May 11, 2025 • 52 mins
ABA on Tap is proud to present an interview with Dena Kelly. (Part II)
Dena Kelly, LPC, BCBA, LBS is a Licensed Professional Counselor and Board Certified Behavior Analyst with over 15 years of experience improving children’s eating behavior and quality of life through evidence-based interventions. Founder of Focused Approach, Dena develops ABA-based feeding programs and trains professionals and caregivers nationwide. She has presented at major conferences such as ABAI and FABA and continues to advance the field through education and advocacy. Dena has led feeding programs in both clinical and multi-state settings, designed diagnostic and therapy services for autism and feeding disorders, and trained teams to manage complex feeding challenges.
Focused Approach uses trusted, research-based techniques to address a wide scale of feeding challenges. Focused Approach delivers training and consultation to BCBA professionals, partners with existing clinics to add results-driven, full feeding programs into their offerings, and delivers direct feeding therapy support for families. Focused Approach goes above and beyond generalized services, tackling the most challenging and unique pediatric challenges.
For more information, visit www.focusedapproach.com
In this episode. Dena discusses the scope of her work involving ABA professionals and how she educates them on feeding disorders, food refusal, providing insight into techniques, procedure, and protocol. She discusses the basics of setting events and stimulus cues, as well as more controversial applications like escape extinction, a procedure that can easily be applied incorrectly if not for the guidance and expertise of someone like Dena Kelly.
This brew is rich and dense, with a warming presence and complex, intense flavors. And we have two full pours for you, staring here with Part I. Enjoy the sense of fullness and satisfaction in this episode, and ALWAYS ANALYZE RESPONSIBLY.
Innovation Moon: ABA Business ConsultingABA OBM business consulting & services | BCBA & autism therapy owners | Proud sponsor of ABA on Tap
Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Welcome to ABA on Tap, where our goal is to find
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we
(00:23):
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.
(00:43):
So without further ado, sitback, relax, and always analyze
responsibly.
SPEAKER_03 (00:51):
All right, all right.
And welcome yet again to ABA onTap.
I am your co-host, Mike Rubio.
And this is part two of ourinterview with Dina Kelley.
Enjoy.
SPEAKER_00 (01:04):
And maybe it has to be pureed because that's going
to be an easier way for them tobe able to consume that in the
beginning.
And then we work our way back upto regular texture.
Maybe he likes it to stab thingswith a fork.
Maybe he'd rather scoop it witha spoon, right?
We're going to find what themost, you know, interesting way
for him to be able to get on tothat food.
(01:25):
But I usually start feedingtherapy trials outside of
mealtime for the same purposeyou were talking about with
trying to get out of the idea ofwe're restricting their actual
eating.
And so I will usually use itduring like a snack time.
So again, we want to be able tohave a break between when they
last ate those chicken nuggetsand when they're going to eat
again so that they're hungry.
(01:47):
But you're going to start withmaybe just that one piece of and
something, depending on whatthat child was doing.
and pair it with that highmotivator so that they get that
one bite in and then they moveon.
If they were to time out thatsession or not have that
interest in being able to evenaccess that motivator or do
SPEAKER_01 (02:08):
that,
SPEAKER_00 (02:09):
is that their feeding at that point is not
directly impacted because thenthey would get down from that
table, that session would beover, and in an hour they're
coming back to eat their chickennuggets that they're used to
actually eating.
But what I have found to befascinating really is, you know,
I think a lot of people, parentsand professionals, are scared of
(02:36):
their child crying.
But I will say, I mean, I havetwo, my kids are older, they're
nine and 12, and they still cryover some silly stuff, right?
And so I feel like it's just ago-to response when the kid just
doesn't want to do something,right?
(02:57):
But what happens when that childstarts crying because we want
them to eat, and I think youwere talking about this earlier
with your daughter, right, isthat if she wasn't eating is
that you were finding yourselfgetting emotional and getting
hype, right?
SPEAKER_03 (03:11):
Start pushing and offering the extrinsic
motivation and you startpandering.
SPEAKER_00 (03:15):
But here's the thing.
I take a most, but, but youdon't do that when you're trying
to have a task that's not eatingrelated, right?
Is you can stay a lot calmer.
And so my like hashtags recentlyhave been take the emotion out
of mealtime because even thoughwe may like love eating, right?
We can't throw that onto thechild.
(03:37):
And I tell parents all the timetoo, because their first thing
when a child takes a bite is,Oh, Do you like it?
Is it good?
Is it delicious?
It doesn't matter, right?
We want to say, how easy wasthat for you to chew?
Nice work.
You did a good job.
Because at the end of the day,we need them to actually be
consuming these foods as opposedto worrying about how much they
(04:01):
love and enjoy, right?
When they pick up their toys inthe playroom, you don't say...
Wasn't that so much fun pickingup the toys?
No, you go, Hey, you did areally great job.
Nice work.
Let's go do, you know, thisother thing that we're going to
go do now.
And so with feeding, it, We getso heightened.
And I say we because, you know,I've been guilty of that as
(04:23):
well.
But I see it so often withparents is that they get so
nervous with the child noteating that they they run
through.
Right.
They go through negotiation.
Yeah.
Then they get to anger.
Then they get to, you know,sadness.
Right.
And then they get to that giveup point.
Right.
So then they go, forget it.
whatever, and just go, right?
(04:44):
And now you're not getting
SPEAKER_03 (04:45):
dessert.
SPEAKER_00 (04:46):
And that's the other thing too, right?
You start throwing in all these,well, now you're not going to
have screens.
Now you're not going to havedessert.
Now you're not going to, howhigh can I up all of those
answers?
And so whenever I do a feedingprogram, whether a child's
verbal or not, is that I havethem very quickly learn what the
(05:06):
contingencies are with mealtime.
There's nothing that gets thrownin in the middle because we're
frustrated.
So at the beginning, it's, youknow, you're going to be able to
get this thing that you reallywant, whether, you know, for a
lot of people, it's watching ashow.
For some kids, it's, you know,playing with mom or dad.
For some kids, it's just beingdone eating, because again,
(05:28):
eating may not necessarily bethat enjoyable for them.
They'd rather just go play bythemselves.
They don't even want somebodyelse to be playing with them.
But that they know what'shappening they're getting all of
our attention and all of our youknow focus when they're doing
what it is that we want them todo and that when they're not
we're staying in a space ofcalmness and so we're not
(05:50):
getting into that anger andwe're not getting into that over
emotional like let me throw abunch of other things at you
because what that does is nowyou have a kid that's heightened
because you're asking them to dosomething that might be hard for
them and now you're heightenedas the parent and so you both
stay up here and everybody's inand everybody just leaves in
tears.
(06:11):
And so, a lot of our times, ourkids are learning to regulate
their emotions across life.
And so our job as parents is tobe able to stay in that calm
space So that our kids can comedown to that space to be able to
be there with us.
And so that is the really hardpart.
And that's why a lot of myprogramming is very heavy in the
(06:34):
parent prep component.
Because, you know, a lot oftimes they come and say, okay,
so what are you going to do toget this kid to eat?
And I say, it actually startswith you.
And it's the same thing withthe, with the therapist, you
know, when you're working in aclinic setting, it starts with
you.
It starts with what is yourreactions and responses to that
child's heightened behavior.
(06:55):
And if we can remain in a calmspace, we get that child to be
able to meet us in that calmspace, which allows for that
successful intervention.
SPEAKER_03 (07:06):
And that means excitement too, or
overexcitement.
So people don't think about thatas an If I'm happy and excited,
that's also calm.
No, it isn't.
You're adding too much.
Just be cool for a second.
SPEAKER_00 (07:18):
I've had some kids over the years that have told me
that I scared them because Iactually got too excited.
They put a bite in and I was
SPEAKER_01 (07:25):
like, oh!
SPEAKER_00 (07:26):
Could you not do that next time?
So yes, you're absolutely right.
It's all of those emotions.
It's staying in a space of calmbecause what we want to be able
to have them realize is thatthis isn't scary.
Eating isn't scary.
It's something that we have tobe able to do for our health and
safety.
(07:46):
And it's something that we haveto do for our social
interactions and psychosocialfunctioning in life.
And so it's a really importantskill.
It's very different for me thanyou know learning to match cards
or learning to you know some ofthe different activities that
the kids might do during the dayeven like sitting in circle time
(08:07):
right like that's a great skilland we definitely have to learn
that skill but to me foodconsumption right comes higher
than some of those otheractivities and so you have to
put more onus on that you haveto be able to have more focus
and seriousness around thatintervention because we need to
(08:28):
figure out how to get that to besuccessful.
SPEAKER_02 (08:31):
Sure.
I had one thing I wanted tofollow up covering a lot of
ground here.
So I want to make sure nothingthat you're saying gets lost
because you're making so manygood points.
Something that you initiallysaid in the beginning is that in
the chicken nuggets example, youmay present other foods, but not
during mealtime.
And I think historically in ABA,we would presented during
(08:52):
mealtime because the motivatingoperations there, right?
Like the motivation is hunger.
So we would then extend that outand we'd say, okay, you know,
first take a bite of whateverand then you can have whatever
the reinforcer is.
A lot of times it would be thepreferred food.
So my question to you is how doyou kind of juxtapose that?
Because somebody in moretraditional ABA might say, well,
(09:14):
they'll just wait you out untilit's mealtime.
Then they get their preferredfood because their motivation is
not as strong there.
Now, historically in ABA whenwe've withheld that maybe we've
created it probably hasn't beenthat successful because then
we've created more foodaversions because they're going
longer and longer without eatingbecause we're withholding that
meal time so they're having moreuncomfortable physiological side
(09:37):
effects which now is justreinforcing their lack of desire
to eat so how do you juxtaposethe motivating operation there
of hunger versus not reallycreating more and more and more
of a food aversion
SPEAKER_00 (09:51):
Sure.
So first of all, right, when wetalked about setting up specific
meal times, we also includesnack times within there.
So there's always a break,right?
And so I would be looking atlike pulling it into one of
those snack times first ratherthan like an actual full meal
time.
And I also would look at thatmeal time still being a chunk of
(10:11):
time away from when the end ofthat feeding intervention was
taking place so that if theyweren't eating that, right,
there's still an hour beforewe're going back to those
chicken nuggets.
The reason that I don't usuallystart with doing meals like
that, right, like your examplewas, you know, if you just take
(10:32):
this bite, then you get to eatthat preferred food that you
want to eat, is that for somekids, and why it's called a
preferred food is just theyprefer it over something else.
But if you say you, if you eatthis, you can have these
nuggets.
They'd rather have nothing.
Then eat that food to get thenuggets.
Right.
And so, so to me, that's not agood motivator.
(10:55):
And so when I look at like, howare we going to motivate them to
do this?
I try not to use food as amotivator at all.
Because the reality is,especially with the children
that have severe feedingdisorders is that food is not
motivating.
They may have safe foods orfoods that they gravitate
towards more than others, but ifgiven the choice between that or
(11:19):
nothing, they're choosingnothing.
That's a good point.
I look at what are those thingsthat are motivating them in
regular life, like outside ofmealtime.
What are the things that theywant those access to?
What does that show that theyabsolutely love?
We're going to save the theviewing of that show for the
(11:40):
completion of, you know, that,that bite of food.
And, and, and again, in thebeginning, you're starting, I
start so small.
I have families that will sitthere and say, really, this is
all we're doing for the sessiontoday.
And I'm like, yes, because theyhave to be able to, to get that
success and feel that, that, youknow, contingency in place,
(12:01):
right?
Like they took that one bite,they were able to swallow it
here.
Yeah.
Let's watch Bluey.
That was outstanding.
