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Nickless T, Davidson B, Finch S, Gold L, Dowell R. Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists. HEALTH POLICY OPEN 2024; 6:100117. [PMID: 38510780 PMCID: PMC10950885 DOI: 10.1016/j.hpopen.2024.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare's Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare's Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.
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Affiliation(s)
- T. Nickless
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
- Word By Mouth Speech Pathology, Melbourne, Australia
| | - B. Davidson
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
| | - S. Finch
- Statistical Consulting Centre, The University of Melbourne, Australia
| | - L. Gold
- Deakin Health Economics, School of Health & Social Development, Deakin University, Australia
| | - R. Dowell
- Department of Audiology & Speech Pathology, The University of Melbourne, Australia
- The Royal Victorian Eye & Ear Hospital, Melbourne, Australia
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Yang Y, Chen D, Cai K, Zhu L, Shi Y, Dong X, Sun Z, Qiao Z, Yang Y, Zhang W, Mao H, Chen A. Effects of mini-basketball training program on social communication impairments and regional homogeneity of brain functions in preschool children with autism spectrum disorder. BMC Sports Sci Med Rehabil 2024; 16:92. [PMID: 38659073 PMCID: PMC11040976 DOI: 10.1186/s13102-024-00885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Social communication impairments (SCI) is a core symptom of autism spectrum disorder (ASD) and is marked by challenges in social interaction. Although physical exercise has been shown to improve SCI, this finding has not been supported by comprehensive scientific evidence. Existing research has established a strong link between the SCI in children with ASD and abnormalities in regional homogeneity (ReHo). Therefore, investigating the effects of physical exercise on SCI and Reho in patients with ASD may help to elucidate the neurological mechanisms involved. METHODS The present study included 30 preschool children diagnosed with ASD, with 15 participants in each group (experimental and control). The experimental group underwent a 12-week mini-basketball training program (MBTP) based on routine behavioral rehabilitation, while the control group only received routine behavioral rehabilitation. The Social Responsiveness Scale-Second Edition (SRS-2) was employed to assess SCI in both groups. Resting-state functional magnetic resonance imaging technology was used to evaluate ReHo in both groups. RESULTS After 12-week of MBTP, significant group × time interactions were observed between the experimental and control groups in total SRS-2 scores (F = 14.514, p < 0.001, ηp2 = 0.341), as well as in the domains of social cognition (F = 15.620, p < 0.001, ηp2 = 0.358), social communication (F = 12.460, p < 0.01, ηp2 = 0.308), and autistic mannerisms (F = 9.970, p < 0.01, ηp2 = 0.263). No statistical difference was found in the scores for the social awareness subscale and social motivation subscale in the group × time interaction (all p > 0.05). The experimental group exhibited increased ReHo in the right Cerebellum_Crus1 and right parahippocampal gyrus, coupled with decreased ReHo in the left middle frontal gyrus (orbital part), left superior frontal gyrus (dorsolateral), left postcentral gyrus, and right superior parietal gyrus. Furthermore, a decrease in ReHo in the left postcentral gyrus positively correlated with changes in social communication scores in SCI behaviors (p < 0.05). CONCLUSIONS Our study underscores the effectiveness of a 12-week MBTP in ameliorating SCI and abnormalities in ReHo among preschool children with ASD. TRIAL REGISTRATION The trial is retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR1900024973; August 5, 2019).
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Affiliation(s)
- Yang Yang
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Dandan Chen
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Kelong Cai
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Lina Zhu
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yifan Shi
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiaoxiao Dong
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhiyuan Sun
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhiyuan Qiao
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yahui Yang
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Weike Zhang
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Haiyong Mao
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
| | - Aiguo Chen
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China.
- Nanjing Sport Institute, Nanjing, Jiangsu, China.
