Use of Props During Mealtime for Children With Autism Spectrum Disorder: Self-Regulation and Reinforcement

PURPOSE: Mealtime is an important family routine for families with children with autism spectrum disorder (ASD). Benefits of eating together during family mealtime include expanded language development, improved social skills, and increased academic success for children. Feeding challenges including food selectivity, sensory sensitivity, and behavior problems are estimated to occur in up to 89% of children with ASD. Disrupted mealtime participation experienced by families with children with ASD and associated feeding challenges place mealtime benefits at risk. Limited research is available regarding strategies or tools families incorporate to support mealtime engagement. The purpose of this study was to explore the frequency and characterize the purpose of tools (props) used during mealtimes with children with ASD.

METHOD: A descriptive study design was used to identify whether and how parents were using tools (props) during mealtime. For the purpose of this study, a prop was any object, typically a child-friendly item or a common household or child object, used during mealtime by the child and/or caregiver. Participants were recruited through a local research registry and local clinics. Families had to have a child aged 2–7 yr with caregiver-reported feeding challenges and a diagnosis of ASD confirmed by a community provider. Children with co-occurring diagnoses such as significant primary sensory impairments, physical disabilities, or genetic disorders were excluded.

One or two mealtime observations were video recorded in the homes of participants during typical mealtimes as defined by each family. Two independent coders analyzed mealtime videos for the frequency of use and purpose of props. Thematic analysis was used to identify the purpose of the props.

RESULTS: Twelve families with a child with ASD and feeding difficulties participated in the study. Two coders analyzed 17 mealtime videos. Props were used in more than half of the family mealtimes. Common props included toys, pacifiers, blankets, and books. Most commonly, props were used to support a child’s behavioral or sensory regulation throughout the mealtime experience. A distinction was not made between behavior and sensory regulation. Rather, regulation was considered to be an overarching purpose, encompassing both sensory and behavioral components. Props were also used as an incentive to reinforce a positive eating or mealtime behavior, although this use was observed in a minority of videos. At times, prop use was seamlessly integrated and at other times more contrived as potentially part of a previous therapeutic experience. The goal of the prop often appeared to be closely related to staying at the table or managing behaviors versus expanding a child’s diet or eating of nonpreferred foods.

CONCLUSION: Families with children with ASD integrate props into the context of family mealtime as a way to support mealtime participation. In this study, props were used to promote a child’s participation in family mealtime by supporting the regulation of the child or providing behavioral reinforcement. The effectiveness of prop use during mealtime could not be determined within the context of the current study but would be important to consider in future studies.

IMPACT STATEMENT: Occupational therapy practitioners should consider the use of props as individualized, accessible, and supportive mealtime interventions for families and children. Practitioners may serve an important role in determining whether the use of toys or manipulatives during mealtime is effective for a child or would align with a family’s mealtime practices.

References

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Johnson, C. R., Turner, K., Stewart, P. A., Schmidt, B., Shui, A., Macklin, E., . . . Courtney, P. M. (2014). Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. Journal of Autism and Developmental Disorders, 44, 2175–2184. https://doi.org/10.1007/s10803-014-2095-9

Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities, 21, 153–166. https://doi.org/10.1177/10883576060210030401

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