Poster Presentations
Friday, September 20, 2024
4:00 pm – 5:30 pm
P01 - A Rapid Review of Device Assisted Therapy for Pediatric Dysphagia Management
Memorie Gosa, PhD CCC-SLP, BCS-S, The University of Alabama; Jeanne Marshall, PhD, University of Queensland
Multiple device-assisted therapeutic modalities have been introduced to assist in the remediation of pediatric dysphagia, including surface electromyography (sEMG) and neuromuscular electrical stimulation (NMES). These modalities are commercially available; however, consensus on the efficacy of these modalities has not been established. The purpose of this project was to determine the effect of device assisted therapy on swallowing physiology and functional feeding outcomes in children with oropharyngeal dysphagia.
A rapid review methodology identified relevant literature through a narrow search strategy applied to three databases using search strategies specific to the electronic database and searching the following keywords and their variations: “pediatric”, “dysphagia”, “device-assisted” and “therapy”. Results included peer-reviewed journal articles relating to device-assisted dysphagia therapy in pediatric patients with dysphagia, one – 18 years of age. Device-assisted therapy was defined as therapy that utilized instruments capable of providing objective data about client performance and/or capable of providing mechanically controlled external stimulation to the client. Data extracted included topic, study design, methodology, outcomes, limitations and reasons for exclusion (if applicable). This rapid review identified seven different articles that met inclusion criteria. Most of the identified papers were observational in nature and reported on the impact of NMES on swallowing physiology and functional feeding outcomes in children. Analysis of the collected articles does not provide sufficient evidence to support the use of NMES in pediatric populations. There is an immediate need for further research into the effect of device-assisted therapeutic modalities on swallowing physiology and functional feeding outcomes in pediatric populations.
At the end of this presentation, participants will be able to:
- Define device-assisted therapy for pediatric dysphagia treatment.
- List two types of device-assisted pediatric dysphagia therapy currently being offered in clinical settings.
- Explain the efficacy of using device-assisted therapy for pediatric dysphagia treatment.
Level: Advanced Discipline: SLP
P02 - Behavioral Treatment for Avoidant Restrictive Intake Disorder in a Typically Developing 4-Year-Old Patient
Rebecca Kramer, PhD; Ryan Davidson, PhD; Sarah Fleet, MD; Boston Children’s Hospital/Harvard Medical School
Avoidant restrictive intake disorder (ARFID) is a psychiatric condition marked by limited food intake or selectivity without body-image concerns, affecting psychosocial function and leading to weight loss and malnutrition. 1, 2. Psychological treatment is an essential component in treating ARFID alongside medical and nutritional interventions. 3 Several treatment manuals have been developed for pediatric ARFID, however there is limited outcome data from randomized clinical trials. 4 Further, to the author’s knowledge, there are no established treatment manuals for psychological/behavioral interventions for children under the age of five who are also typically developing. This case report illustrates a comprehensive behavioral approach to treating ARFID in a typically developing 4-year-old patient, as part of multidisciplinary collaboration. Primary intervention components included graduated exposure and response prevention and positive reinforcement. As a part of standard clinical documentation, tracking of patient’s engagement with safe, moderate and difficult foods was recorded. Over the course of 15 bi-monthly sessions, proportion of trials with engagement of difficult foods increased compared to proportion of trials with engagement of safe foods. Further, two foods transitioned from difficult to moderate and one food from moderate to safe. The current case highlights importance of treatment goals meeting patient and family needs and use of an exposure paradigm to increase overall patient flexibility and improve distress tolerance. Future research is needed to expand identification of effective behavioral interventions, particularly for this age group of typically developing children who may not have access to more intensive services, such as applied behavioral analysis.
At the end of this presentation, participants will be able to:
- Identify role of pediatric psychologist in treatment of ARFID.
- Describe current manualized pediatric ARFID treatment approaches.
- Identify potential treatment targets for typically developing children under five with ARFID using exposure paradigm.
