An Analysis of Parents’ Descriptions of Feeding Strategies Used for Children With Autism Spectrum Disorder

PURPOSE: Between 46% and 89% of children with autism spectrum disorder (ASD) demonstrate problem feeding behaviors such as aversive and restrictive eating-related behaviors (Matson, Fodstad, & Dempsey, 2009). Feeding difficulties are often inadequately addressed due to difficulties ranging from the lack of identification of feeding problems to deficiencies in supportive services (Matson et al., 2009; Rogers, Magill-Evans, & Rempel, 2012).

The purpose of this study is to guide and improve occupational therapy practice by understanding parents’ feeding experiences. Our research question is: What feeding strategies do parents use with their children with ASD, and did they learn those strategies on their own or from a therapist? Comparing feeding strategies that parents have learned from therapists to strategies they have developed on their own provides insight into the need to address feeding as an occupation.

METHOD: This study incorporates the qualitative analysis of open ended questions asked on a questionnaire sent out to parents of children with ASD that currently had an Autism Diagnostic Observation Schedule on file at an autism treatment network site. The children were ages 5–13 yr with a mean age of 9.5 (SD = 2.5), and 81% were male. Respondents included 113 parents (90% female) with a mean age of 39.9 yr (SD = 6.8).

The data from this study were collected from two questions: (1) What feeding strategies do you use that you have learned from a therapist? (2) What feeding strategies do you use that you developed on your own? For both questions, “therapist” did not just include occupational therapists but was described as “any professional that may have worked on eating behaviors with your child.” The data were coded by two researchers familiar with feeding issues. The researchers met and developed one codebook for the two questions. In order to determine reliability of the codebook, researchers then separately coded the data with an unweighted kappa (κ = .81).

RESULTS: The themes for strategies that parents used followed by percent learned from therapists are desensitization and behavior strategies (49.2% from therapists); focusing on the food, including calories and nutrition or altering the food (26.3% from therapists); following the child’s lead, including giving the child what he or she wants and attempting to not make feeding an issue (0% from therapists); altering the home or mealtime environment (21.4% from therapists); and a lack of strategies because strategies both did not work and were not needed (88.9% from therapists).

CONCLUSION: This paper demonstrates feeding strategies that parents both learned from therapists and developed on their own. Parents demonstrated that therapists taught them feeding strategies around components of feeding including desensitization and addressing behaviors. On their own they developed strategies specifically geared toward the occupation of feeding such as altering the home and mealtime environment or following the child’s lead. This study demonstrates the demand for a top-down occupational approach to feeding issues.

References

Matson, J. L., Fodstad, J. C., & Dempsey, T. (2009). The relationship of children’s feeding problems to core symptoms of autism and PDD–NOS. Research in Autism Spectrum Disorders, 3, 759–766. https://doi.org/10.1016/j.rasd.2009.02.005

Rogers, L. G., Magill-Evans, J., & Rempel, G. R. (2012). Mothers’ challenges in feeding their children with autism spectrum disorder—Managing more than just picky eating. Journal of Developmental and Physical Disabilities, 24, 19–33. https://doi.org/10.1007/s10882-011-9252-2