Abstract
This is a case study of a seven year old attending sessions once a week for six weeks with play in a nonpreferred wet food item followed by the presentation of the same wet food for eating using the Sequential Oral Sensory (SOS) approach. Data was collected by coding the SOS hierarchy steps, and results showed the child increased the variety of novel foods in the diet, decreased negative behaviors at mealtime, and accepted the nonpreferred wet food at home closer to the times of direct intervention.
Primary Author and Speaker: Julia Hawkins
Contributing Authors: Bridget Burnett, Julia Corello, Kaitlyn Heath, Abigail Schmidt, Chelsea Scott, David Prier, Alexis Ishman
The Sequential Oral Sensory (SOS) approach, developed by Kay Toomey, uses a hierarchy to guide a child to eat non-preferred foods (Benson, Parke, Gannon & Munoz, 2013) and was used to track child progress with moving towards eating aversive wet foods in this study. Currently, there are few studies which have shown the effectiveness of the SOS approach. The purpose of this study was to determine the effectiveness of tactile play in a non-preferred wet food item using the SOS approach in order to increase oral intake of non-preferred wet foods in children who experience sensory aversions. This case report enrolled a seven year old that attended six OT treatment sessions, one hour in length for six weeks. The child did not have dairy, fruit or vegetable allergies nor a history of aspiration or penetration of food/liquids. The SOS intervention was designed to encourage the use of the hands to manipulate wet food items in order to increase acceptance of wet food items placed in the mouth. The study used a quasi-experimental design with the non-preferred wet food item as the independent variable and the number of times the child initiated contact with the wet food item as the dependent variable. The OT sessions began with 15 minutes of play in a non-preferred wet food item, then 15 minutes of cuing the child to progress through the SOS hierarchy to facilitate eating. Then, free play was provided for 15 minutes if the child progressed on the SOS hierarchy from the previous session. The last 15 minutes of the session included caregiver training on the use of the hierarchy at home. The caregiver completed a family information questionnaire at session 1 and 6 that included medical, feeding and mealtime behavior history. Quantitative data was collected using the SOS hierarchy that reflected how often the child came in contact with the food item through a score of 1 (tolerating food in room), 14 (touch food to lips) and 23 (swallowing food). Qualitative data was collected via scribing observations and quotes collected during direct intervention. The carryover data from the home caregiver was provided inconsistently. Data from each session and from weekly home tracking was analyzed using the Wilcoxon Signed Rank Test and themes were identified throughout the qualitative data to compare if the child improved on the SOS hierarchy from the initial visit with acceptance of the aversive wet food. The child reached the highest score on the home hierarchy closest to direct intervention. The child increased oral acceptance of the non-preferred wet food item over the span of week’s two to six of direct OT sessions. Though inconsistently provided, data from the caregiver which included SOS hierarchy forms, revealed that the caregiver had increased success with carryover closest to direct OT sessions. After each OT treatment session, the child averaged an increase of 3.58 points on the SOS hierarchy with increased success. The child reached the highest level on the hierarchy five out of six times in sessions. Qualitative findings express that the intervention was effective in decreasing negative mealtime behaviors (removing food from mouth and refusing to swallow) through the use of food chaining and reward.The results of this case study provide preliminary evidence that use of the SOS protocol may impact the feeding behaviors of a child who demonstrates food refusals. Although the results cannot be generalized to a wider population, the result may inform future studies using the SOS program which is widely used by OT practitioners. OT practitioners working with children with aversions to wet foods should consider interventions that include play in non-preferred wet food items prior to facilitating eating of the same foods during treatment sessions.
Benson, J., Parke, C., Gannon, C., & Munoz, D. (2013). A retrospective analysis of the sequential oral sensory approach in children in feeding difficulties. Journal of Occupational Therapy, Schools, & Early Intervention, 6(4). doi: 10.1080/19411243.2013.860758
Howe, T. H., & Wang, T. N. (2013). Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties ages birth- 5 years. American Journal of Occupational Therapy, 67, 405-412. doi: 105014/ajot.2013.004564
Peterson, K. M., Piazza, C. C., & Volkert, V. M. (2016). A comparison of a modified sequential oral sensory approach to an applied behavior-analytic approach in the treatment of food selectivity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 49(3), 485-511. doi: 10.1002/jaba.332
SOS Approach to Feeding. (2017). Retrieved from http://sosapproach-conferences.com/about-us/the-sos-approach/