And now we'll come back and tryagain tomorrow.
And maybe we're going to do twobites tomorrow because you did
awesome.
And now you're starting tofigure out that in order to, you
know, see Bluey, you're going tobe able to do those sorts of
things.
That would be what my low, like,like, younger kiddos that you're
(12:24):
not able to include in theprocess of the treatment
planning.
I will always caveat to say thatwhen a child is able to be a
part of the treatment process, Iinclude them in that as much as
possible.
I allow them to be able to picksome reinforcers.
I allow them to be able tochoose foods that they want to
(12:44):
do.
I have them actually group theminto categories.
And then we say like, all right,so out of these Which one might
you be willing to try, right?
And so a lot of times they arein that driver's seat and having
that control component withintheir meals so that they're
feeling better about thechoices, right?
They have a banana in front ofthem because they chose to try
banana today.
(13:05):
So, you know, it gives more ofthat motivation for them to want
to be successful and want to bea part of that.
SPEAKER_02 (13:12):
So starting small, using a non-food related
reinforcer, and then ifpossible, allowing them control.
Thank you very much, Mike.
I know I've been asking a lot ofthe questions.
I still have more, but let mepass it to you so it's not the
tension.
I'm thinking about a million
SPEAKER_03 (13:25):
things.
Me too.
She's covered so much ground.
I'm thinking about all thevariables that go into this.
And so whether we're talkingabout behavior or some incident
that may be related to foodtrauma.
So you've got me thinking about,I mean, way at the One of them
had trouble latching on andfeeding in the beginning.
(13:46):
You're incredibly worried.
They feed on one thing for sixmonths.
You introduce these purees.
You're supposed to, well, a lotof recommendations is to try the
same thing three days in a rowso they can taste it.
And you've got a lot ofregeneration of taste receptors
going on.
So they're not going to rememberit.
And then at the very beginning,you finish those three days of
(14:07):
those pureed pears and you go tosomething different and they
spit it out and immediately yougo back to those pears.
So, I mean, this can start asearly.
It's blowing my mind how manythings could go astray or awry
in terms of some sort of pickytoward restrictive eating, you
(14:29):
know, from the very beginning
SPEAKER_02 (14:30):
to your- Not even with an autism, just
SPEAKER_03 (14:32):
in general.
SPEAKER_00 (14:32):
Right, right.
100%, yep, just even inneurotypical kids.
That's exactly where I wasgoing.
SPEAKER_03 (14:37):
Sorry.
So no, that's exactly where Iwas going.
No, thank you, because that'swhat I was trying to say.
And then all of a sudden, Imean, back to something we
discussed earlier, I don't knowif I'm actually going to get to
a question.
I just have a lot of comments.
I have a lot of comments.
But yeah, no, the idea that, youknow, then they start eating
solids, same thing.
They take to something you're soworried as a parent that they're
having enough colitis intakethat you'll do anything to make
(15:00):
sure that you preserve thatincluding giving them the same
chicken nuggets every day andthe same.
So there's so many opportunitiesto develop these pretty vicious
habitual cycles.
And then maybe you get adiagnosis and a child that is
experiencing heightened sensoryconcerns and that is only gonna
(15:23):
impact that a little further.
And then you get intoadolescence and actually I do
have a question.
You mentioned this earlier.
What is the correlation then, ormaybe you know and you can speak
to this, between picky towardrestrictive eating toward now
maybe the development of aneating disorder.
Is that a possible progressionor is that something separate?
SPEAKER_00 (15:48):
When you say eating disorder, you're talking more
about the anorexia
SPEAKER_03 (15:51):
or bulimia.
So I'll pitch it a differentway.
We're talking about caloricintake versus gustation versus
satiety.
And not that they're unrelated,but how do they all come
together?
Do they ever come together?
Does a parent have to beconcerned that if I don't take,
what is a good level of concernto say, if I don't take care of
this now, my adolescent autisticdaughter is going to end up with
(16:15):
bulimia, for example?
SPEAKER_00 (16:16):
Yeah.
So, so I'll flip it the otherway is that oftentimes a lot of
parents don't want to seek outfeeding therapy because they
have those fears of that childdeveloping what we call, you
know, that bad relationship withfood and it's going to lead to
that eating disorder.
And the reality is there's notgreat data to support that
that's actually the case at all.
You know, the clinic that Iworked at, I was there for over
(16:39):
10 years, but one of the menthat was there he's a graduate
assistant that was his actualhis graduate project was that he
went back over 10 years uhreached out to the families that
had been you know through thosefeeding programs to be able to
see where they were you know atthis point and we weren't seeing
um you know even within our ownstudy development of any
(17:02):
concerns with eating disordersum in that way at all.
I would actually argue that thepsychological component of them
is different.
They can present similarly.
If you have a 16-year-old thathas significant restriction,
she's going to be really gauntand really skinny.
And potentially, one of mypreteens, she was 12, she wasn't
(17:29):
menstruating and she wasn'thitting puberty because she
wasn't eating.
And that is something that alsois a characteristic of anorexia.
Bulimia, you could run intothose concerns as well from that
restrictive eating.
But again, from a psychologicalstandpoint, is that they are
too...
Totally different things is thatI have a 16 year old that is so
(17:51):
restrictive in their eating.
She's not worried about what herbody looks like.
She's worried about what she'sputting inside of her mouth.
And so, so I don't know this,the actual stats on, you know,
how many people started out as,as a restrictive eater and then
turned into, you know, one ofthe classic eating disorder
situations.
(18:11):
But from my experience andresearch and, and, you know,
years of watching people do thisis that, um, it's actually, uh,
it, it, it doesn't seem to havea direct line.
They seem to be very differentpsychological branches.
Um, but, uh, but I, but I willsay I have a lot of families
that hold off on theintervention or fear that
(18:34):
intervention because of thatpotential for an eating
disorder.
And because it's so different,it usually it, it's not, um,
it's not a reason to hold off ontreating the feeding issue if
it's a feeding issue.
SPEAKER_03 (18:47):
Thank you for that.
That was a pressing question.
And I think it's reallyimportant information,
hopefully, for some parents thatmight be listening out there to
be able to make thatdistinction.
And I guess it does make sensein terms of understanding body
image and caloric intake versushaving some fear or some
aversion to what might happen,whether it's from the moment you
(19:08):
taste it or what might happen toyour body once you ingest it.
So, okay, that makes sense.
SPEAKER_00 (19:13):
It is actually interesting.
With my older kids, when we dohave to look at the I actually
will tell the parents I avoidthe child counting the calories
because I don't want that to,you know, become an issue or
something that they end uplooking at.
You know, their focus is oncalories.
eating the food, finding foodsthat are feeling good for their
(19:35):
body and the fruits and thevegetables.
We're not thinking about thefact that, you know, this
avocado has 300 calories in it.
The mom is because she's tryingto make sure that, you know,
she's gaining the weight.
But from the child standpoint,we're looking at it from what
food choices are we making?
We're not thinking about howmany calories are in those
foods.
SPEAKER_03 (19:56):
And that makes sense what you say, too, because
inevitably some parent might behearkening back to their
pediatrician and that growthchart or that weight gain
trajectory, which is still animportant variable, but to your
point, maybe not the mostpressing concern for us through
this process.
So, Mr.
Dan, I know you've been sittingpatiently.
SPEAKER_02 (20:15):
Go ahead, sir.
So I guess with that, let's say,because I remember a client that
was basically on the verge ofgetting a G-tube because they
were so concerned about his, Idon't know if it's failure to
thrive, but he was being so foodadverse that he wasn't able to
get enough calories that theywere like hey if this doesn't
change quickly we're going tohave to take another measure
(20:37):
medically what would be yourthoughts and maybe this is hard
to say because I'm sure there'sa lot of different reasons that
a lot of different individualsdo a lot of different things do
you have any thoughts that whenit gets to that point of it's
like hey we have to do somethingotherwise this individual is
going to have to come in and geta g-tube to get calories any
thoughts on any advice toparents at that point
SPEAKER_00 (20:59):
so often if they're at the point of like within
date, you know, if this child,this is one more meal, right.
They're going to be in thehospital and having an issue.
I actually, as, as opposite asit seems, I will say yes, get
the tube for the short term.
Because what that actuallyallows us to do is because
again, we think about theparents and wanting them to get
(21:21):
the calories.
And if they're at the pointwhere the pediatricians are
asking them for a weight checkevery two days, and they are
super high alert and high onanxiety, they're not going to be
calm at that meal time like wewere talking about because
they're going to be like, justeat it.
We don't want you to be on atube.
And this is so scary.
So I will actually say, ifthey're at the severe point,
(21:43):
right, is that I will actuallysay tube.
Right now, maybe not even aG-tube.
You can do like a lesspermanent.
You could do the NG tube that,you know, a little more
unpleasant because it goes upyour nose and back down, but a
little more in the temporaryspace.
Because then we know at the endof the day that that child is
getting in their calories, thatfamily can sleep better at
(22:05):
night, the pediatrician's notgoing to be so far on their
back.
And then it allows us to go atthat child's pace for the
introduction of new foods,right?
Because if we're in the panicstage, it's going to be like,
you need these foods and youneed them now, right?
We have to really like, youknow, hightail it into this
(22:27):
treatment, which and get them toshut down.
That's not always the mostpleasant.
I want them before they get tothat point because, because then
you have, you have the need thatthey have this restriction, but
they're not one meal away frombeing in the hospital.
If they're at that point, I willsay, get the tube so that we can
(22:47):
use it as I ultimately, thenwhat I do is use it as a
supplement.
So then it becomes, we're goingto do our food.
And if we only get in two bitesin that meal today then you're
doing the full eight ounce feedright for that child and then as
we continue to go oh he actuallyhad three ounces worth of food
today awesome you only need tocome back around with five
(23:09):
ounces of that formula and thenultimately it fades out so that
we get rid of that tube as thattemporary kind of crutch to
allow us to be in a calmer stateas we work through that feeding
and be able to get that childback on track
SPEAKER_02 (23:25):
That makes a lot of sense.
SPEAKER_03 (23:27):
Some people might say, and I hate to bring this up
in a certain sense, but theurgency now necessitates or
justifies escape extinction.
We're going to hold a spoon inyour mouth for 30 seconds.
And I know that that's outthere, right?
Our old colleague.
Yeah.
I want to be cautious with this.
(23:47):
I think the danger with that ishow easily it could be
misapplied.
And then you're talking aboutthat not being necessary in the
gradual approach you're talkingabout.
Could you speak to that a littlebit?
SPEAKER_00 (24:01):
Absolutely.
So it is never my first go-tofor escape extinction, but I do
want to clarify, and I think youhit on both points, right?
Is that in some cases, it isstill needed, but it is needed
from a person that isspecialized in the training to
be able to do it.
So I think that's the importantpiece to highlight there is that
(24:24):
just because you're a BCBA,right, does not mean that you
have the training to utilizeescape extinction in a feeding
protocol in any capacity, right?
But there are some kids incertain situations, whether it
be they're age, whether it betheir functioning level, whether
it be the severity of therefusal that they have, that
(24:47):
requires an intervention such asescape extinction, right?
Because the need is impactingtheir overall functioning.
I'll give you, I have my, mynephew is well, he's now two and
a half, but he was, you know,my, my whole family has, I've
been doing this for 20 years,right?
So they know I do feeding land.
(25:08):
She had this baby six monthsold.
They were weaning him, you know,from breastfeeding a little bit
more and, you know, starting totry some foods and he was eating
a little bit and it reallywasn't consistent.
