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Feeding Intervention in Children with ASD.

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Ashley Armstrong

on 5 March 2014

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Transcript of Feeding Intervention in Children with ASD.

Feeding Intervention in Children with Autism Spectrum Disorder
Typical Issues:
Food Selectivity:
Beware of Fad Treatments
Fad treatments are primary based on pseudoscience & anti-science (faith-driven)
Usually have scientific sounding words and make statements claiming success
Promoted in the media and on the internet
Some truth in the rationale - enough for parents to "buy in"
Feeding problems among children with developmental disabilities range from 13-80%
Children with ASD reportedly eat less foods from each food group than their typically developing peers.
Children whose eating is restricted can have malnutrition, dehydration, and similar health concerns

Children with ASD generally show similar preferences for food by:
Type: starches
Texture: pureed, low texture
Color: only yellow foods
Packaging & Presentation: specific utensils and plates, sitting at a specific spot, no foods touching
Based on Pseudoscience:
Chelation therapy
Lupron therapy
Hyperbaric Oxygen Therapy (HBOT)
Secretin Injections
Antifungal Agent therapy

Other unconventional methods:
Raw Camel Milk therapy
Vitamin therapy
Marijuana therapy
Bleach therapy
Restrictive Diets
Gluten-Free & Casein-Free:
claim that children with autism have "leaky guts" that allow opioids to escape into the bloodstream and then travel to the brain and cause autistic behaviors

Recommended Treatments:
The treatments from the Sharp et al., (2011) study showed:
Increases in consumption & variety of foods.
Decreases in inappropriate behaviors during mealtime.

The approaches Sharp et al., (2011) used were:
Escape Extinction (EE):
Non Contingent Access (NCA):
Differential Reinforcement (DRA):
Stimulus Fading (SF):
Effectiveness of Treatments:
How can this be used within the Classroom?
The Sharp et al., (2011) study was able to train caregivers on how to use the methods at home, and from follow up reports claim to be successful year later.

Teaching Assistants (TA) could be trained on how to use these methods.
This would help keep consistency between home and school environments.
Allow children with ASD to have a successful mealtime at school.
Have the opportunity to form new relationships with peers; because inappropriate behaviors are reduced & are able to eat a more variety of foods.
Why is Intervention Important?

Escape Extinction (EE):
Non Contingent Access (NCA):
Differential Reinforcement (DRA):
Stimulus Fading (SF):
Recommended Daily Intake from Canada's Food Guide:
In the Sharp et al., (2011) study, the median number of foods consumed by the sample was 3.
This was a severe case, as the participants were referred by professionals for feeding treatment; nonetheless, an example of a very restricted diet.
Google search resulted in:
Occurs when the child does not get to avoid or escape a non-preferred task or person.

Most methods involve non-removal of the spoon, additional components may be used to target more persistent refusal behavior (e.g., arm holding or mouth opening).
Occurs when you introduce the child to a reinforcement (e.g., being able to play with a favorite toy) after the child performs the behavior you are looking to accomplish.

Aims to increase appropriate feeding habits (e.g., swallowing foods they do not want to eat) by giving the child a preferred incentive afterward.
Challenges Faced During Mealtime
Children with Autism Spectrum Disorders consume fewer amounts of food, and a less variety of food.
Researchers have linked food selectivity with low intake of Vitamin D, Vitamin A, Vitamin C, Iron, and fat.
Recent research has also suggested restricted diets can affect bone development, especially those following a gluten-free diet.
Disruptive eating behaviors inhibits opportunities to form & maintain relationships.
Food selectivity restricts opportunities for vacations, play-dates, dinning out at restaurants, eating at school etc.
Social Aspect:
Occurs when the child is given access to preferred tangible objects as well as positive reinforcement at all times during feeding.

Enriched environment = reduced problem behaviors
No "reinforcement" taking place because of constant reward. May undermine other approaches such as Escape Extinction.
Occurs when a child is gradually exposed to previously adverse stimuli (non-preferred foods)
Movement through the steps determined by child reaching set benchmarks

Variety Fading (4PF:1NPF)
Texture Fading
Bolus Fading
Children with ASD are at risk for nutritional deficits, therefore the development and evaluation of treatments is needed to increase variety and consumption.
In the Sharp et al., (2011) study, 11 out of 13 families indicated that they were extremely satisfied with the treatment.
Caregivers indicated there was a positive change in mealtime behavior.
The families also viewed the treatment as an appropriate method to address their child's feeding difficulties.
Sharp et al, (2011) found that even a year later, mealtime performance either remained stable or improved after completion of the treatment.

Before treatment the median number of foods consumed by the group was 3, after treatment it was 19.
The foods consumed were also evenly distributed throughout four food groups: fruits, vegetables, proteins & starches.

The Sharp et al., (2011) study was a severe case, with children eating on average 3 foods, whereas other studies have shown an average of 15 foods. Are the methods used in this study too drastic for some children? How far is too far to get a child with severe food selectivity to eat?
"Jayden" & "Brendan"
Have you had experience or know of children with ASD that display food selectivity or behavioral problems when eating? Do you think these methods would be helpful or unhelpful? Why?
Autism Recovered?!
Results from the Sharp et al., (2011) study:

For those of you who have experienced the challenges faced during mealtime, what methods have you tried? Do these methods work?


For those of you who haven't, do you have any ideas for methods that might work that haven't been discussed?
Reference List:
Knox, M., Rue, H. C., Wildenger L., Lamb, K., & Luiselli, J. K., (2014). Intervention for food selectivity in a specialized school setting: Teacher implemented prompting, reinforcement, and demand fading for an adolescent student with autism.
Education & Treatment of Children
, 35(3), 407-417.

Ledford, J. & Gast, D. (2006). Feeding Problems in Children With Autism Spectrum Disorders: A Review. Focus on Autism and other Developmental Disabilities,
Focus on Autism and Other Developmental Disabilities
, 21(3), 153-166.

Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism.
Journal of autism and developmental disorders
, 34(4), 433-438.

Sharp, W., Jaquess, D., Morton, J., & Miles, A., (2011). A retrospective chart review of dietary diversity and feeding behavior of children with autism spectrum disorder before and after admission to a day-treatment program.
Hammill Institute on Disabilities
, 26(1), 37-48.

Still want more information?
Visit "The Scott Center" website: http://www.thescottcenter.org/ for more information on feeding methods for children with ASD.
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