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Blaess M, Eliot K. A Framework for RDN and SLP Collaboration: A Missing Piece in Autism Spectrum Disorder Treatment. J Acad Nutr Diet 2024:S2212-2672(24)00161-8. [PMID: 38615995 DOI: 10.1016/j.jand.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Martha Blaess
- Department of Nutrition and Dietetics, Department of Speech, Language, and Hearing Sciences, Saint Louis University, Saint Louis, MO.
| | - Kathrin Eliot
- Department of Nutritional Sciences, The University of Oklahoma Health Sciences, Oklahoma City, OK
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Breda C, Santero S, Conti MV, Cena H. Programmes to manage food selectivity in individuals with autism spectrum disorder. Nutr Res Rev 2024:1-14. [PMID: 38385245 DOI: 10.1017/s0954422424000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders characterised by impaired social communication and restricted interests/repetitive behaviours. In this regard, sensory processing difficulties and delayed oral motor skills often predispose individuals with ASD to food selectivity (FS). It is usually associated with repetitive eating patterns that can lead to multiple malnutrition conditions. The objective of this narrative review is to present an overview about the existing nutritional interventions aiming at promoting a healthy eating pattern and addressing food selectivity among individuals with ASD. Regarding the interventions targeting nutrition education, the majority of the analysed studies failed to demonstrate their effectiveness. On the other hand, many educational interventions involving taste or cooking sessions, as well as behavioural interventions for FS, demonstrated effective results. Moreover, multidisciplinary in tailoring such programmes, including psychology speech therapy and nutritional skills, is acknowledged as a key approach.
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Affiliation(s)
- Chiara Breda
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Sara Santero
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Maria Vittoria Conti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
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Chung KM, Chung E, Lee H. Behavioral Interventions for Autism Spectrum Disorder: A Brief Review and Guidelines With a Specific Focus on Applied Behavior Analysis. Soa Chongsonyon Chongsin Uihak 2024; 35:29-38. [PMID: 38204739 PMCID: PMC10774556 DOI: 10.5765/jkacap.230019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
We conducted a comprehensive review of behavioral and educational interventions for individuals with autism spectrum disorder (ASD). The most prominent type of intervention, Comprehensive Early Intervention, often referred to as Early Intensive Behavioral Intervention (EIBI), has been found to be particularly effective in improving intelligence and adaptive behaviors. The naturalistic developmental behavioral intervention, designed to enhance social and communication abilities, showed effectiveness in improving language, cognitive function, and social initiation. However, more studies are needed to examine its effectiveness. Intensive individualized intervention, which provides a tailored intervention for a specific target behavior, was effective in improving social skills and communication, as well as reducing sleep, eating, and toileting problems. Cognitive behavioral therapy (CBT) is the most effective method for dealing with emotional difficulties, but it has not been widely used because of the shortage of trained experts. Parent-mediated intervention (PMI) involves parents acquiring knowledge and specific skills to improve their child's functioning or reduce challenging behaviors. Speech and language therapy, sensory integration, Treatment and Education of Autistic and related Communications Handicapped Children, developmental approaches, and social stories are frequently used interventions. However, evidence of their effectiveness has yet to be well established. Based on these findings, intervention recommendations for autism include EIBI, Early Start Denver Model, intensive individualized intervention, CBT, and PMI. The choice of intervention should be tailored to the individual's needs and delivered by qualified professionals with expertise in the specific intervention.