And most of the time he wasputting it in and he was
spitting it out and now hedidn't even want to take his
bottles anymore and he wasreally starting to struggle he
(25:29):
was losing weight meal time wasnot fun for anyone and they were
struggling as to decide what todo right and so obviously at 11
months old You're not going tosay, okay, so which food would
you want to choose to eat today,right?
Because the 11-month-old's notgoing to make that choice.
He's typically developing,right?
(25:49):
So we weren't having necessarilyconcerns from a sensory
perspective.
We had him checked medicallyfrom, like, an issue of
swallowing or any concerns thatwould be there.
And I think that's an importantcomponent to note as well is
that if there's any issue of–whether or not a child can eat
or if there's certain texturesthat they can eat, I will always
(26:11):
refer first medically to getcleared because I don't have a
medical degree and so that'sgonna be an important component,
right?
So he was cleared medically,he's typically developing, he's
11 months old and he is losingweight and not intaking any food
and it's making his sleepstruggle, it's making his
overall functioning during theday, he's just miserable.
(26:33):
And he was a perfect case to beable to utilize an escape
extinction protocol.
And for me, I think you saidwhen you said escape extinction,
that you hold it in their mouthfor 30 seconds.
Don't do that.
No, no.
That's something we had heard.
SPEAKER_03 (26:50):
Something we had heard.
And I was like, wait, we had anold colleague who had moved away
and she called us and was like,yeah, can we run a situation by
you guys?
And I was like, yeah, no.
And these, so these kids areabout to get a G tube.
No, they're just picky eaters.
Oh my goodness.
Get out of there.
Run.
SPEAKER_00 (27:05):
Yeah.
So I would, Never recommend itfor a picky eater.
But when you have this sort ofsituation, right?
But so he's 11 months old.
So we utilize what I callnon-removal of the spoon.
So he sat in his high chair andwe held the spoon up there.
And again, he's going to crybecause he's an 11 month old
boy, right?
And they cry all the time.
And so he would put it in andhis habit that he had developed
(27:27):
was spit it back out, right?
So we would scoop it up from hischair, right?
And we would say, all right, tryit again.
Um, And then when he got thatbite in and we go, yay! He would
get like, and he loved that.
He wanted more.
He would, that was his favorite.
More, more.
Right.
And so, all right, next bite.
And then we can do it again.
And now I will tell you, causehe's my own nephew, like at two
(27:48):
and a half years old, the childwill not stop eating.
He loves eating.
He eats all day.
You know, my sister andbrother-in-law are always like,
can we send you our food billnow?
Because you know, you fixed himtoo well.
But, but there are thosesituations where when you have a
child that is, quickly slidingdown a path that would lead to
(28:11):
more needed medical interventionand it is impacting them across
the board.
It's a quick and effective andethical approach way to treat
feeding when done by anappropriate feeding professional
so again that that's my biggestred disclaimer is that it is
never something that should bedone willy-nilly um it should
(28:32):
never be done by somebody that'snot trained it should never be
done for a child that's just inthat picky you know you're not
going to be like trying tobroccoli um you know even if
you're eating other things iwant you to eat this broccoli
and i'm going to hold it up toyour mouth i would never.
Because from an ethicalstandpoint, that's not
appropriate.
But again, when you check all ofthose other boxes, there are
(28:52):
times where that intervention isthe one that's warranted and the
one that will come out with thatmost effective result for that
child.
SPEAKER_03 (29:00):
I like that.
I think we can break it down tothat that one phrase you keep
saying, so that the notion thathow do we get the child just to
try it?
Because until they try it, theyhave no chance of deriving any
sort of reinforcement orotherwise from it.
And just, and yet that simplepremise can become a huge
challenge.
And yeah, you can, you know, youcan drum up some really
(29:22):
interesting strategies to tryand get them to get that first
taste.
And then you have to considerthe rest of the variables in
terms of any sort of medicalneed.
And, you
SPEAKER_00 (29:32):
know, it can't just be Yeah,
SPEAKER_03 (29:34):
that's all.
I mean, think about so manylayers that we've just gone
through that, you know, as aparent, you're you're so stuck
on the fact your child is noteating or they, you know,
they're not gaining weight orthey're losing weight.
And that becomes your yourdriving force.
It can be very challenging tothen look at the rest of the
landscape, I think, becausewe're covering so many variables
(29:54):
that need to be considered here.
SPEAKER_00 (29:56):
Right.
But both from the parent and theBCBA, the best thing that we do,
again, is remain calm in thoseintervention times.
I think as a BCBA, we are soquick to go, that's not working,
let's change it.
As opposed to allowing us to sitkind of in that moment with that
child of that, I don't want todo this.
(30:18):
And they're sitting there andthey're staring at, you know,
that little strawberry on theirplate.
And we're so used to eitherlike, over-talking, right?
Oh, yeah.
It's like, come on, you can doit.
It's just one little bite.
You've got this.
Remember, we're going to do allthese things.
And the
SPEAKER_03 (30:32):
parents doing it here and dads here doing the
same thing.
SPEAKER_00 (30:33):
You've got a whole crowd chattering at you.
Right, it's all going on.
And all that's doing is actuallybuilding that child's anxiety.
And so I find if we all stay inthis space, people are scared of
silence, right?
We've got to embrace thatsilence sometimes.
And sometimes we just sit thereand you see that child's like,
you know, years going of, okay,this is scary, but I really do
(30:57):
want to watch that show or thisis good.
You know, they're thinking aboutthis out there and you're
seeing, you know, the therapistor the parent, they're ready to
go do whatever it is that we'redoing, but we're sitting here
and we're waiting and they'reworking their way through it.
And when they get that bite, itcannot tell you the enjoyment I
get as a therapist and watchboth the parents and that
child's face actually go, I didit.
(31:21):
And it's that sense, it's noteven always like, that was
delicious.
It's much more like that prideof they did something that was
hard.
And it was like, and you seethat face of like, And then they
want to tell everybody.
I have little three-year-oldsthat are like, mom, dad, the
cat, whoever else is over there.
(31:42):
I just need to tell everybodythat will listen to me, I took
that bite of pizza.
And so it really comes much moreaway from, wow, that food was so
good.
And more, I did this hard thingand I can do hard things.
So now I'm not going to be asscared of that pizza because
that wasn't so scary.
(32:02):
And that's the...
That's the satisfaction I wantthem to start getting.
That's the more internal drivewe can get more than we can get
the necessary internal enjoymentof the actual food.
But I can get them to actuallyenjoy the satisfaction that
comes from doing those hardthings and being able to eat
(32:22):
those foods.
SPEAKER_03 (32:24):
I like that stepwise progression because, again, we
would want them to immediatelyenjoy that food.
And what you're saying is, no,the first step is them just
realizing I didn't die.
And then now I'll take anotherbite.
and hey, that's actually prettygood.
So again, I think that's reallyimportant to highlight because
as behavior analysts, we alwayshave this perfectly envisioned
(32:45):
three-part contingency where ofcourse the child has to take a
bite and if they don't, nowwe're facing failure, right?
I didn't do this right.
You're saying, no, if you've gotthe right, if you're pretty
confident in your protocol,you're going to repeat.
And this might result in no biteof food in their mouth, but you
keep applying the protocol andanalyzing what, what can we do
(33:07):
next?
SPEAKER_00 (33:07):
Give it time.
Give it a chance.
And again, I mean, there'scertainly been times where I've
had to adjust my protocols orchange my plans based on how
things go.
But I think sometimes we are soquick, um, to say, I thought
this was gonna work and thisisn't working and quickly change
to something else where if wehad just given it one more day
(33:28):
or given it another opportunityand readjusted really looking at
what was our reaction orresponses in those moments to be
able to see what adjustments canbe made, I think you'd actually
have more success.
SPEAKER_02 (33:41):
For sure.
I think, Mike, you talked about,too, the fact of just if we can
get it to happen, if we can finda way to reinforce.
But like you mentioned, Dina, aswell, that we have to be careful
because I think sometimes that'swhere parents are trying to
hide.
They're trying to stick stuff inor hide it just to get them to
have that bite.
And then it actually makes itway worse.
So we have to be very carefulwith that.
(34:03):
I have a, so you kind of talkedabout it a little bit about the
collaboration piece, but Iwanted to highlight that because
I think that's so important andpass it over to you.
I'll share one small anecdotebecause I, historically, I
wonder, and I think that maybewe've done more damage than good
with feeding in ABA.
And I'm interested to get kindof your suggestion moving
(34:25):
forward, because I remembertrying to get an individual to
take a bite of a strawberry, andI've shared this example
multiple times, but this wasearly, Dan.
This was 15 years ago.
It was just traditional ABA,Dan.
We were going to sit therebecause you set the first thing
contingency, and once you setit, then you can't do anything
else, God forbid.
Again, I've learned from this,but it was almost an hour and a
(34:50):
half of this individual.
He was strapped in his littlehigh chair, tantruming to not
take a strawberry, take a biteof a strawberry, and eventually
did.
And I left that session like,yes, I'm so proud that
eventually followed throughbecause literally it was five
minutes before I was going toleave that session.
I was like, oh, no.
What am I going
SPEAKER_03 (35:10):
to do?
SPEAKER_02 (35:10):
And if this kid doesn't, you know, follow
through on a contingency, I saidthe world's going to explode,
followed through.
And then, you know, laterlooking back of maybe that
probably wasn't the best way ofgoing about it.
And maybe we've created morefood aversion.
So that's a story to ask thequestion of the importance of
collaboration, because in ABA,we've done, you know,
(35:33):
everything's on the three-partcontingency and we are the
experts in behavior, but thatdoesn't make us the experts in
feeding or sleeping or motorskills or anything like that.
It means we can work withindividuals that maybe are more
experts in these fields, butsomehow a lot of this gets put
on to us.
And now maybe we've done moreharm than good in saying, well,
it's the antecedent behaviorconsequence.
(35:54):
You just set that contingencyand they need to eat.
And if they don't, you don'tgive them anything they want.
And maybe we've made it wayworse.
So that's kind of a long windedquestion to say, number one, do
you think that historicallymaybe we've made it worse?
And can you talk about theimportance of collaboration with
people that actually do knowwhat they're doing in the
feeding realm, not just thebehavioral realm?
SPEAKER_00 (36:16):
Sure.
So I'm going to break that aparta little bit.
SPEAKER_01 (36:19):
Please do.
SPEAKER_00 (36:20):
So I think that the harm that happens to the point
that we were just talking aboutis when people that aren't
properly trained or supervisedto implement feeding
interventions are implementingfeeding interventions, right?
Like that's first and foremostis that I look at the BCBA as
really like a generalpractitioner.
They know a little bit ofeverything, but they're not
(36:43):
necessarily a specialist, right?
So when you go to your familydoctor and you have a heart
issue, the doctor might give youone initial recommendation.
And if that doesn't work,they're going, we're sending you
to the cardiologist, right?
Because that's the specialistthat specializes in that heart
issue.
It's a great analogy.
That's great.
And so I I do think that that'san important component.
And I stress that every time Ido a CEU or anything, I say, you
(37:03):
know, the CEU does not lead youto being able to be a feeding
expert and being able to doanything.
So I think the only componentthat I would look at as harmful
is when a BCBA is implementingfeeding procedures without
having training or appropriatesupervision to be able to do so.
I actually think when you lookat the feeding research is that
(37:25):
ABA has done a lot of greatinterventions and great help
with children with feedingchallenges across the board for
years.
And that, you know, I think overtime, and I think as feeding has
continued on in ABA land is thatwe figured out how to
(37:46):
collaborate with otherprofessionals.
And I think when you say, youknow, somebody that would be
more specialized in feeding, I'mI'm guessing you're talking more
in the realm of like the speechand OT, because that seems to be
where they, you know, whensomebody thinks about feeding,
that's usually the first type ofdemographic that they're going
(38:06):
to go to, right?
