to high procedural integrity on the treatment procedures, and they continued testing for generalization and maintenance. His mother reported high satisfaction with the program and outcomes and acceptability of the treatment procedures. Gains were maintained for over 2 years.

Side Deposit with Regular Texture Food for Clinical Cases In-Home (Taylor, 2020)

Research has shown effectiveness of nonremoval of the spoon and physical guidance in increasing consumption and decreasing inappropriate mealtime behavior. The side deposit has been used to treat passive refusal in 2 studies (1 in a highly specialized hospital setting) using lower manipulated-texture foods on an infant gum brush. We extended the literature by using regular texture bites of food with a finger prompt and side deposit (placing bites inside the side of the child’s mouth via the cheek) in an intensive (2-3 week) home-based program setting in Australia, demonstrating that attention and tangible treatments alone were ineffective prior, fading the tangible treatment, showing caregiver training, and following up. 2 male children with autism spectrum disorder (with texture/variety selectivity; one with liquid dependence) participated in their homes. A 5-year-old boy with autism consumed 4 specific foods and no fruits or raw or separate vegetables or age-appropriate texture foods. A 4-year-old male with autism, medication refusal, and iron deficiency with supplement dependency was dependent on liquids and formula to meet his nutritional needs via baby bottle. He did not eat any foods, only specific biscuits and a homemade fruit smoothie as a nonself-feeder. He did not drink out of an open cup. He would not eat from his school lunchbox if a nonpreferred food was included. He had had over 2 years of failed treatment attempts from multiple disciplines. We used a reversal design to replicate effectiveness of the side deposit added to a treatment package. For both participants, we observed a >98% decrease in latency to acceptance, a 100% decrease in inappropriate mealtime behavior, and a 100% increase in consumption with the side deposit added. Variety was increased to over 85 regular texture foods including steak and salad. 100% of admission goals were met including independently scooping and biting off, chewing regular texture, self-drinking from open cup, taking medication from a medicine cup, and transitioning independently to the table. Caregivers were trained to high procedural integrity and the protocol was generalized to school and the community (restaurant). Gains maintained to 3 and 1.5 years. This is important work in adding to the literature and support for the side deposit and expanding to regular texture, as well as replicating and extending empirically supported treatments for feeding internationally to the home setting.