Background

1. Using a Family-Centered, Multicomponent Intervention Package to Promote the Food Acceptance of Children with Autism Spectrum Disorder (ASD) Julia Brunson, MOTS and Jennifer Hill, MOTS Investigators: Joanna Cosbey, PhD, OTR/L and Deirdre Muldoon, CCC-SLP, BCBA University of New Mexico Occupational Therapy Graduate Program Background Participants Results Blake is a 6 year old boy whose food repertoire consists of 34 foods, not including snacks and desserts. Blake’s challenging mealtime behaviors include leaving the table and minimal use of utensils. Blake often times takes longer than 20 minutes to finish a meal and tantrums when presented with less-preferred foods. Craig is a 9 year old boy whose food repertoire consists of 10 foods, not including snacks and desserts. Craig’s challenging mealtime behaviors include licking food, regurgitating food, and leaving the table. Stephen is a 5 year old boy whose food repertoire consists of 22 foods, not including snacks and desserts. Stephen’s main challenging mealtime behavior is playing with food, leaving the table, and refusing to taste unfamiliar foods. When presented with less-preferred foods, Stephen cries, whines, or protests. Dominic is an 8 year old boy whose food repertoire consists of 8 foods, not including snacks or desserts. Dominic’s challenging mealtime behaviors include leaving the table, taking longer than 20 minutes to finish a meal, and overstuffing his mouth. When presented with less-preferred foods, Dominic tantrums, cries, or protests. • Approximately 80% of children with developmental disabilities have feeding problems (Field, Garland, & Williams, 2003) • In comparison to typically developing peers, children with ASD have significantly greater feeding problems and eat a narrower range of food (Kozlowski, Matson, Belva, & Rieske, 2012; Schreck, Williams, & Smith, 2004) • Approximately 60-90% of children with ASD exhibit feeding difficulties, such as food selectivity, food refusal, and resistance to trying new foods (Bruns & Thompson, 2011; Kerwin, Eicher, & Gelsinger, 2005) • Well researched and effective interventions for children with ASD and mealtime challenges include escape extinction, reinforcement, prompting, stimulus fading, and combining or sequencing new foods with a familiar food (Volkert & Piazza, 2012) • There is limited research to support interventions related to food characteristics, communication, and the physical environment • Currently, there is no study that combines multiple techniques across various domains into one intervention package • Data will be collected for up to 3 behaviorally defined responses for each participant • Data will be analyzed using visual data analysis strategies such as examining graphed data for level and trend • Results of intervention cannot be determined as of date due to ongoing data collection • Baseline data indicate that, in general: • Parents are consistently not offering less-preferred foods • When presented with less-preferred foods, children are not accepting the food • Challenging behaviors, such as leaving the table, may be influenced by parent or sibling presence or behaviors • Interobserver agreement (IOA) is 80%-100% during baseline • Procedural fidelity is 100% during baseline Conclusions Purpose This study addressed multiple dimensions of mealtime for children with ASD and their families. Results from initial baseline data is consistent with previous studies indicating that children with ASD eat a limited variety of foods, exhibit challenging behaviors during mealtime, or refuse to try new foods. These difficulties are important to address because they may lead to child nutritional problems and increase family stress.Prospectively, these individualized intervention packages will improve children’s mealtime behaviors. It is predicted that parents will find the intervention acceptable. Additionally, it is anticipated that parents’ prior knowledge of strategies will increase intervention acceptability and procedural fidelity. To determine the efficacy and social validity of a multicomponent intervention package designed to improve the acceptance of less preferred foods and/or food groups by young children with Autism Spectrum Disorder (ASD). Procedures • 1. Review: previous evaluations, medical history, and confirm ASD diagnosis • 2. Assessment: child’s performance, parent’s interactions, child’s preferences, and interview parent about mealtimes • 