Nutritional Disorders Telehealth Network Project

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Behavior Management

Behavioral management procedures systematically apply positive and negative consequences contingent on specific child behaviors. Behavior management procedures consist of techniques based on learning principles that can be applied to problems to strengthen adaptive behaviors and weaken maladaptive behaviors. Of particular interest in clinical feeding interventions are 1) aspects of the feeder’s responses that have an inadvertent affects on feeding patterns and 2) planned techniques for “unlearning” or modifying maladaptive feeding patterns by rearranging social and environmental consequences for feeding. Behavior management techniques have been particularly recommended for problems related to food selectivity, mealtime conduct problems, and delays in self-feeding, as opposed to problems with quantity of intake which may be more affected by appetitive variables.
 
Background Education for Providers
Considerable evidence supports the use of behavioral approaches in the treatment of feeding disorders. Behavioral treatment goals generally consist of (1) decreasing behavioral problems at meals; (2) decreasing parent stress at meals; (3) increasing pleasurable parent-child interactions at meals; (4) increasing oral intake or variety of oral foods; (4) advancing texture (e.g. moving from purees and smooth foods to chewable solids); and (5) increasing the structure and routine of meals. Behavioral treatment strategies include implementation of mealtime structure and a feeding schedule, appetite manipulation, behavior management, and parent training. Ongoing consultation with other specialists, especially a dietician and speech pathologist, is frequently necessary to monitor the safety of the therapeutic plan that can result in transient weight loss, or that may unmask oral motor or swallowing deficits as behavioral resistance to feeding begins to resolve.
 
The essential elements of behavior management are (1) to identify the targeted behavior for change; (2) select techniques to increase or decrease behaviors congruent with feeding goals; and (3) develop a treatment plan that consistently pairs a contingency (positive or negative) with the targeted behavior. Strategies to increase positive behaviors include use of positive and negative reinforcement and discrimination training. To reduce negative behaviors, treatments typically include extinction, satiation, punishment, and desensitization. Typically, behavioral strategies are used in combination to create the strongest treatment effects in the shortest period of time. 
 
Click here for an overview of behavior management principles and strategies.
 
 
Instructions for Provider
 
Principles to INCREASE behavior 
Underlying Principle
Description of Application
Example
Supplemental Materials for at Home Behavioral Management
 
 
Positive consequences for desired behavior
 
Give praise, physical affection, or tangible rewards
 
 
 
 
 
Terminate aversive stimulus contingent on desired behavior
 
 
Release physical restraint when child accepts food
 
 
 
 
Reinforce target behavior in presence of defined stimulus
 
 
 Praise modeled behavior of eating
 
 
 
 
Reinforce successive approximations toward desired response
 
Praise 1) looking at food, then
2) allowing food to touch lips, then
3) opening mouth, then
4) accepting food
 
 
 
 
 
 
Gradually remove assistance and reinforcement needed to maintain behavior
 
 
Decrease extent of guidance and rewards as child gains self-feeding skills
 
 
 
 
 
 
Principles to DECREASE Behavior
Underlying Principle
Description of Application
Example
Supplemental Materials for at Home Behavioral Management
 
 
Withholding rewarding stimulus contingent on target response
 
Ignore mild inappropriate behavior
Continue prompts during escape behavior
 
 
 
 
 
Present aversive stimulus or remove rewarding stimulus contingent on undesired behavior
 
 
Use timeout
Give verbal reprimand Restrict toys
Use overcorrection
 
Timeout (.pdf)
Referral (.pdf)
 
 
Pair conditioned aversive stimulus with absence of aversive events or with presence of positive events
 
 
Distract child during fearful procedure
Use gentle massage to promote acceptance of touch
 
 
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Page Updated 04/15/2014