Level: Intermediate Discipline: Psych
P03 - Clinimetric Review of Patient Reported Outcome Measures (PROMs) for the Feeding Skills Domain of Pediatric Feeding Disorder (PFD)
Jeanne Marshall, PhD, Queensland Children’s Hospital; Memorie Gosa, PhD, CCC-SLP, BCS-S, The University of Alabama; Pamela Dodrill, PhD, CCC-SLP, BCS-S, CNT, Brigham and Women’s Hospital/ Harvard
In research and clinical practice, there is little clarity with regards to assessment processes to make a diagnosis for pediatric feeding disorder (PFD). This clinimetric review addresses the question: What are the clinimetric properties of Patient/Proxy Reported Outcome Measure (PROM) tools that are used to assess feeding skills in PFD in children > six months of age?
Studies less than 20 years old describing published PROMs for feeding-skills based PFD in children were included. A comprehensive search strategy informed by a research librarian was used across four databases. Information from each PROM was extracted regarding purpose, target population and age-range, administration details, assessment properties and how different items on each PROM mapped to the other domains of PFD. Each tool was also categorized using the International Classification of Functioning and Health. The different items for each PROM were mapped to the diagnostic criteria for PFD. Clinimetric properties of each tool were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, using a revised scoring system developed by Cordier et al. (2015).
A total of 14 PROMs that met inclusion criteria were identified from 22 included papers. PROMs were predominantly used for evaluative/discriminative purposes. Reported psychometric properties were variable.
A comprehensive diagnostic process will likely require use of a combination of clinical assessments and PROMs, and consideration of the functional impact of any identified impairments. Of the PROMs available, there is no single tool available that captures all areas needed for a diagnosis of PFD.
At the end of this presentation, participants will be able to:
- Define the four domains of pediatric feeding disorder (PFD).
- List at least two clinical tools available to identify feeding skill impairment as part of the PFD assessment.
- Explain the benefit of using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for the assessment of patient/parent reported outcome measures.
Level: Intermediate Discipline: SLP
P04 - Intensive Feeding Program: Where Do We Begin?
Micheline Silva, PhD; Maureen Hockaday, MA, CCC-SLP, CLC; Nationwide Children’s Hospital
The intensive feeding track at Nationwide Children’s Hospital is an eight-week, day program for children with chronic pediatric feeding disorder. It involves integrative work of various disciplines to address different aspects of a child’s feeding problem including medical, nutritional, oral-motor and behavioral components.
An innovation in this program is that a psychologist and a feeding therapist collaboratively developed a protocol to determine foundational skills shown by a child upon admission, or basic behaviors a child needs to show consistently in a therapeutic setting, before food/drink can be more successfully introduced. These include separating from caregiver, sitting in a supportive seat and properly responding to contingent access to rewards upon the compliance with gradually more challenging feeding demands. As the level of demand increases, it is expected that inappropriate behaviors will also increase. The developed protocol, the Assessment of Child’s Tolerance of Feeding Interventions (ACT-FI), appears to be an efficient tool to systematically test a child’s level of foundational skills and suggest starting points for intervention.
As part of the admission process, the ACT-FI shifts the focus away from elicitation of problematic behaviors. For all patients starting the intensive feeding track, the therapist on the team first establishes rapport and gives the patient non-contingent access to preferred toys/activities. A flowsheet provides guidance on increasing the demand. Use of the ACT-FI has allowed the team at NCH to establish attainable goals and has allowed patients to demonstrate success with foundational skills necessary to move forward with feeding.
At the end of this presentation, participants will be able to:
- Identify key elements to consider when establishing feeding intervention starting points.
- Describe how a child’s inappropriate behaviors during mealtime can interfere with their progress in feeding therapy.
- Describe at least one way to systematically assess a child’s tolerance to gradually more challenging feeding demands.
Level: Advanced Discipline: SLP
P05 - Multidisciplinary Feeding Co-Treatment for Youth With ARFID: Improvements in Mealtime Behavior and Parent Feeding Stress
Sara Turner, MS, PhD, University of Utah; Marley Rosello, BA, University of Utah; Stacey Browning, OT, Intermountain Health Primary Children’s Hospital; Hillary Torres, NP, Intermountain Health Primary Children’s Hospital; Anna Ermarth, MD, University of Utah
Introduction: Youth with ARFID and their caregivers often experience mealtime stress and difficulties with mealtime behaviors that can be targeted with multidisciplinary intervention. An outpatient co-treatment feeding program was created to address family feeding challenges utilizing OT and CBT techniques. Caregivers learned and practiced behavioral interventions to address mealtime behaviors with live feedback. We expected that youth mealtime behaviors and parent feeding stress would improve with intervention.
