As I have developed my own approach to feeding therapy as a behavior analyst, and later as I have worked to build Sprouts Feeding Therapy as a business, I have often gotten to thinking about what “behavioral feeding therapy” may mean to the average person, perhaps a parent trying to find an appropriate service provider for their child.
The behavioral approach to feeding therapy is not the go-to method that most doctors and other professionals recommend to families (typically it is speech therapy or occupational therapy based treatment). Considering the effectiveness of ABA (applied behavior analysis) principles when applied to feeding problems and the years of research in this area, I think this lack of attention must just come down to a shortage of available and accessible information on the topic. Learning about behavioral feeding therapy and how successful it is requires some digging of sorts. Unlike feeding therapy that is more sensory or nutrition related, you won’t find blog upon blog of tips and techniques festooned with cute logos and pictures…you will instead find journal articles that you can only read if you have access to certain libraries or $35.95 burning a hole in your pocket! Frustrating? Yes!
I suppose that some of the general myths that exist in regards to ABA may carry over to behavioral feeding therapy. I think it would be a shame if parents overlooked this type of therapy because they think: “Oh, well my child doesn’t have autism...this wouldn’t be right for her,” or, “Isn’t that behavior modification? I think that would be too negative for my child.” While ABA has found a home in a few specific populations, there are many ABA techniques that are used effectively across a variety of ages, developmental levels, conditions, etc…it’s just that almost nobody outside of the field knows about it! The wonderful thing about applied behavior analysis is that it takes place in the real world, with individuals who have varying skills, needs, and motivations. Once a child’s feeding challenges are identified, the specific issues that are observed can be treated using behavioral techniques tailored to the child. By targeting specific problems one by one in a structured manner, results are seen…and generally very quickly!
If you were to observe a behavioral feeding session and a feeding session conducted by a therapist with a different philosophy, the foods/utensils/seating arrangement may not be different at all. The therapists may even give similar instructions to the child during the session, and they may be targeting the same goals. However, upon closer examination, you would probably notice some differences. The behavioral therapist may always use a clear, consistent word, phrase, or gesture to instruct the child on what to do. When the child is successful, you will observe immediate and predictable delivery of a reward, whether that be praise, a sticker, brief TV time, etc. The behavioral therapist may appear more persistent once something is presented to the child’s mouth, and will require that the child be successful with each instruction that is given. Because success is so critical, you may notice that easier, smaller goals are addressed first to establish the new expectations from the very start of therapy. With the behavioral therapist, sessions will follow a specific, consistent procedure, and changes will be made systematically. You will also notice that the behavioral therapist will ignore the child’s negative behaviors. Rather than comforting or engaging with a child who is whining, the therapist will indirectly try to make the session more positive by talking about fun topics, singing songs, and most importantly, providing lots of positive interaction when the child is on task!
A behavioral feeding therapist will focus on what can be readily observed during sessions, and will avoid making assumptions about what is going on in the child’s mind. This is because a lot of times, our assumptions are wrong and may lead to ineffective procedures…then it’s back to the drawing board! When focusing on a specific feeding issue, strategies will be used to increase or decrease food acceptance and feeding skills to the point that the child is successfully eating. Skills can be shaped up gradually, and new foods and drinks can be faded in using steps as needed. The behavioral feeding therapist will always be considering the child’s motivation to eat (this is probably the most important part!!!), because if motivation is lacking, progress will understandably be difficult. Maintaining the child’s desire to eat through the use of effective rewards keeps meals positive; if the child actually wants to be a part of the process, reaching goals can become easy and enjoyable!
While this explanation merely scratches the surface of what behavioral therapy is, I hope that I am succeeding at doing my part in making behavioral feeding therapy more accessible to you, whether you’re a parent, professional in a related field, or just curious!
Until next time,