The Effects of Applied Behavior Analysis-Based Parent-Implemented Interventions for Children with Pediatric Feeding Disorder: A Systematic Review and Meta-Analysis

Abstract

Feeding difficulties occur at a high rate in children with normal development and at a disproportionally high rate in children with developmental disabilities. Prolonged problematic eating, categorized as Pediatric Feeding Disorder (PFD), can result in poor physical growth and jeopardize overall health. Extant research on applied behavior analysis (ABA) based parent-implemented interventions (PIIs) has been widely accepted and found to be effective in supporting children with feeding difficulties. A vast majority of studies have separately explored the efficacy of ABA-based interventions and PIIs for children with feeding difficulties. In addition, previous meta-analyses and systematic reviews have focused on studies utilizing single-case research design. Present study comprehensively assessed the overall effectiveness of ABA-based PIIs for children with PFD with studies utilizing group experimental design. Meta-analytic procedures were used to estimate the effects of ABA-based PIIs on child and parent outcomes for children with PFD. A total of 11 studies were included in the analysis. Characteristics of the parent training programs was summarized. A random-effect model was employed and the results showed a moderate but statistically significant effect size (g = -0.73, 95% CI [-1.34, -0.13]) for ABA-based PIIs on child feeding outcomes, indicating a positive impact on mitigating child feeding challenges. However, the effect size estimate for one of the parental outcomes (i.e., parent stress) was small and statistically nonsignificant (g = -0.38, 95% CI [-0.83, 0.07]). Moderator analysis was also performed to examine the moderating effects of the following variables on child feeding outcomes and parental outcomes: training delivery format, direct child participation, utilization of escape extinction, and utilization of consequence- and antecedent-based treatment package. Results showed that all four variables had a moderating effect on child feeding outcomes but only two variables showed a moderating effect on parental stress. This study not only marked as the first attempt to systematically evaluate the empirical evidence from group experimental designed studies, but also explored potential moderators that may play vital roles in the effectiveness of ABA-based PIIs with children with PFD. Discussion of the implications along with future directions conclude this dissertation.