Speech or OT.
And I think for me, what I lookat is there's components in
which we can all work togetherin the areas in which we are
most benefited, right?
So from a speech perspective, Icollaborate with speech a lot
when I have kids that might notbe having great oral motor
(38:26):
skills.
So, you know, I may have to workwith the family on pureed food
while the speech therapist isgetting the child to actually
have some solid jaw strength andmoving their tongue around and
being able to have the abilityto manage the regular textured
food, right?
When I have an OT console,that's a lot of times, you know,
go back to that idea of safetywhile you're eating.
(38:48):
And I'm a huge advocate for kidssitting while they're eating and
not standing and dancing andrunning around.
But there's some kids that weknow, right, that don't have
good core strength and musclestrength.
And so when they sit in a chair,they're kind of like, right,
like they're hunched down andthey're not really sitting up
properly.
And so I need, you know, that'sthe OT area.
And so that's where a hugebenefit is that they can, you
(39:11):
know, work with that child to beable to develop that opportunity
to sit them up straight so thatwhen they're eating, it's
successful.
As well as that hand-eyecoordination, you think about
all the things that are involvedwith nutrition.
with self-feeding, right?
Scooping and stabbing bites arenot easy, especially for kids
that may have some fine motordifficulties.
And so, you know, I love theopportunity to be able to say,
(39:33):
this is a great thing that canbe worked on during OT sessions
that also can benefit within thefeeding session.
What I do see a lot of that inmy experience, and I will say
most of my experience is withpretty severe issues restrictive
eater.
So I don't work a lot with theyounger kids in that early
(39:58):
intervention land, which iswhere I think, you know, more
education needs to go into toyour point of like, let's kind
of set the premise before iteven becomes an issue.
So it doesn't become an issue,right?
I think that's a great part.
So I will caveat with saying,you know, most of the
individuals that I've seen overmy whole career have been pretty
severe and significant.
(40:20):
They are not responsive often tofood integration, food exposure,
food interaction, right?
So a lot of things that I hearabout are like cook with your
child or play– with the food,right?
So let's put the broccoli hereand let's play with, you know,
(40:44):
moving the little dino nuggetover to the tree and do all of
that stuff.
Let's squeeze the fruit and seehow it feels.
Let's lick it.
Oftentimes, it does one of twothings, right?
The one thing it can do is thatit can desensitize a highly
sensitive child to thosefeelings and those textures.
(41:05):
So now maybe a child that neverwanted to be around even the
look of food, right, can bethere and hold it, play with it,
but they seem to get the brickwall when it actually comes to
like eating the food.
So that's an area of concernthat I see with a lot of
families, but with some of them,it actually works
(41:28):
counterproductive because it'snot pleasant for some and for
some foods.
When I think about eating food,I love to eat food.
We've all talked about this.
We love to eat food.
I don't want to stick my hand inthe bowl of pudding or I don't
necessarily want to squeeze araspberry in my fingers.
(41:52):
It doesn't feel as good to me.
That's not going to get me toactually want to eat it more.
That's going to make me go, itdoesn't feel so good.
And now I don't want to eat it.
And so I look at thoseinterventions as potentially
helpful for some kids that fallin more of that picky eater
category, where they're not inthat severe case at this point,
(42:12):
you know, they have theopportunity to be able to work
through some of those things ina more like low key fun way.
But at the end of the day, youknow, for me, what used to be
like the parents motto all thetime, they always say don't play
with your food.
We're really not supposed toplay with food, we're supposed
to play with toys and othertypes of things.
(42:33):
And so when I come in, for afeeding program.
I'm looking at how do we set ourmealtime expectations?
And our mealtime expectationsare that, you know, we're
putting out the foods that we'regoing to eat today, whether that
starts with just one little bitefor a kiddo up to, you know, a
full plate of food for a meal,depending on where they are in
their treatment program.
And we're going to scoop or stabor pick up our bites, depending
(42:56):
on what would be appropriate forwhat that child's skill level is
at.
And we're going to just pop themin and eat it and be done.
You don't need to be inspectingthe food, looking at it.
Sometimes when we expose oursenses too much, it can actually
work in the opposite directionand become aversive.
(43:17):
And so when we have a child thathas such significant restriction
already, and again, it'simpacting all of those things
that we've talked about today, Ifind that those interventions
aren't helpful in most cases.
But I do find the huge benefitof collaboration and finding
(43:37):
ways to be able to work with,like we were talking about the
speech and the OT, withnutrition for some of the kids
that are trying to get off of
SPEAKER_01 (43:44):
tubes.
SPEAKER_00 (43:45):
I have to know for this child's height and weight,
what caloric intake do I need toget them to during a day?
What variety of fruits andvegetables and proteins do they
need to be able to warrantgetting off of the tube?
Sometimes it's connecting withGI.
If we've got a child that isconstipated, you're not going to
(44:06):
feel like eating if you'reconstipated, right?
But part of the reason you'reconstipated is because you're
not eating.
So there's like that viciouscycle.
And so we have to be able tofind that balance in, you know,
how can we work with GI and say,can we clear out this
constipation issue kind of so wecan start fresh and give them
that opportunity for success?
Because you don't want to beable to work on feeding if
(44:29):
they're not hungry or notfeeling well physically with
themselves.
So I think that there's, but tome, there's
SPEAKER_01 (44:36):
huge
SPEAKER_00 (44:36):
benefit to ABA feeding.
I think ABA feedinginterventions have done wonders
for families in a lot of ways.
I could line up tens of hundredsof families that have had great
success.
But again, I think it reallycomes down to every individual
(44:59):
child.
We can look in the ABA land tothings that we don't necessarily
promote, right?
We could think about like thehyperbaric chamber sort of
situation, right?
Where some people will say, oh,we take my child with autism.
We heard about the hyperbaricchamber or we heard about a
specific diet.
We're going to cut out all ofthese things because it's going
to cure their autism,
SPEAKER_01 (45:20):
right?
SPEAKER_00 (45:22):
We hear that stuff all the time.
But what's funny is you'realways going to find somebody
that's going to say, That curedmy child.
That was helpful.
That worked.
And so my answer toprofessionals and to families
all the time is when they say,should I keep doing X, Y, or Z?
Should I keep doing thisintervention?
(45:43):
Should I keep doing thatintervention?
Whatever it might be.
As I say, let's take some data.
Look at the data.
Are you seeing progress?
What are the goals?
What are you trying to get to?
And if it's working for you, doit.
I'm not going to say don't dothat because that's not the
approach that I would take.
If you're having success with itand you're doing well, awesome.
(46:04):
Keep doing that.
If you're finding that you andyour child are not having the
success that you want or hittingthe goals that you want, then
you have to be able to look atwhat are the other options out
there and what can you do.
I think that's the best answer Ican give from thinking about how
(46:27):
to approach that from all thosedifferent angles.
SPEAKER_02 (46:30):
Thank you for clarifying, too, because I
probably should have worded itdifferently because, you know, I
kind of live in my bubble ofin-home ABA therapy.
And I think you're 100 percentright that ABA probably has had
a net positive, almost certainlyhas had a net positive impact on
feeding.
And when it's done with themultidisciplinary approach, like
you've talked about,collaborating with specialists
(46:52):
like yourselves, maybe evenspeech or occupational
therapists.
I was just thinking about, youknow, the in-home therapy, how
so often it maybe is miserableAnd everything is done by the
BCBA without any collaboration.
And then you run intopotentially detrimental effects.
So thank you for clarifyingthat.
SPEAKER_01 (47:10):
Yeah,
SPEAKER_02 (47:10):
I think that is an important piece.
SPEAKER_03 (47:13):
Well, we we warned you that this would fly by.
Give us the five minute warninghere for any pressing questions.
You mentioned special diets andthen it clicked.
GFCF.
I've been doing this for a longtime.
That's probably a whole separateepisode.
But you alluded to it in termsof I remember way back in early
(47:34):
practice and maybe gluten freefoods weren't so attractive at
that time.
I think they've gottenincredibly good and better since
then.
But I remember, you know, not.
ABA and those types ofinterventions not playing so
well.
And then I remember, you know,hitting the point in my career
where I was going like, well, itgot the whole family started
(47:55):
doing it, got them all to sitaround the table.
And so, of course, the kid got Imean, yes, it makes sense.
Like, even if they didn't have agluten sensitivity, look at all
these other behaviors thatchanged.
And then it obviously it failedfor some people, too, because
they were expecting the child toeat it on their own.
And it wasn't the mostattractive food and nowhere
close to what they were eating.
And Anyway, so it didn't go verywell.
(48:16):
But I really like the way youkind of conceptualize that.
Is it working for you?
It's not harmful?
Okay.
Look at the data.
Keep giving it a shot and dowhat you need there.
So that's really good.
We won't get too much furtherinto the diets.
Dina, I do want to give you achance to tell our listeners
where to find you and all theincredible things you do for
(48:39):
people out in Pennsylvania.
So if you could just tell us thename of your center.
maybe a website address.
And I don't know if you wantpeople emailing you questions,
but you're welcome to share thatinformation as well before we
close.
SPEAKER_00 (48:52):
Absolutely.
Yes.
So all of my programs areactually completely virtual so
my center is my dining roomtable most days but it has
actually worked really wellbecause it again puts it on a
parent first focus and so itreally gives that that onus to
the family to make the changebecause when you're in a clinic
(49:12):
setting a lot of times and I'msure a lot of ABA clinics just
feel this too is the family likedrops off that child and says
here you go you know and I'mgonna go do all of the other
things that have to get donewhich is great but feeding is
about that family time, thatfamily connection.
And ultimately, the family isthe one that's going to be doing
most of the meals.
And so they need to be the mostinvolved in that.
(49:33):
And so all of my programs arevirtual.
They are very heavy in parentinvolvement and training and
prep as far as that interventiongoes.
My website isfocusedapproach.com.
And people can absolutely emailme directly.
It's just dkelly atfocusedapproach.com.
And I do direct feedingintervention as well as a lot of
(49:56):
professional development andCEUs for BCBAs and ABA clinics
that are interested in how theycan, you know, make some
improvements on that feedingbehavior for their children.
SPEAKER_03 (50:06):
We'll make sure and include that information No
(50:37):
trickery, meaning don't try tosneak new foods into their
preferred foods.
And like we like to say on ABAon Tab Dan, always analyze
SPEAKER_02 (50:46):
responsibly.
SPEAKER_03 (50:46):
Thank you, Dina.
SPEAKER_00 (50:48):
Thank you guys so much.
SPEAKER_02 (50:51):
Thank you so much, Dina.
That was a
SPEAKER_00 (50:52):
pleasure.
Thank you guys so much.
I love any opportunity to talkabout feeding.
Always, always excited to dothat.
SPEAKER_03 (51:00):
Thank you.
We hope people find you throughthis and maybe we get more
people going your way.
And again, yeah, thank you somuch.
We learned a ton.
Yeah.
Anything that we can ever do foryou, you ever want to come back
on to promote something, pleasejust let us know.
We will send you as soon as wecan if you want.
So we do it out of courtesy.
(51:20):
We send the Zoom audio toguests.
Most of them don't want to takethe time to listen to it.
So they say it's OK.
Yeah.
So if you're OK with us justpublishing.
Yep.
If at any point you were tolisten to it or somebody tells
you, hey, we heard you.
And I don't know any concernarises from it.
Just let us know.
We're glad this.
Yes, it's our content.
We're not going to keep it up ifyou're not comfortable with it.
(51:41):
That's only happened once out ofalmost 60 episodes.