Methods: 20 youth with ARFID (M age=9.91, SD=3.19 years; 55 percent female) were enrolled in a six (6) session feeding co-treatment program. Sessions included an occupational therapist, pediatric psychologist, patient with ARFID and their caregiver. Questionnaires on mealtime behaviors, general caregiver stress and caregiver feeding stress and self-efficacy were collected at pre and post treatment.
Results: Paired samples t-tests assessed for change from pre to post treatment. Results indicated that enjoyment of food (M pre=2.49, SD=.59) was higher after intervention (M post=2.70, SD=.70) t(18) = -2.28, p (2-tailed) = .035 as was food responsiveness (M pre=1.87, SD=.58; M post= 2.07, SD=.59), t(18) = -3.04, p (2-tailed) = .007. Food fussiness also decreased from pre (M pre =4.12, SD=.61) to post intervention (M=3.90, SD=.71), t(18) = 2.49, p (2-tailed) = .023. There was also a significant decrease in the amount of caregiver stress related to feeding a child with ARFID from pre (M=79.15, SD=16.75) to post treatment (M=66.25, SD =23.15), t(19) = 2.81, p (2-tailed) = .011.
Conclusions: Results indicate that multidisciplinary family treatment for ARFID may improve youth mealtime behavior and caregiver feeding stress.
At the end of this presentation, participants will be able to:
- Describe individual and family behaviors that contribute to mealtime challenges in ARFID.
- Identify behavioral targets for intervention.
- Explain improvements in outcomes with a multidisciplinary family feeding intervention.
Level: Intermediate Discipline: Psych
P06 - Reliability and Validity of the Functional Oral Intake Scale - Pediatric
Memorie Gosa, PhD, CCC-SLP, BCS-S, The University of Alabama
Background: There is a need for a valid and reliable clinical tool to track functional feeding outcomes and support needs in pediatric populations. The FOIS (Crary et al, 2005) has been used to track functional feeding outcomes in adult populations. A pediatric adaption was developed, along with the original authors. The FOIS-P is a six point feeding scale that allows an infant’s feeding skills to be categorized across a functional continuum (1 = all PG feeds, no PO; 6 = all PO with no therapeutic compensations required). This study aimed to determine the reliability and validity of the FOIS-P.
Methods: 143 patients records were reviewed for medical history and feeding variables. 20 pediatric clinicians participated (15 speech-language pathologists, 2 physicians, 1 nurse, 2 dietitians).
Results: Reliability -There was a high degree of correlation between clinician scores on FOIS-P. On scores 1, 4, 5, 6, there was >98 percent clinician agreement. On scores 2 and 3, there was initially 91 percent agreement; After training, this was improved to 97 percent agreement. Validity – The FOIS-P was highly associated with other clinical measures. FOIS-P scores are significantly positively associated with GA at birth, negatively associated with degree of respiratory illness, and negatively associated with degree of aspiration. The FOIS-P also detected change over time. Specifically, FOIS-P scores are significantly positively correlated with corrected GA and % PO.
Conclusion: The FOIS-P is reliable and valid tool for tracking functional feeding outcomes and patient support needs in pediatric populations.
At the end of this presentation, participants will be able to:
- Formulate a definition of pediatric feeding disorder.
- List three feeding compensations commonly used in the pediatric population.
- List at least one tool that can be used to track functional feeding outcomes in children.
Level: Intermediate Discipline: SLP
P07 - Teachers’ Perception of Efficacy of a Relational Mealtime Approach in a School-Based Early Intervention Setting
Rhoda Kwan, MSc, SLP, Thye Hua Kwan Moral Charities
Introduction: Avoidant/Restrictive Food Intake Disorder (ARFID) has wide ranging impact on nutrition, development, and quality of life (Dolman et al., 2020). Coupled with high comorbidity rates with autism (8.2-54.75 percent; Sanchez‐Cerezo et al., 2023), this poses a significant impact on the early intervention population. Early research suggests that a relational approach could be helpful in addressing the underlying difficulties of ARFID (Wong & Rowell, 2018).
