Date Presented 03/27/20
The purpose of the study was to examine the effectiveness of a parent-mediated, in-home feeding intervention (parent-training, direct intervention, and parent coaching) over six months for families with children with ASD. The findings support preliminary evidence of the intervention at improving eating skills and mealtime behaviors in children with ASD and the need for more targeted feeding interventions for children with ASD that involve the parents within the natural context of the home.
Primary Author and Speaker: Karla Ausderau
Additional Authors and Speakers: Shannon Kant, Jessica Muesbeck, Libby Hladik, Holly Romaniak, Brittany St. John
PURPOSE: Children with autism have a high prevalence of feeding challenges that can impact their development, health, social interactions, and parent–child relationships. Current evidence-based interventions are limited and are primarily centered on the child with a focus on discrete skills such as bites acceptance, increasing general food variety, and behaviors even though the prevalence and negative effects on the family have been clearly established. The purpose of this pilot study was to assess the feasibility and effectiveness of a parent-mediated in-home feeding intervention for families with children with autism at achieving child and family mealtime goals.
DESIGN: A quasi-experimental pre- and post-test design was used to establish and measure the achievement of child eating and mealtime goals.
METHODS: Seventeen families with children with autism and feeding challenges ages 2 to 7 years participated in an in-home, parent-mediated intervention. The intervention occurred over six-months and included a combination of parent training, direct intervention, and parent coaching. Goal Attainment Scaling (GAS) T scores were calculated and used as the primary intervention outcome measure. Each family collaborated on setting three goals prior to initiation of intervention.
RESULTS: Fifteen families completed the study and reported high satisfaction with participation. Families received an average of 26 sessions that lasted on average 1 ½ hours. The majority of family goals focused on tasting new foods and expanding dietary repertoire. Goal Attainment Scaling T-scores ranged from 45.59 to 76.44. Within the sample, 78.57% (n = 11) of participants achieved higher than expected goal achievement, with T-scores from 52.2 to 76.44. Seven of these T-scores fell more than one standard deviations above the mean. One participant, 7.14% (n = 1), achieved their goals at the expected outcome with a T-score of 50. Consequently, 14.29% (n = 2), of participants had intervention outcomes as lower than expected with T-scores below 50.
Individual child goals were grouped in the following categories: tasting new foods, increasing food repertoire, increasing vegetable intake, self-help skills, behaviors, dietary/nutrition, and managing age appropriate textures. Data violated assumptions of normality, so we conducted a non-parametric Kruskal-Wallis H test to investigate if there were significant differences in GAS scores based on goal category. Using the Kruskal-Wallis H test, we did not detect a significant difference between the seven goal categories, X2(6) = 4.18, p = .65. Participants had overall better than expected outcomes for feeding and mealtime goals regardless of goal category.
CONCLUSION: Emerging evidence from the literature points to a need for more targeted feeding interventions for children with ASD that involve the parents within the natural context of the home. The study demonstrates that an in-home parent-mediated intervention may be effective at improving feeding skills in children with autism while addressing parent goals. The majority of goals for the children and families were met, with all families exceeding expectations in at least one goal area. Findings support in-home parent-mediated interventions to address feeding and mealtime challenges within the natural environment of the family’s home in an ecologically valid context. In addition, occupational therapy practitioners can use this intervention to target a variety of specific feeding and mealtime goals due to its non-discriminatory increase in goal achievement across goal categories and participants. Future research should explore the intervention in a larger randomized control sample to further validate the intervention effectiveness in a more heterogeneous sample.
References
Ausderau, K. K., St. John, B., Kwaterski, K. N., Nieuwenhuis, B., & Bradley, E. (2019). Parents’ strategies to support mealtime participation of their children with autism spectrum disorder. American Journal of Occupational Therapy, 73(1), 7301205070p1-7301205070p10. https://doi.org/10.5014/ajot.2019.024612
Curtin, C., Hubbard, K., Anderson, S. E., Mick, E., Must, A., & Bandini, L. G. (2015). Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3308-3315. doi:http://dx.doi.org/10.1007/s10803-015-2490-x
Johnson, C. R., Brown, K., Hyman, S. L., Brooks, M. M., Aponte, C., Levato, L., ... & Eng, H. (2018). Parent training for feeding problems in children with autism spectrum disorder: Initial randomized trial. Journal of Pediatric Psychology, 44(2), 164-175. https://doi.org/10.1093/jpepsy/jsy063
Marshall, J., Ware, R., Ziviani, J., Hill, R. J., & Dodrill, P. (2015). Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: A systematic review and meta-analysis. Child: Care, Health and Development, 41(2), 278-302. doi:http://dx.doi.org/10.1111/cch.12157
