Date Presented 3/31/2017
A systematic review was conducted to assess effectiveness of feeding and mealtime interventions implemented in natural contexts and relevant to occupational therapy for children with autism spectrum disorder. Research studies were vigorously evaluated for quality and effectiveness of interventions.
Primary Author and Speaker: Julie Diaz
Additional Authors and Speakers: Joanna Cosbey
PURPOSE AND BACKGROUND: The purpose of this systematic review is to address the American Occupational Therapy Association research priority of family and caregiver needs by identifying and analyzing the evidence for feeding and mealtime behavior interventions for children with ASD. Children with ASD frequently have difficulties with mealtime occupations, which can directly impact the health and well-being of the child and the family’s co-occupation of sharing meals together. The unique expertise of occupational therapy practitioners can support families as they develop meaningful mealtime experiences. Unfortunately, most of the research in this area has occurred in a clinical setting with therapists as interventionists. Parent involvement in the home promotes carryover of skills outside of intervention. This review fills the gap related to analyzing evidence-based practices relevant to occupational therapy and feeding interventions specifically (1) for children with ASD, (2) in the natural contexts, and (3) with the parents or caregivers as interventionists.
DESIGN: A systematic review was conducted to identify published interventions that fall within the occupational therapy scope of practice and occur in natural settings and contexts. Fifteen articles met the initial criteria for the review, all using single-case experimental design methodology.
METHOD: This review included a rigorous database search. Each article was reviewed for quality of research design using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) level-of-evidence ratings for single-case experimental design, quality indicators for single-subject research, and SCRIBE guidelines. Each article was also evaluated for the practicality of implementation of the intervention through an adapted FAME scale.
RESULTS: According to the AACPDM, the articles reviewed had levels of evidence ranging from Level II to Level V with some generalizability. The quality indicators and SCRIBE scales ranged from 25 to 42 points out of 46 points. The interventions were rated to be moderately to clearly practical and appropriate for occupational therapy practitioners using the FAME.
CONCLUSION: Several high-quality studies that included generalizability and rated as practical for implementation were identified. The interventions in these studies included mostly behavioral strategies, including reinforcement, escape extinction, demand fading, behavioral momentum, and peer modeling. Although only one study was conducted by an occupational therapist (OT), the other interventions are consistent with our scope of practice and could be facilitated by an OT for parent implementation with little training.
IMPACT STATEMENT: This project analyzes the research on contextually based services to children with ASD during mealtimes. It identifies evidence-based practices and provides direction for OTs to select feeding interventions for children with ASD to support the families within the natural co-occupation of mealtimes.