So I think people would feelpretty comfortable and they, you
know, they say things they wantto say and nobody nobody's
worried about that.
But yeah, anything we can everdo for you again, we can't thank
you enough for your time and andfor sharing all your knowledge
today.
SPEAKER_00 (51:57):
Great.
Thank you so much.
It was great to meet you guys.
Have a good rest of your day.
SPEAKER_03 (52:00):
Thanks a lot.
You
SPEAKER_00 (52:01):
too.
Bye-bye.
SPEAKER_03 (52:02):
ABA on Tap is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.
Welcome to ABA on Tap, where our goal is to find
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we
(00:23):
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.
(00:43):
So without further ado, sitback, relax, and always analyze
responsibly.
SPEAKER_03 (00:51):
All right, all right.
And welcome yet again to ABA onTap.
I am your co-host, Mike Rubio.
And this is part two of ourinterview with Dina Kelley.
Enjoy.
SPEAKER_00 (01:04):
And maybe it has to be pureed because that's going
to be an easier way for them tobe able to consume that in the
beginning.
And then we work our way back upto regular texture.
Maybe he likes it to stab thingswith a fork.
Maybe he'd rather scoop it witha spoon, right?
We're going to find what themost, you know, interesting way
for him to be able to get on tothat food.
(01:25):
But I usually start feedingtherapy trials outside of
mealtime for the same purposeyou were talking about with
trying to get out of the idea ofwe're restricting their actual
eating.
And so I will usually use itduring like a snack time.
So again, we want to be able tohave a break between when they
last ate those chicken nuggetsand when they're going to eat
again so that they're hungry.
(01:47):
But you're going to start withmaybe just that one piece of and
something, depending on whatthat child was doing.
and pair it with that highmotivator so that they get that
one bite in and then they moveon.
If they were to time out thatsession or not have that
interest in being able to evenaccess that motivator or do
SPEAKER_01 (02:08):
that,
SPEAKER_00 (02:09):
is that their feeding at that point is not
directly impacted because thenthey would get down from that
table, that session would beover, and in an hour they're
coming back to eat their chickennuggets that they're used to
actually eating.
But what I have found to befascinating really is, you know,
I think a lot of people, parentsand professionals, are scared of
(02:36):
their child crying.
But I will say, I mean, I havetwo, my kids are older, they're
nine and 12, and they still cryover some silly stuff, right?
And so I feel like it's just ago-to response when the kid just
doesn't want to do something,right?
(02:57):
But what happens when that childstarts crying because we want
them to eat, and I think youwere talking about this earlier
with your daughter, right, isthat if she wasn't eating is
that you were finding yourselfgetting emotional and getting
hype, right?
SPEAKER_03 (03:11):
Start pushing and offering the extrinsic
motivation and you startpandering.
SPEAKER_00 (03:15):
But here's the thing.
I take a most, but, but youdon't do that when you're trying
to have a task that's not eatingrelated, right?
Is you can stay a lot calmer.
And so my like hashtags recentlyhave been take the emotion out
of mealtime because even thoughwe may like love eating, right?
We can't throw that onto thechild.
(03:37):
And I tell parents all the timetoo, because their first thing
when a child takes a bite is,Oh, Do you like it?
Is it good?
Is it delicious?
It doesn't matter, right?
We want to say, how easy wasthat for you to chew?
Nice work.
You did a good job.
Because at the end of the day,we need them to actually be
consuming these foods as opposedto worrying about how much they
(04:01):
love and enjoy, right?
When they pick up their toys inthe playroom, you don't say...
Wasn't that so much fun pickingup the toys?
No, you go, Hey, you did areally great job.
Nice work.
Let's go do, you know, thisother thing that we're going to
go do now.
And so with feeding, it, We getso heightened.
And I say we because, you know,I've been guilty of that as
(04:23):
well.
But I see it so often withparents is that they get so
nervous with the child noteating that they they run
through.
Right.
They go through negotiation.
Yeah.
Then they get to anger.
Then they get to, you know,sadness.
Right.
And then they get to that giveup point.
Right.
So then they go, forget it.
whatever, and just go, right?
(04:44):
And now you're not getting
SPEAKER_03 (04:45):
dessert.
SPEAKER_00 (04:46):
And that's the other thing too, right?
You start throwing in all these,well, now you're not going to
have screens.
Now you're not going to havedessert.
Now you're not going to, howhigh can I up all of those
answers?
And so whenever I do a feedingprogram, whether a child's
verbal or not, is that I havethem very quickly learn what the
(05:06):
contingencies are with mealtime.
There's nothing that gets thrownin in the middle because we're
frustrated.
So at the beginning, it's, youknow, you're going to be able to
get this thing that you reallywant, whether, you know, for a
lot of people, it's watching ashow.
For some kids, it's, you know,playing with mom or dad.
For some kids, it's just beingdone eating, because again,
(05:28):
eating may not necessarily bethat enjoyable for them.
They'd rather just go play bythemselves.
They don't even want somebodyelse to be playing with them.
But that they know what'shappening they're getting all of
our attention and all of our youknow focus when they're doing
what it is that we want them todo and that when they're not
we're staying in a space ofcalmness and so we're not
(05:50):
getting into that anger andwe're not getting into that over
emotional like let me throw abunch of other things at you
because what that does is nowyou have a kid that's heightened
because you're asking them to dosomething that might be hard for
them and now you're heightenedas the parent and so you both
stay up here and everybody's inand everybody just leaves in
tears.
(06:11):
And so, a lot of our times, ourkids are learning to regulate
their emotions across life.
And so our job as parents is tobe able to stay in that calm
space So that our kids can comedown to that space to be able to
be there with us.
And so that is the really hardpart.
And that's why a lot of myprogramming is very heavy in the
(06:34):
parent prep component.
Because, you know, a lot oftimes they come and say, okay,
so what are you going to do toget this kid to eat?
And I say, it actually startswith you.
And it's the same thing withthe, with the therapist, you
know, when you're working in aclinic setting, it starts with
you.
It starts with what is yourreactions and responses to that
child's heightened behavior.
(06:55):
And if we can remain in a calmspace, we get that child to be
able to meet us in that calmspace, which allows for that
successful intervention.
SPEAKER_03 (07:06):
And that means excitement too, or
overexcitement.
So people don't think about thatas an If I'm happy and excited,
that's also calm.
No, it isn't.
You're adding too much.
Just be cool for a second.
SPEAKER_00 (07:18):
I've had some kids over the years that have told me
that I scared them because Iactually got too excited.
They put a bite in and I was
SPEAKER_01 (07:25):
like, oh!
SPEAKER_00 (07:26):
Could you not do that next time?
So yes, you're absolutely right.
It's all of those emotions.
It's staying in a space of calmbecause what we want to be able
to have them realize is thatthis isn't scary.
Eating isn't scary.
It's something that we have tobe able to do for our health and
safety.
(07:46):
And it's something that we haveto do for our social
interactions and psychosocialfunctioning in life.
And so it's a really importantskill.
It's very different for me thanyou know learning to match cards
or learning to you know some ofthe different activities that
the kids might do during the dayeven like sitting in circle time
(08:07):
right like that's a great skilland we definitely have to learn
that skill but to me foodconsumption right comes higher
than some of those otheractivities and so you have to
put more onus on that you haveto be able to have more focus
and seriousness around thatintervention because we need to
(08:28):
figure out how to get that to besuccessful.
SPEAKER_02 (08:31):
Sure.
I had one thing I wanted tofollow up covering a lot of
ground here.
So I want to make sure nothingthat you're saying gets lost
because you're making so manygood points.
Something that you initiallysaid in the beginning is that in
the chicken nuggets example, youmay present other foods, but not
during mealtime.
And I think historically in ABA,we would presented during
(08:52):
mealtime because the motivatingoperations there, right?
Like the motivation is hunger.
So we would then extend that outand we'd say, okay, you know,
first take a bite of whateverand then you can have whatever
the reinforcer is.
A lot of times it would be thepreferred food.
So my question to you is how doyou kind of juxtapose that?
Because somebody in moretraditional ABA might say, well,
(09:14):
they'll just wait you out untilit's mealtime.
Then they get their preferredfood because their motivation is
not as strong there.
Now, historically in ABA whenwe've withheld that maybe we've
created it probably hasn't beenthat successful because then
we've created more foodaversions because they're going
longer and longer without eatingbecause we're withholding that
meal time so they're having moreuncomfortable physiological side
(09:37):
effects which now is justreinforcing their lack of desire
to eat so how do you juxtaposethe motivating operation there
of hunger versus not reallycreating more and more and more
of a food aversion
SPEAKER_00 (09:51):
Sure.
So first of all, right, when wetalked about setting up specific
meal times, we also includesnack times within there.
So there's always a break,right?
And so I would be looking atlike pulling it into one of
those snack times first ratherthan like an actual full meal
time.
And I also would look at thatmeal time still being a chunk of
(10:11):
time away from when the end ofthat feeding intervention was
taking place so that if theyweren't eating that, right,
there's still an hour beforewe're going back to those
chicken nuggets.
The reason that I don't usuallystart with doing meals like
that, right, like your examplewas, you know, if you just take
(10:32):
this bite, then you get to eatthat preferred food that you
want to eat, is that for somekids, and why it's called a
preferred food is just theyprefer it over something else.
But if you say you, if you eatthis, you can have these
nuggets.
They'd rather have nothing.
Then eat that food to get thenuggets.
Right.
And so, so to me, that's not agood motivator.
(10:55):
And so when I look at like, howare we going to motivate them to
do this?
I try not to use food as amotivator at all.
Because the reality is,especially with the children
that have severe feedingdisorders is that food is not
motivating.
They may have safe foods orfoods that they gravitate
towards more than others, but ifgiven the choice between that or
(11:19):
nothing, they're choosingnothing.
That's a good point.
I look at what are those thingsthat are motivating them in
regular life, like outside ofmealtime.
What are the things that theywant those access to?
What does that show that theyabsolutely love?
We're going to save the theviewing of that show for the
(11:40):
completion of, you know, that,that bite of food.
And, and, and again, in thebeginning, you're starting, I
start so small.
I have families that will sitthere and say, really, this is
all we're doing for the sessiontoday.
And I'm like, yes, because theyhave to be able to, to get that
success and feel that, that, youknow, contingency in place,
(12:01):
right?
Like they took that one bite,they were able to swallow it
here.
Yeah.
Let's watch Bluey.
That was outstanding.
And now we'll come back and tryagain tomorrow.
And maybe we're going to do twobites tomorrow because you did
awesome.
And now you're starting tofigure out that in order to, you
know, see Bluey, you're going tobe able to do those sorts of
things.
That would be what my low, like,like, younger kiddos that you're
(12:24):
not able to include in theprocess of the treatment
planning.
I will always caveat to say thatwhen a child is able to be a
part of the treatment process, Iinclude them in that as much as
possible.
I allow them to be able to picksome reinforcers.
I allow them to be able tochoose foods that they want to
(12:44):
do.
I have them actually group theminto categories.
And then we say like, all right,so out of these Which one might
you be willing to try, right?
And so a lot of times they arein that driver's seat and having
that control component withintheir meals so that they're
feeling better about thechoices, right?
They have a banana in front ofthem because they chose to try
banana today.
(13:05):
So, you know, it gives more ofthat motivation for them to want
to be successful and want to bea part of that.
SPEAKER_02 (13:12):
So starting small, using a non-food related
reinforcer, and then ifpossible, allowing them control.
Thank you very much, Mike.
I know I've been asking a lot ofthe questions.
I still have more, but let mepass it to you so it's not the
tension.
I'm thinking about a million
SPEAKER_03 (13:25):
things.