Aims: This pilot case study sought to increase mealtime participation in two children with ARFID attending an early intervention centre (EIPIC) by adapting a relational approach by Lively, McAllister, & Doeltgen (2019). The transference of the approach to the group setting was examined as well.
Approach: The transdisciplinary model is employed in EIPIC, with the teacher as key worker and intervention carried out in groups. The teacher focused on building relationships with the children during snack times in class while transforming the time to a naturalistic meal. Child engagement and interaction with food during snack time as well as teacher perception of efficacy were measured. A familial approach was also adopted with the team visiting the family at home to collect information and give tailored strategies to meet family’s mealtime goals.
Conclusion: After a period of 1.5 months, the teachers perceived improvements in the children’s presentation. Work with either family remained an ongoing process due to various familial factors. In summary, the relational mealtime approach shows promise in a group setting in EIPIC. However, it might require long-term commitment from the team and family before conclusions can be drawn.
At the end of this presentation, participants will be able to:
- Explain the relational approach to ARFID intervention.
- Explain the transference of a relational approach to ARFID intervention in a transdisciplinary group setting.
- Explain the challenges of working with the family in a community setting under a relational approach.
Level: Introductory Discipline: SLP
P08 - The Effect of Post-Discharge Telehealth Sessions Following Treatment in an Intensive Multidisciplinary Feeding Program
Jazmine Peyton, CPNP, CHOC Children’s
Parents frequently report increased stress when transitioning from an intensive inpatient feeding program to the home environment. This study evaluates transitional stress scores and the effect of telehealth as a post-discharge intervention following a three-week inpatient feeding admission.
It is a prospective study among patients discharged from the CHOC Children’s Multidisciplinary Feeding Program between January 2023 to June 2024. Two groups of families were recruited during the admission. Because of licensure requirements, the experimental group is a convenience sample of families who reside in the state of California. They agreed to three follow up sessions within one month conducted over Zoom© communication software.
Initial findings suggest that telehealth used as a post-discharge intervention following a three-week inpatient feeding admission may be beneficial to reducing stress and improving outcomes. The multidisciplinary team is able to use the telehealth platform to address these challenges for participants and provide parent education/coaching during the transition home.
At the end of this presentation, participants will be able to:
- Access data on parental stress and satisfaction before and after telehealth visits.
- Explain the use of telehealth modality to improved outcomes as a follow up after discharge from intensive inpatient feeding program.
- Explain the conceptual themes addressed during telehealth visits after intensive inpatient program.
Level: Introductory Discipline: RN
P09 - The Effects of Applied Behavior Analysis Based Parent Implemented Intervention for Children With Pediatric Feeding Disorder: A Systematic Review and Meta-Analysis
Ruqian Ma, MA, MSW, EdS, University of Washington
Feeding difficulties occur at a high rate in children with normal development and at a disproportionally high rate in children with developmental disabilities. Prolonged problematic eating, categorized as pediatric feeding disorder (PFD), can result in poor physical growth and jeopardize overall health. Extant research on applied behavior analysis (ABA) based parent-implemented intervention (PII) has been widely accepted and found to be effective in supporting children with feeding difficulties. A vast majority of studies have separately explored the efficacy of ABA-based interventions and PIIs for children with feeding difficulties. In addition, previous systematic reviews and meta-analysis have focused on studies utilizing single-case research design. This study comprehensively assessed the overall effectiveness of ABA-based PII for children with PFD with studies utilizing group experimental design. Meta-analytic procedures were used to estimate the effects of ABA-based PIIs on child outcomes for children with PFD. A total of 11 studies with a total number of 396 participants were included in this analysis. The included studies yielded an overall effect of d = 1.06, indicating a large effect size on child feeding-related outcomes. Moderator analysis will be performed to further determine to what extent do characteristics of child participants (e.g., comorbidity, race, gender), delivery format of training and treatment components of PII moderate parent related outcomes. Preliminary data also suggested that there is a need to develop high-quality randomized controlled trials with larger sample size to determine the intervention impact on child feeing outcomes.
