Registered Behavior Technician FAQs

Feeding disorders are very common. Though it is hard to quantify, “[a]pproximately 20-50% of normally developing children, and 70-89% of children with developmental disabilities” (1) have a feeding disorder. How does this happen so frequently?!

According to Dr. Kay Toomey’s research and reviews of other studies, of children who have feeding disorders, between 65-95% of cases are caused by both behavioral and natural, organic causes (2017) (2). In other words, more often than not, a feeding disorder is not just behavioral! For example, a child that has undiagnosed reflux or allergies has learned to refuse food, because they have learned that food causes them to have an upset stomach. They may continue to refuse food even after receiving treatment for the initial physiological problem. A child that has choked on some solids because of undiagnosed oral dysphagia will begin to only eat liquid and purees to avoid choking. A child that is refusing crunchy foods could have sensory processing disorder and benefit from desensitization. A child that is having a hard time breathing will refuse food in order to get enough oxygen to survive. The examples could go on and on. Every child is different, and needs to be diagnosed and treated holistically.

Some signs that may indicate your child could have a feeding disorder include:

• If your child eats less than 20 foods
• If mealtimes take more than 30 minutes
• If they refuse all of food of a certain texture or color, or are they having difficulty transitioning to solids
• If they are choking, coughing, or gagging while eating
• If they are demonstrating a lot of negative behaviors during meal times
• If they have difficulty with mealtime routines or have a hard time sitting at the table
• If they have difficulty chewing or swallowing (example: food left in their mouth after they’ve finished eating)

If you think your child could have a feeding disorder, or you feel that you’ve exhausted your options at home and don’t know where else to go, your child could likely benefit from a feeding evaluation and possibly feeding therapy. A pediatric feeding specialist can help you determine the cause, if a cause is present, make appropriate referrals, and plan the best course of treatment. Slowly, your child will become an adventurous and independent eater!

Sources:

1. 2013. June 13. Banchaun Benjasuwantep, Suthida Chaithirayanon, and  Monchutha Eiamudomkan. Feeding Problems in Healthy Young Children: Prevalence, Related Factors and Feeding Practices. Published online 2013 Jun 13. doi: 10.4081/pr.2013.e10
2. Toomey, Kay (2017). Top Ten Myths of Mealtime in America. SOS Approach to Feeding. https://sosapproach-conferences.com/resources/top-ten-myths-of-mealtime-in-america/

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Starting your Clinical Fellowship year is exciting—but it can also feel overwhelming. Before you jump in, take a little time to reflect. Asking yourself the right questions now can help you find the best fit and start your career with confidence.

1. Who will my clients be?

Do you see yourself in pediatrics (schools, outpatient, hospital?) or working with adult patients (in the hospital, SNF, outpatient, or specializing?),? What areas draw you in? Articulation, AAC, literacy, language, or feeding? You don’t have to have it all figured out—but having a general direction helps.

2. What work environment fits me best?

Think about where you thrive! Do you prefer a fast-paced clinic , scheduling yourself in a school environment, or in home with your patients? Do you want to work closely with other professionals everyday or have more independence?

3. What kind of support do I need?

Your CF supervisor plays a huge role in your experience. Ask yourself: Do I want hands-on guidance? Frequent feedback? A team I can easily turn to with questions? An experienced mentor?

4. What do I want to learn this year?

Your CF isn’t just about completing hours—it’s about growing your skills. What do you want to feel confident in by the end of the year?

5. What are my non-negotiables?

Consider what matters most to you. Ask about caseload size (both appointments and number of patients/students whose cases you must manage), work-life balance, mentorship, or pay structure (W2 vs 1099). Knowing your priorities will help you make the right decision.

You can also ask about benefits! Some benefits make a big difference today like PTO, paid holidays (are they taken out of your PTO?), medical coverage, and more. Other will shape your future in a big way, like the retirement plan options.

6. How will I take care of myself?

This year can be demanding. Think about how you’ll manage stress, stay organized, and maintain balance so you can show up as your best self.

Your CF year is just the beginning. Taking time to reflect now can set you up for a more meaningful, supported, and successful start in the field. And if you can, find a mentor who will guide you through these sometimes-challenging questions.

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Teletherapy, also called tele-practice or tele-speech, has become more popular during the uncertain circumstances and stay at home orders of COVID-19. Teletherapy can bring a sense of familiarity in uncertain times, as your child can have a weekly live speech therapy visit with a consistent speech language pathologist (SLP). A relationship is built, and the therapist and child share smiles and laughter in between working on their goals. With teletherapy, children can continue to receive continuity of care even as they stay safe at home! But does this foreign method of attending speech therapy really work?

Research is largely in agreement: Teletherapy is a very effective way of teaching kids speech and language!

With teletherapy, speech therapy is provided via a video chat platform that is secure. MetroEHS’s online platform includes fun games, a box for clients to watch applicable videos and talk through worksheets or read stories, screen share, practice cards, and, of course,  a live-streaming video SLP guiding them through all of it. All of these features engage most children, including those on the Autism Spectrum. This 1:1 teletherapy has been proven effective: according to a review of 7 studies of school-aged children, “telehealth is a promising method for treating children” (1). Another study looking specifically at children with ASD stated, “All [14] studies reported high levels of programme acceptability and parent satisfaction with the telehealth component of the intervention” (2). And another states, “Emerging research in telepractice treatment for ASD clients already shows success in both direct and indirect interactions” (3).

If a child is too young or difficult to engage, the SLP may opt for a parent training approach. The parent will receive a list of supplies to gather from around the house, and the SLP will teach the parent how to target the child’s goals. The parent is encouraged to ask questions, and the SLP coaches as the parent engages their child and completes their goals. This has also been proven effective for children learning language! Evidence suggests, “that parent-mediated intervention training delivered remotely can improve parents’ knowledge in [autism spectrum disorder] ASD, parent intervention fidelity, and subsequently improve the social behavior and communication skills of their children with ASD (4).

Feeding Therapy can be provided with a similar model. The SLP guides the caregiver during the session, and talks through strategies and techniques for children accepting the food, chewing, and swallowing. Providing feeding therapy online can be beneficial because the SLP can see where the child typically sits, the types of eating utensils that are used, and overall family dynamic- all of which play a major role in carryover of skills to the home environment. What better way to support generalization to home, than having therapy in the home! Feeding Teletherapy, too, is an excellent and effective substitute to in-person therapy, according to research (5)!

As you can see, teletherapy is a powerful alternative to in-person therapy, especially during situations when receiving in-person therapy is difficult or impossible for families. If you would like more information about teletherapy, to enroll your child, or a free “Teletherapy Tour” to see our platform, please contact MetroEHS today!

Resources

1. 2017. Wales, D., Skinner, L., et al. The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review. International Journal of Telerehabilitation, 9(1), 55-70.
2. 2018. Sutherland, R., Trembath, D., et al. Telehealth and Autism: A Systematic Search and Review of the Literature. International Journal of Speech-Language Pathology, 20(3), 324-336.
3. 2015, April 28. Cornish, Nate. Social Mediating: Using Telepractice for Clients With Autism. ASHAwire.
4. 2017. Parsons, D., Cordier, R., et al. Parent-Mediated Intervention Training Delivered Remotely for Children With Autism Spectrum Disorder Living Outside of Urban Areas: Systematic Review. Journal of Medical Internet Research, 19(8), e198.
5. 2008. Clawson, Seldon, Lacks, Deaton, Hall, Bach. Complex pediatric feeding disorders: using teleconferencing technology to improve access to a treatment program. Pediatric Nursing, 34(3): 213-6.