Me too.
She's covered so much ground.
I'm thinking about all thevariables that go into this.
And so whether we're talkingabout behavior or some incident
that may be related to foodtrauma.
So you've got me thinking about,I mean, way at the One of them
had trouble latching on andfeeding in the beginning.
(13:46):
You're incredibly worried.
They feed on one thing for sixmonths.
You introduce these purees.
You're supposed to, well, a lotof recommendations is to try the
same thing three days in a rowso they can taste it.
And you've got a lot ofregeneration of taste receptors
going on.
So they're not going to rememberit.
And then at the very beginning,you finish those three days of
(14:07):
those pureed pears and you go tosomething different and they
spit it out and immediately yougo back to those pears.
So, I mean, this can start asearly.
It's blowing my mind how manythings could go astray or awry
in terms of some sort of pickytoward restrictive eating, you
(14:29):
know, from the very beginning
SPEAKER_02 (14:30):
to your- Not even with an autism, just
SPEAKER_03 (14:32):
in general.
SPEAKER_00 (14:32):
Right, right.
100%, yep, just even inneurotypical kids.
That's exactly where I wasgoing.
SPEAKER_03 (14:37):
Sorry.
So no, that's exactly where Iwas going.
No, thank you, because that'swhat I was trying to say.
And then all of a sudden, Imean, back to something we
discussed earlier, I don't knowif I'm actually going to get to
a question.
I just have a lot of comments.
I have a lot of comments.
But yeah, no, the idea that, youknow, then they start eating
solids, same thing.
They take to something you're soworried as a parent that they're
having enough colitis intakethat you'll do anything to make
(15:00):
sure that you preserve thatincluding giving them the same
chicken nuggets every day andthe same.
So there's so many opportunitiesto develop these pretty vicious
habitual cycles.
And then maybe you get adiagnosis and a child that is
experiencing heightened sensoryconcerns and that is only gonna
(15:23):
impact that a little further.
And then you get intoadolescence and actually I do
have a question.
You mentioned this earlier.
What is the correlation then, ormaybe you know and you can speak
to this, between picky towardrestrictive eating toward now
maybe the development of aneating disorder.
Is that a possible progressionor is that something separate?
SPEAKER_00 (15:48):
When you say eating disorder, you're talking more
about the anorexia
SPEAKER_03 (15:51):
or bulimia.
So I'll pitch it a differentway.
We're talking about caloricintake versus gustation versus
satiety.
And not that they're unrelated,but how do they all come
together?
Do they ever come together?
Does a parent have to beconcerned that if I don't take,
what is a good level of concernto say, if I don't take care of
this now, my adolescent autisticdaughter is going to end up with
(16:15):
bulimia, for example?
SPEAKER_00 (16:16):
Yeah.
So, so I'll flip it the otherway is that oftentimes a lot of
parents don't want to seek outfeeding therapy because they
have those fears of that childdeveloping what we call, you
know, that bad relationship withfood and it's going to lead to
that eating disorder.
And the reality is there's notgreat data to support that
that's actually the case at all.
You know, the clinic that Iworked at, I was there for over
(16:39):
10 years, but one of the menthat was there he's a graduate
assistant that was his actualhis graduate project was that he
went back over 10 years uhreached out to the families that
had been you know through thosefeeding programs to be able to
see where they were you know atthis point and we weren't seeing
um you know even within our ownstudy development of any
(17:02):
concerns with eating disordersum in that way at all.
I would actually argue that thepsychological component of them
is different.
They can present similarly.
If you have a 16-year-old thathas significant restriction,
she's going to be really gauntand really skinny.
And potentially, one of mypreteens, she was 12, she wasn't
(17:29):
menstruating and she wasn'thitting puberty because she
wasn't eating.
And that is something that alsois a characteristic of anorexia.
Bulimia, you could run intothose concerns as well from that
restrictive eating.
But again, from a psychologicalstandpoint, is that they are
too...
Totally different things is thatI have a 16 year old that is so
(17:51):
restrictive in their eating.
She's not worried about what herbody looks like.
She's worried about what she'sputting inside of her mouth.
And so, so I don't know this,the actual stats on, you know,
how many people started out as,as a restrictive eater and then
turned into, you know, one ofthe classic eating disorder
situations.
(18:11):
But from my experience andresearch and, and, you know,
years of watching people do thisis that, um, it's actually, uh,
it, it, it doesn't seem to havea direct line.
They seem to be very differentpsychological branches.
Um, but, uh, but I, but I willsay I have a lot of families
that hold off on theintervention or fear that
(18:34):
intervention because of thatpotential for an eating
disorder.
And because it's so different,it usually it, it's not, um,
it's not a reason to hold off ontreating the feeding issue if
it's a feeding issue.
SPEAKER_03 (18:47):
Thank you for that.
That was a pressing question.
And I think it's reallyimportant information,
hopefully, for some parents thatmight be listening out there to
be able to make thatdistinction.
And I guess it does make sensein terms of understanding body
image and caloric intake versushaving some fear or some
aversion to what might happen,whether it's from the moment you
(19:08):
taste it or what might happen toyour body once you ingest it.
So, okay, that makes sense.
SPEAKER_00 (19:13):
It is actually interesting.
With my older kids, when we dohave to look at the I actually
will tell the parents I avoidthe child counting the calories
because I don't want that to,you know, become an issue or
something that they end uplooking at.
You know, their focus is oncalories.
eating the food, finding foodsthat are feeling good for their
(19:35):
body and the fruits and thevegetables.
We're not thinking about thefact that, you know, this
avocado has 300 calories in it.
The mom is because she's tryingto make sure that, you know,
she's gaining the weight.
But from the child standpoint,we're looking at it from what
food choices are we making?
We're not thinking about howmany calories are in those
foods.
SPEAKER_03 (19:56):
And that makes sense what you say, too, because
inevitably some parent might behearkening back to their
pediatrician and that growthchart or that weight gain
trajectory, which is still animportant variable, but to your
point, maybe not the mostpressing concern for us through
this process.
So, Mr.
Dan, I know you've been sittingpatiently.
SPEAKER_02 (20:15):
Go ahead, sir.
So I guess with that, let's say,because I remember a client that
was basically on the verge ofgetting a G-tube because they
were so concerned about his, Idon't know if it's failure to
thrive, but he was being so foodadverse that he wasn't able to
get enough calories that theywere like hey if this doesn't
change quickly we're going tohave to take another measure
(20:37):
medically what would be yourthoughts and maybe this is hard
to say because I'm sure there'sa lot of different reasons that
a lot of different individualsdo a lot of different things do
you have any thoughts that whenit gets to that point of it's
like hey we have to do somethingotherwise this individual is
going to have to come in and geta g-tube to get calories any
thoughts on any advice toparents at that point
SPEAKER_00 (20:59):
so often if they're at the point of like within
date, you know, if this child,this is one more meal, right.
They're going to be in thehospital and having an issue.
I actually, as, as opposite asit seems, I will say yes, get
the tube for the short term.
Because what that actuallyallows us to do is because
again, we think about theparents and wanting them to get
(21:21):
the calories.
And if they're at the pointwhere the pediatricians are
asking them for a weight checkevery two days, and they are
super high alert and high onanxiety, they're not going to be
calm at that meal time like wewere talking about because
they're going to be like, justeat it.
We don't want you to be on atube.
And this is so scary.
So I will actually say, ifthey're at the severe point,
(21:43):
right, is that I will actuallysay tube.
Right now, maybe not even aG-tube.
You can do like a lesspermanent.
You could do the NG tube that,you know, a little more
unpleasant because it goes upyour nose and back down, but a
little more in the temporaryspace.
Because then we know at the endof the day that that child is
getting in their calories, thatfamily can sleep better at
(22:05):
night, the pediatrician's notgoing to be so far on their
back.
And then it allows us to go atthat child's pace for the
introduction of new foods,right?
Because if we're in the panicstage, it's going to be like,
you need these foods and youneed them now, right?
We have to really like, youknow, hightail it into this
(22:27):
treatment, which and get them toshut down.
That's not always the mostpleasant.
I want them before they get tothat point because, because then
you have, you have the need thatthey have this restriction, but
they're not one meal away frombeing in the hospital.
If they're at that point, I willsay, get the tube so that we can
(22:47):
use it as I ultimately, thenwhat I do is use it as a
supplement.
So then it becomes, we're goingto do our food.
And if we only get in two bitesin that meal today then you're
doing the full eight ounce feedright for that child and then as
we continue to go oh he actuallyhad three ounces worth of food
today awesome you only need tocome back around with five
(23:09):
ounces of that formula and thenultimately it fades out so that
we get rid of that tube as thattemporary kind of crutch to
allow us to be in a calmer stateas we work through that feeding
and be able to get that childback on track
SPEAKER_02 (23:25):
That makes a lot of sense.
SPEAKER_03 (23:27):
Some people might say, and I hate to bring this up
in a certain sense, but theurgency now necessitates or
justifies escape extinction.
We're going to hold a spoon inyour mouth for 30 seconds.
And I know that that's outthere, right?
Our old colleague.
Yeah.
I want to be cautious with this.
(23:47):
I think the danger with that ishow easily it could be
misapplied.
And then you're talking aboutthat not being necessary in the
gradual approach you're talkingabout.
Could you speak to that a littlebit?
SPEAKER_00 (24:01):
Absolutely.
So it is never my first go-tofor escape extinction, but I do
want to clarify, and I think youhit on both points, right?
Is that in some cases, it isstill needed, but it is needed
from a person that isspecialized in the training to
be able to do it.
So I think that's the importantpiece to highlight there is that
(24:24):
just because you're a BCBA,right, does not mean that you
have the training to utilizeescape extinction in a feeding
protocol in any capacity, right?
But there are some kids incertain situations, whether it
be they're age, whether it betheir functioning level, whether
it be the severity of therefusal that they have, that
(24:47):
requires an intervention such asescape extinction, right?
Because the need is impactingtheir overall functioning.
I'll give you, I have my, mynephew is well, he's now two and
a half, but he was, you know,my, my whole family has, I've
been doing this for 20 years,right?
So they know I do feeding land.
(25:08):
She had this baby six monthsold.
They were weaning him, you know,from breastfeeding a little bit
more and, you know, starting totry some foods and he was eating
a little bit and it reallywasn't consistent.
And most of the time he wasputting it in and he was
spitting it out and now hedidn't even want to take his
bottles anymore and he wasreally starting to struggle he
(25:29):
was losing weight meal time wasnot fun for anyone and they were
struggling as to decide what todo right and so obviously at 11
months old You're not going tosay, okay, so which food would
you want to choose to eat today,right?
Because the 11-month-old's notgoing to make that choice.
He's typically developing,right?
(25:49):
So we weren't having necessarilyconcerns from a sensory
perspective.
We had him checked medicallyfrom, like, an issue of
swallowing or any concerns thatwould be there.
And I think that's an importantcomponent to note as well is
that if there's any issue of–whether or not a child can eat
or if there's certain texturesthat they can eat, I will always
(26:11):
refer first medically to getcleared because I don't have a
medical degree and so that'sgonna be an important component,
right?
So he was cleared medically,he's typically developing, he's
11 months old and he is losingweight and not intaking any food
and it's making his sleepstruggle, it's making his
overall functioning during theday, he's just miserable.
(26:33):
And he was a perfect case to beable to utilize an escape
extinction protocol.
And for me, I think you saidwhen you said escape extinction,
that you hold it in their mouthfor 30 seconds.
Don't do that.
No, no.
That's something we had heard.
SPEAKER_03 (26:50):
Something we had heard.
