A Systematic Review of Caregiver-Implemented Mealtime Interventions for Children With Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) frequently have difficult mealtimes. A systematic review analyzed current evidence relevant to occupational therapy (OT) and mealtime interventions (a) for children with ASD, (b) occurring in the natural contexts, and (c) with parents/caregivers as interventionists. Database search identified 13 relevant articles. Each article was reviewed for practicality of implementation through a modified Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) scale and for quality of research design using three measures specifically designed for single-case experimental design research. The majority of articles reviewed demonstrated rigorous research design with strong evidence for the effectiveness of caregiver-implemented interventions. Six intervention techniques were identified, with all studies using a reinforcement strategy and at least one other technique. This review identifies evidence-based practices for OTs to support children with ASD and their families within the natural co-occupation of mealtimes. Effective techniques and recommendations for practice are included.

A Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors in Children With ASD: Report of Follow-Up Data on a Train-the-Trainer Model Using EAT-UP.

Purpose: This research note outlines the usefulness of Easing Anxiety Together with Understanding and Perseverance (EAT-UP), a train-the-trainer, family-centered feeding intervention, for promoting food acceptance of children with autism spectrum disorder (ASD). This report is a follow-up on a pilot study (n = 4) of the EAT-UP intervention previously completed by the same authors. Method: Participants were 3 families of children with ASD receiving services from an outpatient department of a larger rehabilitation hospital in the northeastern United States. Three professionals working with the families were also recruited and trained by the first author, a speech-language pathologist experienced with the EAT-UP method. Initial assessment was followed by a baseline period for each participant. An individual mealtime plan was drafted for each family. Data on acceptance of less preferred food and the presence of challenging mealtime behaviors were recorded using direct observation and pre-, mid-, and postintervention measures and questionnaires. Results: All children demonstrated increased food acceptance and dietary diversity and decreased challenging behaviors. Caregivers reported decreases in the frequency of problem behaviors and in the number of problem mealtime behaviors. Measures of procedural fidelity increased from 50% to 100% for registered behavior technicians and parents over the course of the EAT-UP intervention period. Conclusions: EAT-UP is an effective model for training professionals who work with families of children with ASD and challenging mealtime behavior. Implications for interprofessional practice and research are discussed.

EAT-UP™ Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors: A Single-Case Experimental Design Replicated Across Three Families of Children with Autism Spectrum Disorder.

This study evaluated the effectiveness of a family-centered feeding intervention, Easing Anxiety Together with Understanding and Perseverance (EAT-UP™), for promoting food acceptance of children with autism spectrum disorder at home. A concurrent multiple-baseline design was used with systematic replication across three families. Baseline was followed by an 'Intervention-Coaching' phase and then an 'Intervention-Independent' phase. Using direct observation and pre- and post-intervention questionnaires, data on acceptance of less preferred foods and challenging mealtime behaviors were collected. Procedural fidelity was monitored throughout all study phases. Data were analyzed using visual analysis and measures of effect size. All children demonstrated increases in food acceptance (effect size >0.90) and dietary diversity and decreased challenging behaviors. Implications for practice and research are discussed.

Sensory processing disorders and social participation.

Participation in social aspects of daily life is crucial to children's development. Although disability status is recognized to affect children's ability to participate in social activities, little is understood about the impact of sensory processing disorders (SPD) on children's social participation. We examined the social participation patterns of 2 groups of children (ages 6-9): (1) children with SPD and (2) their typically developing peers. All children participated in a structured interview to report their social participation patterns, including activity patterns and social networks. We used parent and teacher questionnaires to triangulate the data gathered from the children. Results revealed that the 2 groups of children demonstrated generally similar patterns of activity preferences and use of free time but had significant differences in areas related to intensity and enjoyment of involvement and in their social networks. Implications for future research and interventions are discussed.