Behavioral parent training in the treatment of selective food refusal: An ecological analysis.

摘要

This study investigated ecological variables related to the feeding environment of children with selective food refusal. A home-based approach to the treatment of feeding problems, which focused on training the parent in behavioral skills designed to manage the child's eating, and on direct manipulation of the child's feeding environment, was used.;The primary purpose of this study was to evaluate the effects of an initial parent training condition directed at behavior management skills on the ecological variables of interest. A related purpose was to analyze the effects of a parent training component directed at changing physical and structural ecological variables of feeding with children exhibiting selective food refusal. The ecological conditions analyzed were offering meals and snacks at consistent times, making the child's meals time-limited, seating the child at the table for meals, and having the child eat with another member of the family besides the parent responsible for feeding.;Repeated observation of ecological variables was conducted with four families of feeding-disordered children in baseline and during an initial parent training condition directed at increasing parents' behavior management skills during feeding. One family terminated treatment prematurely. With two families for whom ecological conditions remained below a desired level after the initial treatment condition, the ecological variables were altered by teaching parents to change ecological aspects of the feeding environment using behavior management skills taught in the previous condition. The effects of each parent training component were analyzed in a multiple baseline design across parent-child dyads.;Results demonstrated that, during the initial training condition, the parent's use of contingency management procedures increased, and the child's acceptance of target foods increased. The parents' use of contingency management procedures was maintained during the ecological training component. For two of the three subjects, the children's acceptance of target foods was maintained during the ecological training component. For two of the subjects, a partial change in the ecological variables occurred with the implementation of the initial parent training component. For the two subjects who participated in the ecological training component, change in the ecological variables was in the desired direction.