And I was like, wait, we had anold colleague who had moved away
and she called us and was like,yeah, can we run a situation by
you guys?
And I was like, yeah, no.
And these, so these kids areabout to get a G tube.
No, they're just picky eaters.
Oh my goodness.
Get out of there.
Run.
SPEAKER_00 (27:05):
Yeah.
So I would, Never recommend itfor a picky eater.
But when you have this sort ofsituation, right?
But so he's 11 months old.
So we utilize what I callnon-removal of the spoon.
So he sat in his high chair andwe held the spoon up there.
And again, he's going to crybecause he's an 11 month old
boy, right?
And they cry all the time.
And so he would put it in andhis habit that he had developed
(27:27):
was spit it back out, right?
So we would scoop it up from hischair, right?
And we would say, all right, tryit again.
Um, And then when he got thatbite in and we go, yay! He would
get like, and he loved that.
He wanted more.
He would, that was his favorite.
More, more.
Right.
And so, all right, next bite.
And then we can do it again.
And now I will tell you, causehe's my own nephew, like at two
(27:48):
and a half years old, the childwill not stop eating.
He loves eating.
He eats all day.
You know, my sister andbrother-in-law are always like,
can we send you our food billnow?
Because you know, you fixed himtoo well.
But, but there are thosesituations where when you have a
child that is, quickly slidingdown a path that would lead to
(28:11):
more needed medical interventionand it is impacting them across
the board.
It's a quick and effective andethical approach way to treat
feeding when done by anappropriate feeding professional
so again that that's my biggestred disclaimer is that it is
never something that should bedone willy-nilly um it should
(28:32):
never be done by somebody that'snot trained it should never be
done for a child that's just inthat picky you know you're not
going to be like trying tobroccoli um you know even if
you're eating other things iwant you to eat this broccoli
and i'm going to hold it up toyour mouth i would never.
Because from an ethicalstandpoint, that's not
appropriate.
But again, when you check all ofthose other boxes, there are
(28:52):
times where that intervention isthe one that's warranted and the
one that will come out with thatmost effective result for that
child.
SPEAKER_03 (29:00):
I like that.
I think we can break it down tothat that one phrase you keep
saying, so that the notion thathow do we get the child just to
try it?
Because until they try it, theyhave no chance of deriving any
sort of reinforcement orotherwise from it.
And just, and yet that simplepremise can become a huge
challenge.
And yeah, you can, you know, youcan drum up some really
(29:22):
interesting strategies to tryand get them to get that first
taste.
And then you have to considerthe rest of the variables in
terms of any sort of medicalneed.
And, you
SPEAKER_00 (29:32):
know, it can't just be Yeah,
SPEAKER_03 (29:34):
that's all.
I mean, think about so manylayers that we've just gone
through that, you know, as aparent, you're you're so stuck
on the fact your child is noteating or they, you know,
they're not gaining weight orthey're losing weight.
And that becomes your yourdriving force.
It can be very challenging tothen look at the rest of the
landscape, I think, becausewe're covering so many variables
(29:54):
that need to be considered here.
SPEAKER_00 (29:56):
Right.
But both from the parent and theBCBA, the best thing that we do,
again, is remain calm in thoseintervention times.
I think as a BCBA, we are soquick to go, that's not working,
let's change it.
As opposed to allowing us to sitkind of in that moment with that
child of that, I don't want todo this.
(30:18):
And they're sitting there andthey're staring at, you know,
that little strawberry on theirplate.
And we're so used to eitherlike, over-talking, right?
Oh, yeah.
It's like, come on, you can doit.
It's just one little bite.
You've got this.
Remember, we're going to do allthese things.
And the
SPEAKER_03 (30:32):
parents doing it here and dads here doing the
same thing.
SPEAKER_00 (30:33):
You've got a whole crowd chattering at you.
Right, it's all going on.
And all that's doing is actuallybuilding that child's anxiety.
And so I find if we all stay inthis space, people are scared of
silence, right?
We've got to embrace thatsilence sometimes.
And sometimes we just sit thereand you see that child's like,
you know, years going of, okay,this is scary, but I really do
(30:57):
want to watch that show or thisis good.
You know, they're thinking aboutthis out there and you're
seeing, you know, the therapistor the parent, they're ready to
go do whatever it is that we'redoing, but we're sitting here
and we're waiting and they'reworking their way through it.
And when they get that bite, itcannot tell you the enjoyment I
get as a therapist and watchboth the parents and that
child's face actually go, I didit.
(31:21):
And it's that sense, it's noteven always like, that was
delicious.
It's much more like that prideof they did something that was
hard.
And it was like, and you seethat face of like, And then they
want to tell everybody.
I have little three-year-oldsthat are like, mom, dad, the
cat, whoever else is over there.
(31:42):
I just need to tell everybodythat will listen to me, I took
that bite of pizza.
And so it really comes much moreaway from, wow, that food was so
good.
And more, I did this hard thingand I can do hard things.
So now I'm not going to be asscared of that pizza because
that wasn't so scary.
(32:02):
And that's the...
That's the satisfaction I wantthem to start getting.
That's the more internal drivewe can get more than we can get
the necessary internal enjoymentof the actual food.
But I can get them to actuallyenjoy the satisfaction that
comes from doing those hardthings and being able to eat
(32:22):
those foods.
SPEAKER_03 (32:24):
I like that stepwise progression because, again, we
would want them to immediatelyenjoy that food.
And what you're saying is, no,the first step is them just
realizing I didn't die.
And then now I'll take anotherbite.
and hey, that's actually prettygood.
So again, I think that's reallyimportant to highlight because
as behavior analysts, we alwayshave this perfectly envisioned
(32:45):
three-part contingency where ofcourse the child has to take a
bite and if they don't, nowwe're facing failure, right?
I didn't do this right.
You're saying, no, if you've gotthe right, if you're pretty
confident in your protocol,you're going to repeat.
And this might result in no biteof food in their mouth, but you
keep applying the protocol andanalyzing what, what can we do
(33:07):
next?
SPEAKER_00 (33:07):
Give it time.
Give it a chance.
And again, I mean, there'scertainly been times where I've
had to adjust my protocols orchange my plans based on how
things go.
But I think sometimes we are soquick, um, to say, I thought
this was gonna work and thisisn't working and quickly change
to something else where if wehad just given it one more day
(33:28):
or given it another opportunityand readjusted really looking at
what was our reaction orresponses in those moments to be
able to see what adjustments canbe made, I think you'd actually
have more success.
SPEAKER_02 (33:41):
For sure.
I think, Mike, you talked about,too, the fact of just if we can
get it to happen, if we can finda way to reinforce.
But like you mentioned, Dina, aswell, that we have to be careful
because I think sometimes that'swhere parents are trying to
hide.
They're trying to stick stuff inor hide it just to get them to
have that bite.
And then it actually makes itway worse.
So we have to be very carefulwith that.
(34:03):
I have a, so you kind of talkedabout it a little bit about the
collaboration piece, but Iwanted to highlight that because
I think that's so important andpass it over to you.
I'll share one small anecdotebecause I, historically, I
wonder, and I think that maybewe've done more damage than good
with feeding in ABA.
And I'm interested to get kindof your suggestion moving
(34:25):
forward, because I remembertrying to get an individual to
take a bite of a strawberry, andI've shared this example
multiple times, but this wasearly, Dan.
This was 15 years ago.
It was just traditional ABA,Dan.
We were going to sit therebecause you set the first thing
contingency, and once you setit, then you can't do anything
else, God forbid.
Again, I've learned from this,but it was almost an hour and a
(34:50):
half of this individual.
He was strapped in his littlehigh chair, tantruming to not
take a strawberry, take a biteof a strawberry, and eventually
did.
And I left that session like,yes, I'm so proud that
eventually followed throughbecause literally it was five
minutes before I was going toleave that session.
I was like, oh, no.
What am I going
SPEAKER_03 (35:10):
to do?
SPEAKER_02 (35:10):
And if this kid doesn't, you know, follow
through on a contingency, I saidthe world's going to explode,
followed through.
And then, you know, laterlooking back of maybe that
probably wasn't the best way ofgoing about it.
And maybe we've created morefood aversion.
So that's a story to ask thequestion of the importance of
collaboration, because in ABA,we've done, you know,
(35:33):
everything's on the three-partcontingency and we are the
experts in behavior, but thatdoesn't make us the experts in
feeding or sleeping or motorskills or anything like that.
It means we can work withindividuals that maybe are more
experts in these fields, butsomehow a lot of this gets put
on to us.
And now maybe we've done moreharm than good in saying, well,
it's the antecedent behaviorconsequence.
(35:54):
You just set that contingencyand they need to eat.
And if they don't, you don'tgive them anything they want.
And maybe we've made it wayworse.
So that's kind of a long windedquestion to say, number one, do
you think that historicallymaybe we've made it worse?
And can you talk about theimportance of collaboration with
people that actually do knowwhat they're doing in the
feeding realm, not just thebehavioral realm?
SPEAKER_00 (36:16):
Sure.
So I'm going to break that aparta little bit.
SPEAKER_01 (36:19):
Please do.
SPEAKER_00 (36:20):
So I think that the harm that happens to the point
that we were just talking aboutis when people that aren't
properly trained or supervisedto implement feeding
interventions are implementingfeeding interventions, right?
Like that's first and foremostis that I look at the BCBA as
really like a generalpractitioner.
They know a little bit ofeverything, but they're not
(36:43):
necessarily a specialist, right?
So when you go to your familydoctor and you have a heart
issue, the doctor might give youone initial recommendation.
And if that doesn't work,they're going, we're sending you
to the cardiologist, right?
Because that's the specialistthat specializes in that heart
issue.
It's a great analogy.
That's great.
And so I I do think that that'san important component.
And I stress that every time Ido a CEU or anything, I say, you
(37:03):
know, the CEU does not lead youto being able to be a feeding
expert and being able to doanything.
So I think the only componentthat I would look at as harmful
is when a BCBA is implementingfeeding procedures without
having training or appropriatesupervision to be able to do so.
I actually think when you lookat the feeding research is that
(37:25):
ABA has done a lot of greatinterventions and great help
with children with feedingchallenges across the board for
years.
And that, you know, I think overtime, and I think as feeding has
continued on in ABA land is thatwe figured out how to
(37:46):
collaborate with otherprofessionals.
And I think when you say, youknow, somebody that would be
more specialized in feeding, I'mI'm guessing you're talking more
in the realm of like the speechand OT, because that seems to be
where they, you know, whensomebody thinks about feeding,
that's usually the first type ofdemographic that they're going
(38:06):
to go to, right?
Speech or OT.
And I think for me, what I lookat is there's components in
which we can all work togetherin the areas in which we are
most benefited, right?
So from a speech perspective, Icollaborate with speech a lot
when I have kids that might notbe having great oral motor
(38:26):
skills.
So, you know, I may have to workwith the family on pureed food
while the speech therapist isgetting the child to actually
have some solid jaw strength andmoving their tongue around and
being able to have the abilityto manage the regular textured
food, right?
When I have an OT console,that's a lot of times, you know,
go back to that idea of safetywhile you're eating.
(38:48):
And I'm a huge advocate for kidssitting while they're eating and
not standing and dancing andrunning around.
But there's some kids that weknow, right, that don't have
good core strength and musclestrength.
And so when they sit in a chair,they're kind of like, right,
like they're hunched down andthey're not really sitting up
properly.
And so I need, you know, that'sthe OT area.
And so that's where a hugebenefit is that they can, you
(39:11):
know, work with that child to beable to develop that opportunity
to sit them up straight so thatwhen they're eating, it's
successful.
As well as that hand-eyecoordination, you think about
all the things that are involvedwith nutrition.
with self-feeding, right?
