Specialized Outpatient Services

Eliminate Your Child’s Challenging Behavior – Fast.

CARD’s Specialized Outpatient Services (SOS) provides services to individuals with and without developmental disabilities.

What is SOS?

CARD® SOS is a unique service that targets a child’s more extreme behavior, which can jeopardize a child’s health or safety and make daily life difficult for a family. These services are a short-term intervention meant to address an immediate need. Our goal is to make the home lives of our patients as healthy, enjoyable, and productive as possible.

The behaviors addressed by CARD® SOS tend to be more severe in nature. Often, other providers have attempted unsuccessfully to address these behaviors. Utilizing the principles of applied behavior analysis (ABA), the CARD® SOS team provides consultation and direct 1-to-1 interventions to reduce inappropriate behaviors and increase socially appropriate behaviors.

How to Get Started

CARD® provides SOS services all over the world. However, because of staffing and logistical limitations, some services are only available in certain centers. For more information or to start the intake process, contact CARD® SOS at 855-345-2273. Typically, after a brief phone consultation, we will schedule an initial evaluation and provide recommendations.

CARD® Classes

CARD® offers a variety of customized, hands-on classes and seminars that provide ongoing development for families, caregivers, professional educators, clinicians, and students with the opportunity to benefit from over 150 years of experience from leading experts in the field.

CARD® Classes are held at a variety of CARD® centers, as well as community centers around the country. Please click on the links below to learn more about each opportunity and register today! If you have any questions, please contact (855) 345-2273.

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Challenging Behavior Center

Autism presents families with numerous hurdles to overcome on a daily basis. Behavior problems are often one of the most cited concerns by parents. These issues not only inhibit the development of the child but can also curtail the activities of the family as a whole.

Common behavior problems seen within the autism spectrum disorder that can cause significant harm to the child and others include the following:

  • Self-injury (self-biting, scratching, pinching, hitting, etc.);
  • Aggression toward others;
  • Property destruction;
  • Pica (eating inedible objects); and
  • Non-compliance.

Other challenging behaviors include:

  • Sleep dysregulation;
  • Inappropriate toileting; and
  • Inappropriate sexual behavior.

Behavioral Intervention

Behavioral interventions have been utilized to address challenging behavior for decades. Between the years of 1960-1995, over 550 peer-reviewed studies were published documenting the effectiveness of ABA techniques in teaching skills to children with autism (Matson, et al, 1996). Currently, ABA-based interventions are considered to be the gold standard in intervention. The CARD’s SOS provides services for individuals with and without developmental disabilities, who display problem behavior in the home, school, and/or community setting. Utilizing the principles of ABA, the CARD® SOS team provides consultation and direct 1-to-1 intervention to reduce inappropriate behaviors and increase socially appropriate behaviors. Using state-of-the-art functional assessment procedures, presenting symptoms are identified and assessed. A function-based intervention is then developed to replace the challenging behaviors with newly acquired, appropriate skills. Skills that are targeted for acquisition range from basic language and play skills to more complex social skills. Once new behaviors are mastered, CARD® focuses on a generalization of the newly acquired skills to the home, school, and community settings. Significant time and effort are invested in caregiver training to ensure that the child uses the new appropriate behaviors across all environments and with individuals outside of the treatment team and family.

Feeding Center

For many individuals, great joy can be found in the act of eating. However, for some children, this seemingly simple act can cause great strain on the individual and the family.

Pediatric feeding disorders occur when a child does not consume enough food or liquid to gain weight and grow as expected. On a whole, feeding issues are relatively common in children and even more common in children with developmental disabilities. However, the severity of feeding issues can differ greatly from child to child.


At the beginning of his services with the CARD’s SOS Feeding Center, Mitchell was small for his age, being within the 10th and 25th percentiles for height and weight for his age. Upon discharge, Mitchell is 37.5 lbs. (on the 50th percentile) and 38 inches tall (between the 25th and 50th percentiles).

Age 3 y 5m 3y 10m
Weight 30 lb 37.5 lb
Height 36″ 39″
Food Texture Mushy (i.e. porridge, mashed potato) Regular texture, bite size
Seating High chair, bathtub An age-appropriate booster seat
Feeding Style Mom fed him Self-feeder
Amount of Time Per Day Feeding Him 5 meals, each at least 1 hour 4 meals, each averaging 30 minutes
Variety Less than 10 foods eaten consistently, only water Anything we put in front of him. At least 40 different foods
Inappropriate Mealtime Behaviors Gagging, crying, throwing up, cough, giving back food Almost non-existent
Chewing Swallowed food whole Self-regulates chewing


A child with a feeding disorder may only eat a few foods, completely avoiding entire food groups, textures or liquids necessary for proper development. As a result, children diagnosed with feeding disorders are at greater risk for compromised physical and cognitive development. Children with feeding disorders may also develop slower, experience behavioral problems, and even fail to thrive. Severe feeding disorders can cause children to feel socially isolated and often put financial strains on families.