At the end of this presentation, participants will be able to:
- Identify the impact of aba-based parent implemented intervention on children with pediatric feeding disorder.
- Describe the systematic-review and meta-analysis.
- Explain the aba-based parent implemented intervention for children with pediatric feeding disorder.
Level: Introductory Discipline: Psych
P010 - Tracking Functional Feeding Outcomes in the Newborn Period and Throughout Childhood
Memorie Gosa, PhD, CCC-SLP, BCS-S, The University of Alabama; Pamela Dodrill, PhD, CCC-SLP, BCS-S, CNT, Brigham and Women’s Hospital/ Harvard
Preterm and other high-risk infants often display difficulty establishing oral (per os, PO) feeding. Most initially require gavage (PG) tube feeds. Then, as they transition to PO feeds, many require the use of therapeutic compensations (e.g. special bottle nipples, positioning, strategies) to assist them to feed safely and efficiently. Some infants continue to require therapeutic compensations +/- PG feeds post-discharge home from hospital. There is a need to track functional feeding outcomes and support needs in pediatric populations.
We describe how we used the Functional Oral Intake Scale–Pediatric to track the PO progress in infants during their NICU stay and across the first year at home.
Specifically, in our Level III NICU:
During their NICU stay:
- >95 percent of infants require PG feeds
- ~35 percent of infants require compensations
- ~5 percent of infants require thickened liquids
At the time of discharge home:
- ~25 percent continue to display immature/ disordered feeding skills
- 2 percent require home PG feeding
- the remainder are fully PO fed, but require compensations +/- thickened liquids
At home, within 1 month of discharge (0-2 months CA):
- ~90 percent of NICU infants are breastfeeding/ bottle feeding without need for compensations
- 10 percent continue to require some compensations
- ~35 percent of infants attending NICU follow-up clinic display delayed transition to solid foods at 8 and 12 month CA
Through systematic data collection, we are better able to guide staff and parent expectations regarding attainment of feeding milestones, and plan appropriate support services for infants continuing to need support to feed safely.
At the end of this presentation, participants will be able to:
- Name at least one feeding intervention that may be used to assist high-risk infants in attaining full and safe oral feeding.
- List at least one clinical data point that may be used to document the efficacy of feeding interventions.
- List at least one tool that can be used to track functional feeding outcomes in infants and children.
Level: Intermdiate Discipline: SLP
P011 - Use of Trial-Based Functional Analyses in a Clinical Feeding Intervention
Meg Stone-Heaberlin, PsyD, Cincinnati Children’s Hospital Medical Center; Anne Kalomiris, PhD, Cincinnati Children’s Hospital Medical Center; Sarah Vitale, PsyD, Cincinnati Children’s Hospital Medical Center; Hannah Young, PhD, BCBA, Cincinnati Children’s Hospital Medical Center; Lori Vincent, PsyD, BCBA-D, University of Cincinnati; Kathleen King, MEd, University of Cincinnati; Elaina Cohen, MEd, University of Cincinnati
Despite the many benefits of using functional analyses to determine the function of challenging behavior prior to intervention and in research, functional analyses are not commonly used in clinical settings due to time and resource restrictions. The current study will present data from an outpatient feeding clinic, which includes a team of psychologists and occupational therapists, using brief, trial-based functional analyses to determine the function of challenging mealtime behaviors prior to selecting and implementing a feeding treatment plan. Two different trial lengths were piloted in the current study (10 trials each of test and control, and five trials each of test and control). Based on preliminary analyses, it was found that trial-based functional analyses can be an effective and efficient means to determine the function of inappropriate mealtime behaviors prior to feeding intervention in clinical settings. Benefits and limitations of using fewer trials to determine the function of behavior will be discussed, as well as supplemental assessment tools to measure feeding skills and behaviors that may be useful.
At the end of this presentation, participants will be able to:
- Describe how functional analysis can be used to determine the function of feeding behaviors.
- the benefits and limitations of using two different trial lengths of functional analyses in a clinical setting
- Explain how formal data collection can shape feeding treatment plans for interdisciplinary teams.
Level: Introductory Discipline: Psych