Scooping and stabbing bites arenot easy, especially for kids
that may have some fine motordifficulties.
And so, you know, I love theopportunity to be able to say,
(39:33):
this is a great thing that canbe worked on during OT sessions
that also can benefit within thefeeding session.
What I do see a lot of that inmy experience, and I will say
most of my experience is withpretty severe issues restrictive
eater.
So I don't work a lot with theyounger kids in that early
(39:58):
intervention land, which iswhere I think, you know, more
education needs to go into toyour point of like, let's kind
of set the premise before iteven becomes an issue.
So it doesn't become an issue,right?
I think that's a great part.
So I will caveat with saying,you know, most of the
individuals that I've seen overmy whole career have been pretty
severe and significant.
(40:20):
They are not responsive often tofood integration, food exposure,
food interaction, right?
So a lot of things that I hearabout are like cook with your
child or play– with the food,right?
So let's put the broccoli hereand let's play with, you know,
(40:44):
moving the little dino nuggetover to the tree and do all of
that stuff.
Let's squeeze the fruit and seehow it feels.
Let's lick it.
Oftentimes, it does one of twothings, right?
The one thing it can do is thatit can desensitize a highly
sensitive child to thosefeelings and those textures.
(41:05):
So now maybe a child that neverwanted to be around even the
look of food, right, can bethere and hold it, play with it,
but they seem to get the brickwall when it actually comes to
like eating the food.
So that's an area of concernthat I see with a lot of
families, but with some of them,it actually works
(41:28):
counterproductive because it'snot pleasant for some and for
some foods.
When I think about eating food,I love to eat food.
We've all talked about this.
We love to eat food.
I don't want to stick my hand inthe bowl of pudding or I don't
necessarily want to squeeze araspberry in my fingers.
(41:52):
It doesn't feel as good to me.
That's not going to get me toactually want to eat it more.
That's going to make me go, itdoesn't feel so good.
And now I don't want to eat it.
And so I look at thoseinterventions as potentially
helpful for some kids that fallin more of that picky eater
category, where they're not inthat severe case at this point,
(42:12):
you know, they have theopportunity to be able to work
through some of those things ina more like low key fun way.
But at the end of the day, youknow, for me, what used to be
like the parents motto all thetime, they always say don't play
with your food.
We're really not supposed toplay with food, we're supposed
to play with toys and othertypes of things.
(42:33):
And so when I come in, for afeeding program.
I'm looking at how do we set ourmealtime expectations?
And our mealtime expectationsare that, you know, we're
putting out the foods that we'regoing to eat today, whether that
starts with just one little bitefor a kiddo up to, you know, a
full plate of food for a meal,depending on where they are in
their treatment program.
And we're going to scoop or stabor pick up our bites, depending
(42:56):
on what would be appropriate forwhat that child's skill level is
at.
And we're going to just pop themin and eat it and be done.
You don't need to be inspectingthe food, looking at it.
Sometimes when we expose oursenses too much, it can actually
work in the opposite directionand become aversive.
(43:17):
And so when we have a child thathas such significant restriction
already, and again, it'simpacting all of those things
that we've talked about today, Ifind that those interventions
aren't helpful in most cases.
But I do find the huge benefitof collaboration and finding
(43:37):
ways to be able to work with,like we were talking about the
speech and the OT, withnutrition for some of the kids
that are trying to get off of
SPEAKER_01 (43:44):
tubes.
SPEAKER_00 (43:45):
I have to know for this child's height and weight,
what caloric intake do I need toget them to during a day?
What variety of fruits andvegetables and proteins do they
need to be able to warrantgetting off of the tube?
Sometimes it's connecting withGI.
If we've got a child that isconstipated, you're not going to
(44:06):
feel like eating if you'reconstipated, right?
But part of the reason you'reconstipated is because you're
not eating.
So there's like that viciouscycle.
And so we have to be able tofind that balance in, you know,
how can we work with GI and say,can we clear out this
constipation issue kind of so wecan start fresh and give them
that opportunity for success?
Because you don't want to beable to work on feeding if
(44:29):
they're not hungry or notfeeling well physically with
themselves.
So I think that there's, but tome, there's
SPEAKER_01 (44:36):
huge
SPEAKER_00 (44:36):
benefit to ABA feeding.
I think ABA feedinginterventions have done wonders
for families in a lot of ways.
I could line up tens of hundredsof families that have had great
success.
But again, I think it reallycomes down to every individual
(44:59):
child.
We can look in the ABA land tothings that we don't necessarily
promote, right?
We could think about like thehyperbaric chamber sort of
situation, right?
Where some people will say, oh,we take my child with autism.
We heard about the hyperbaricchamber or we heard about a
specific diet.
We're going to cut out all ofthese things because it's going
to cure their autism,
SPEAKER_01 (45:20):
right?
SPEAKER_00 (45:22):
We hear that stuff all the time.
But what's funny is you'realways going to find somebody
that's going to say, That curedmy child.
That was helpful.
That worked.
And so my answer toprofessionals and to families
all the time is when they say,should I keep doing X, Y, or Z?
Should I keep doing thisintervention?
(45:43):
Should I keep doing thatintervention?
Whatever it might be.
As I say, let's take some data.
Look at the data.
Are you seeing progress?
What are the goals?
What are you trying to get to?
And if it's working for you, doit.
I'm not going to say don't dothat because that's not the
approach that I would take.
If you're having success with itand you're doing well, awesome.
(46:04):
Keep doing that.
If you're finding that you andyour child are not having the
success that you want or hittingthe goals that you want, then
you have to be able to look atwhat are the other options out
there and what can you do.
I think that's the best answer Ican give from thinking about how
(46:27):
to approach that from all thosedifferent angles.
SPEAKER_02 (46:30):
Thank you for clarifying, too, because I
probably should have worded itdifferently because, you know, I
kind of live in my bubble ofin-home ABA therapy.
And I think you're 100 percentright that ABA probably has had
a net positive, almost certainlyhas had a net positive impact on
feeding.
And when it's done with themultidisciplinary approach, like
you've talked about,collaborating with specialists
(46:52):
like yourselves, maybe evenspeech or occupational
therapists.
I was just thinking about, youknow, the in-home therapy, how
so often it maybe is miserableAnd everything is done by the
BCBA without any collaboration.
And then you run intopotentially detrimental effects.
So thank you for clarifyingthat.
SPEAKER_01 (47:10):
Yeah,
SPEAKER_02 (47:10):
I think that is an important piece.
SPEAKER_03 (47:13):
Well, we we warned you that this would fly by.
Give us the five minute warninghere for any pressing questions.
You mentioned special diets andthen it clicked.
GFCF.
I've been doing this for a longtime.
That's probably a whole separateepisode.
But you alluded to it in termsof I remember way back in early
(47:34):
practice and maybe gluten freefoods weren't so attractive at
that time.
I think they've gottenincredibly good and better since
then.
But I remember, you know, not.
ABA and those types ofinterventions not playing so
well.
And then I remember, you know,hitting the point in my career
where I was going like, well, itgot the whole family started
(47:55):
doing it, got them all to sitaround the table.
And so, of course, the kid got Imean, yes, it makes sense.
Like, even if they didn't have agluten sensitivity, look at all
these other behaviors thatchanged.
And then it obviously it failedfor some people, too, because
they were expecting the child toeat it on their own.
And it wasn't the mostattractive food and nowhere
close to what they were eating.
And Anyway, so it didn't go verywell.
(48:16):
But I really like the way youkind of conceptualize that.
Is it working for you?
It's not harmful?
Okay.
Look at the data.
Keep giving it a shot and dowhat you need there.
So that's really good.
We won't get too much furtherinto the diets.
Dina, I do want to give you achance to tell our listeners
where to find you and all theincredible things you do for
(48:39):
people out in Pennsylvania.
So if you could just tell us thename of your center.
maybe a website address.
And I don't know if you wantpeople emailing you questions,
but you're welcome to share thatinformation as well before we
close.
SPEAKER_00 (48:52):
Absolutely.
Yes.
So all of my programs areactually completely virtual so
my center is my dining roomtable most days but it has
actually worked really wellbecause it again puts it on a
parent first focus and so itreally gives that that onus to
the family to make the changebecause when you're in a clinic
(49:12):
setting a lot of times and I'msure a lot of ABA clinics just
feel this too is the family likedrops off that child and says
here you go you know and I'mgonna go do all of the other
things that have to get donewhich is great but feeding is
about that family time, thatfamily connection.
And ultimately, the family isthe one that's going to be doing
most of the meals.
And so they need to be the mostinvolved in that.
(49:33):
And so all of my programs arevirtual.
They are very heavy in parentinvolvement and training and
prep as far as that interventiongoes.
My website isfocusedapproach.com.
And people can absolutely emailme directly.
It's just dkelly atfocusedapproach.com.
And I do direct feedingintervention as well as a lot of
(49:56):
professional development andCEUs for BCBAs and ABA clinics
that are interested in how theycan, you know, make some
improvements on that feedingbehavior for their children.
SPEAKER_03 (50:06):
We'll make sure and include that information No
(50:37):
trickery, meaning don't try tosneak new foods into their
preferred foods.
And like we like to say on ABAon Tab Dan, always analyze
SPEAKER_02 (50:46):
responsibly.
SPEAKER_03 (50:46):
Thank you, Dina.
SPEAKER_00 (50:48):
Thank you guys so much.
SPEAKER_02 (50:51):
Thank you so much, Dina.
That was a
SPEAKER_00 (50:52):
pleasure.
Thank you guys so much.
I love any opportunity to talkabout feeding.
Always, always excited to dothat.
SPEAKER_03 (51:00):
Thank you.
We hope people find you throughthis and maybe we get more
people going your way.
And again, yeah, thank you somuch.
We learned a ton.
Yeah.
Anything that we can ever do foryou, you ever want to come back
on to promote something, pleasejust let us know.
We will send you as soon as wecan if you want.
So we do it out of courtesy.
(51:20):
We send the Zoom audio toguests.
Most of them don't want to takethe time to listen to it.
So they say it's OK.
Yeah.
So if you're OK with us justpublishing.
Yep.
If at any point you were tolisten to it or somebody tells
you, hey, we heard you.
And I don't know any concernarises from it.
Just let us know.
We're glad this.
Yes, it's our content.
We're not going to keep it up ifyou're not comfortable with it.
(51:41):
That's only happened once out ofalmost 60 episodes.
So I think people would feelpretty comfortable and they, you
know, they say things they wantto say and nobody nobody's
worried about that.
But yeah, anything we can everdo for you again, we can't thank
you enough for your time and andfor sharing all your knowledge
today.
SPEAKER_00 (51:57):
Great.
Thank you so much.
It was great to meet you guys.
Have a good rest of your day.
SPEAKER_03 (52:00):
Thanks a lot.
You
SPEAKER_00 (52:01):
too.
Bye-bye.
SPEAKER_03 (52:02):
ABA on Tap is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.
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In 1997, actress Kristin Davis’ life was forever changed when she took on the role of Charlotte York in Sex and the City. As we watched Carrie, Samantha, Miranda and Charlotte navigate relationships in NYC, the show helped push once unacceptable conversation topics out of the shadows and altered the narrative around women and sex. We all saw ourselves in them as they searched for fulfillment in life, sex and friendships. Now, Kristin Davis wants to connect with you, the fans, and share untold stories and all the behind the scenes. Together, with Kristin and special guests, what will begin with Sex and the City will evolve into talks about themes that are still so relevant today. "Are you a Charlotte?" is much more than just rewatching this beloved show, it brings the past and the present together as we talk with heart, humor and of course some optimism.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com