There are many different types of feeding disorders, and they can take on one or more of the following forms:

  • Difficulty in accepting and swallowing different food textures;
  • Throwing tantrums at mealtimes;
  • Refusing to eat certain food groups;
  • Refusing to eat any solids or liquids;
  • Choking, gagging or vomiting when eating;
  • Oral motor and sensory problems;
  • Dependence upon high-calorie substances; and
  • Gastrostomy (g-tube) or naso-gastric (ng-tube) dependence.

In most cases, no single factor accounts for a child’s feeding problem. Rather, several factors can interact to produce the problem. Feeding disorders typically develop for several reasons, including medical conditions (food allergies), anatomical or structural abnormalities (e.g., cleft palate), and reinforcement of inappropriate behavior. Unfortunately, at this time, the concise etiology of pediatric feeding disorders is still unknown.

While a wide variety of factors can contribute to feeding disorders, certain medical and psychological conditions may accompany feeding disorders more often, such as the following:

  • Gastroesophageal reflux disease;
  • Gastrointestinal motility disorders;
  • Failure to thrive;
  • Prematurity;
  • Oral Motor Dysfunction (dysfunctional swallow, dysphasia, and oral motor dysphasia);
  • Food allergies;
  • Delayed exposure to a variety of foods; and
  • Behavior management issues.

Awareness of risk factors and clinical presentations of feeding disorders, combined with appropriate referrals at an early age, will produce the best outcomes for children and their families.

Feeding Disorders

Research has shown that there are significant differences in the eating patterns of children with autism and those who are neuro-typical. Some children with autism are shown to be more selective in the types of food eaten, textures of food, and variety. Additionally, these children tend to need more specific environments and utensils (Shreck 2006). Nutritional intake is also seen to be lower for children on the autism spectrum (Bandini, 2010; Cermak, 2009).

Behavioral Intervention for Feeding Disorders

Behavior disorders (including feeding disorders) often involve an interaction of operant and biological variables. Behavioral psychology allows for systematic analysis of environmental variables. This allows the underlying function of the target behavior to be covered. Treatment intervention can then be developed fully when the function is known (Piazza 2003a).

Behavioral interventions have been shown to be useful in reducing, and even eliminating, not only tantrums and non-compliance during meals but, also, the use of tube feedings (Piazza 2003b; Matson, 2005; Linschield, 2006). Interventions of these types have been published in peer-reviewed literature dating back to the mid-1970s.

The CARD® Feeding center provides services for individuals (a) with and without developmental disabilities, (b) who display difficulties in self-feeding or have problems such as partial or total food refusal or food selectivity by type or texture, and (c) who do not have a feeding disorder of a biological basis (as determined by a pre-screened medical examination).

Trained clinicians design interventions based on the results of a systematic assessment of an individual’s feeding problem. Intervention can be provided either in the center or home setting.

As individuals show consistent improvement in feeding skills, caregivers are trained to implement interventions with clinician support. Treatment goals have been met once individuals demonstrate generalization to novel foods and are eating well with caregivers in the home setting, and caregivers feel confident implementing procedures independently.

Medical Facilitation Center

There are many ways to compromise medical interventions. One oft-cited reason is simply a failure to comply with recommendations. This includes non-compliance with medication, as well as regular testing, follow-up visits, and examinations. For children on the autism spectrum, this failure to comply can be taken to an even greater level, involving tears and tantrums due to possible difficulties with sudden changes in environments and routines.

The Medical Facilitation Center provides behavioral services to individuals to assist in assuring the individual’s adherence to medical procedures. Medical procedures include, but are not limited to, the administration of oral medication (capsules and tablets), capsule endoscopy, physical examinations, dental visits, obtaining vital signs, and IV procedures. Families are required to show documentation of a thorough physical examination by a licensed physician prior to intervention.

After a review of the patient’s medical history, our staff is able to design a personalized behavioral intervention to teach the patient necessary new skills and to desensitize the patient to medical procedures. Once the individual has shown mastery of the specific procedure, all caregivers are trained to implement the successful intervention.

Case Study

Eli, 9 years old, was required to take nine pills each day to adhere to his medical regimen. At the beginning of treatment, Eli willingly put the pill in his mouth but was not able to swallow it. Using size fading, Eli began his intervention using very small placebo pills (tapioca). Once he was successful in swallowing that size, the size was increased systematically. When he was able to swallow the biggest pill size (capsule size 0), his mother began to run the sessions with great success.

School Consultations

CARD® SOS services are available to individual schools and entire school districts. For more information, contact us.

The Individuals with Disabilities Education Act (IDEA) requires that Individualized Education Programs (IEPs) address behavior problems that interfere with a child’s ongoing learning. This includes conducting a functional behavior assessment to determine the underlying reasons that the problem behavior occurs. Once the function of the behavior is known, an intervention based upon that function can be constructed. Function-based interventions are shown to be more effective and long-lasting in addressing problem behavior.

Staff members are able to meet with school personnel, families, and children in order to conduct a thorough functional assessment. This can include the following:

  • Indirect functional assessment;
  • Direct functional assessment; and
  • Experimental functional analysis.

All assessments are tailored to the individual child. Behavioral recommendations can be provided upon request to guide the formation of a child’s Behavior Intervention Plan (BIP).