Snack Time Intervention for Preschoolers With Autism Spectrum Disorder: Fun and Function

BACKGROUND AND PURPOSE: Children with autism spectrum disorder (ASD) often have selective eating behaviors that may potentially lead to nutritional deficit (Zimmer et al., 2012), disruption of family mealtime, parental stress, and long-term behavioral issues (Johnson et al., 2014). Between 50% and 90% of children with ASD experience eating difficulties, such as food selectivity (Sharp et al., 2013). Additionally, children with ASD have difficulty generalizing skills learned in therapy sessions to the home environment.

A group-based snack time intervention offers a positive environment to provide opportunities to improve food selectivity. The authors developed and tested a manualized, group-based, snack time intervention to promote food exploration and eating in children with ASD. Additionally, this protocol had a strong emphasis on caregiver training to promote generalization to the home environment. The research question was, Does a manualized, group-based snack time intervention improve eating behaviors in young children with ASD?

METHOD: This single-group, pre–post design included 12 children, ages 3–6 yr, diagnosed with ASD. Children and caregivers were recruited to participate through flyers posted at a Midwestern institution. An interdisciplinary team of occupational therapists, graduate students, and nurse practitioners provided a snack time intervention in small groups, with 2–5 children in each group, biweekly for 8 wk. This intervention combined environmental arrangement, child-centered play, responsiveness, scaffolding, modeling, and encouragement of peer interaction. A combination of three to six familiar and novel healthy foods were offered at each session.

Statistical analysis included descriptive statistics for number of foods eaten and Wilcoxon signed-rank test to analyze the parent questionnaires. Data from the Food Frequency Questionnaire and the Brief Assessment of Mealtime Behavior in Children were collected from parents before and after intervention. Additional data included number of new foods eaten at snack time and at home and qualitative data from parents regarding strategies used at home that were introduced during the intervention (e.g., visual supports, sensory activities prior to eating). Videos of each session were analyzed by two independent raters using 30-s interval scoring for food-related behaviors. Video data were graphed and visually analyzed to determine differences in eating behaviors during the intervention.

RESULTS: Results from this pilot study indicate that the median for total new foods tried during the intervention was 10.50 (range = 2–18) for total new foods tried during the intervention and 3.00 (range = 0–7) for new foods tried at home. Forty-one percent of participants showed improved mealtime behaviors at home (e.g., less screaming, less turning their face or body away from food, more remaining seated until mealtime was over) following the intervention. Finally, there was a trend toward offering more vegetables and grains postintervention than preintervention.

CONCLUSION: Children with ASD ages 3–6 yr and their caregivers may benefit from a group-based snack time intervention. Additional studies are needed with a bigger sample size to generalize the findings from this pilot study.

IMPACT STATEMENT: This manualized, group-based intervention showed positive changes in children’s food intake and mealtime behaviors at home and during the intervention. Additionally, the caregivers reported that they were able to use some of the strategies taught during the intervention at home.

References

Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 739–747. https://doi.org/10.1007/s10803-007-0441-x

Johnson, C. R., Turner, K., Stewart, P. A., Schmidt, B., Shui, A., Macklin, E., . . . Hyman, S. L. (2014). Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. Journal of Autism and Developmental Disorders, 44, 1–10. https://doi.org/10.1007/s10803-014-2095-9

Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., . . . Jaquess, D. L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis. Journal of Autism and Developmental Disorders, 43, 2159–2173. https://doi.org/10.1007/s10803-013-1771-5

Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42, 549–556. https://doi.org/10.1007/s10803-011-1268-z