3. Baseline Data Collection: collect data on behaviorally defined responses for parent and child during regular meals or snack sessions • 4. Planning: develop individualized interventions with parent and child addressing- • Food characteristics: altering target foods such as the texture or color of food, etc. • Communication supports: supporting the child’s expressive and/or receptive communication such as visual supports, menus, etc. • Physical environment: changing the environment in which the meals take place such as location, seating, distractors, etc. • Social environment: modifying the parent/child interactions such as use of praise, prompting strategies, etc. • 5. Intervention: • Coaching: parent implements intervention with researcher supervision and coaching including prompting, modeling, and other support as necessary • Independent: parent implements intervention without any coaching (parents transition to this phase when they have reached 80% or greater independence with implementation of intervention strategies) • 6. Follow-up: reassessment and maintenance (1 time per month for 1-3 months) • (Note: Interobserver agreement and procedural fidelity will be collected throughout all phases of the study) Research Questions Does a family-centered, multicomponent intervention package developed in conjunction with parents and/or caregivers improve the acceptance of less preferred foods and/or food groups by young children with ASD? What are the parents’ perceptions of the treatment acceptability of the intervention package? Does parents’ prior knowledge of the various components of the intervention package influence the intervention acceptability and procedural fidelity of the intervention? Implications for Occupational Therapy • Provides a comprehensive view of feeding difficulties • Recognizes the complexity of mealtime challenges • Provides possible intervention strategiesthat occupational therapists can use for children with mealtime challenges • Promotes occupation-based and family-centered practices • Encourages occupational therapists to work in the area of mealtime challenges • Fosters research in single subject research design to encourage rigorous, individualized treatment plans Research Design • Single-subject research design (multiple baseline across participants with generalization probes) • AACPDM Level of Evidence II • Pre- and post-intervention assessments References Bruns, D. A., & Thompson, S. (2011). Time to eat: Improving mealtimes of young children with autism. Young Exceptional Children, 14, 3-18. doi: 10.1177/1096250611402169 Crist, W., & Napier-Phillips, A. (2001). Mealtime behaviors of young children: A comparison of normative and clinical data. Developmental and Behavioral Pediatrics, 22(5), 279-286. NO DOI Davies, W. H., Satter, E., Berlin, K. S., Sato, A. F., Silverman, A. H., Fischer, E. A.,… & Rudolph, C. D. (2006). Reconceptualizing feeding and feeding disorders in interpersonal context: The case for a relational disorder. Journal of Family Psychology, 20, 409-417. doi: 10.1037/0893-3200.20.3.409 Field, D., Garland, M., & Williams, K. (2003). Correlates of specific childhood feeding problems. Journal of Paediatrics and Child Health, 39, 299-304. doi: 10.1046/j.1440-1754.2003.00151.x. Kerwin, M. E., Eicher, P. S., & Gelsinger, J. (2005). Parental report of eating problems and gastrointestinal symptoms in children with pervasive developmental disorders. Children's Health Care, 34(3), 221-234. doi: 10.1207/s15326888chc3403_4 Kozlowski, A. M., Matson, J. L., Belva, B., & Rieske, R. (2012). Feeding and sleeping difficulties in toddlers with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 385-390. Schreck, K. A., Williams, K., & Smith, A.F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34(4), 433-438. doi: 10.1023/B:JADD.0000037419.78531.86 Volkert, V. M. & Piazza, C. C. (2012). Pediatric feeding Disorders. Handbook of Evidence-Based Practice in Clinical Psychology, Child, and Adolescent Disorders (pp.323-337). doi: 10.1002/9781118156391.ebcp001013 Data Collection Tools • Interview and observation • Pre- and post-intervention assessments: 24-hour food recall interview, Brief Autism Mealtime Behavior Inventory (BAMBI), Behavioral Pediatrics Feeding Assessment Scale (BPFAS), Food Frequency Questionnaire, Family Quality of Life Survey, Adapted Goodness of Fit Scale, an adapted version of the Prior Knowledge Questionnaire • Child and parent target behaviors