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Affiliation(s)
- Kyong-Mee Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Eunsun Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Hoomyung Lee
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
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Craig F, DE Giacomo A, Operto FF, Margari M, Trabacca A, Margari L. Association between feeding/mealtime behavior problems and internalizing/externalizing problems in autism spectrum disorder, other neurodevelopmental disorders and typically developing children. Minerva Pediatr (Torino) 2023; 75:536-543. [PMID: 30761818 DOI: 10.23736/s2724-5276.19.05371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND The aim of current study was to examine the nature and prevalence of feeding problems and mealtime behavior problems in children with autism spectrum disorder (ASD) comparing to children with other neurodevelopmental disorders (NNDs) and TD children. We also investigated the impact of intelligence quotient (IQ) and/or emotional and behavioral problems on feeding and mealtime behavior problems. METHODS Participants completed the following tests: Social Communication Questionnaire (SCQ), Child Behavior Checklist (CBCL), Brief Autism Mealtime Behavior Inventory (BAMBI) and Behavioral Pediatric Feeding Assessment Scale (BPFAS). RESULTS Children with ASD showed more feeding and mealtime behavior problems including food refusal (P<0.001, P<0.001) and limited variety of foods (P=0.014; P=0.018) compared with NDDs and TD children. ASD group showed more problems in mealtime behavior (P=0.034) and parent behaviors (P=0.028) compared to TD group. Internalizing (P=0.003) and externalizing (P=0.008) problems were positively related to parent frustration during mealtime in ASD group. CONCLUSIONS These results suggest that routine screening for feeding and mealtime behavior problems among children with ASD is necessary to prevent dietary inadequacies that may be associated with eating habits.
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Affiliation(s)
- Francesco Craig
- Unit for Severe Disabilities in Developmental Age and Young Adults, IRCCS Eugenio Medea, Brindisi, Italy
| | - Andrea DE Giacomo
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesca F Operto
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mariella Margari
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Trabacca
- Unit for Severe Disabilities in Developmental Age and Young Adults, IRCCS Eugenio Medea, Brindisi, Italy -
| | - Lucia Margari
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Hodges AK, Hathaway KL, McMahon MXH, Volkert VM, Sharp WG. Treatment of Feeding Concerns in Children With Autism Spectrum Disorder: A Systematic Review of Behavioral Interventions With Caregiver Training. Behav Modif 2022:1454455221137328. [DOI: 10.1177/01454455221137328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Successful feeding intervention ultimately requires generalization and adoption of treatment into the home. Treatment models, however, differ regarding how and when caregivers are integrated into care delivery process. Some treatments involve a primary model of parent training with caregivers serving as co-therapist at the onset of intervention, while others involve a complimentary model where a therapist delivers the intervention and caregiver training occurs once the child’s behavior is stable. This review systematically evaluates the evidence-base regarding behavioral feeding intervention for children with autism spectrum disorder (ASD), with a specific focus on interventions involving parent training. Results provide further evidence regarding the potential benefits of behavioral intervention to improve feeding concerns in ASD, while also highlighting growing attention to documenting and/or evaluating parent training within the treatment literature. Important questions remain regarding factors guiding the use of a primary or complimentary model of parent training.
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Affiliation(s)
- Abby K. Hodges
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Kristin L. Hathaway
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Meara X. H. McMahon
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Valerie M. Volkert
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - William G. Sharp
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
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8
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Elsayed HE, Thompson KL, Conklin JL, Watson LR. Systematic Review of the Relation Between Feeding Problems and Sensory Processing in Children With Autism Spectrum Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2875-2899. [PMID: 36356224 DOI: 10.1044/2022_ajslp-21-00401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Many studies have linked sensory sensitivities to feeding problems in children with autism spectrum disorder (ASD). Despite the importance of sensory processing for a variety of mealtime and eating skills, the specific sensory processes that may impact feeding problems in children with ASD have not been comprehensively reviewed. Thus, the goal of this systematic review was to understand the associations between sensory processing and feeding difficulties in children with ASD. METHOD This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, CINAHL Plus with Full Text (EBSCOhost), Scopus (Elsevier), and Embase (Elsevier) databases were searched from their dates of inception through the final search date of April 19, 2022, for English language studies that examined both sensory processing and feeding among children with ASD. Studies were assessed for quality using the Joanna Briggs Institute critical appraisal tools. RESULTS A total of 27 studies were included. Findings supported the existence of a relationship between sensory processing and feeding problems in children with ASD. Specifically, studies reported that overall scores on sensory processing measures as well as measures of oral sensory processing were frequently associated with feeding problems. CONCLUSIONS This review supports the development of future feeding interventions focusing on sensory processing given the relationship between sensory processing and feeding problems among children with ASD. Future research should focus on utilizing consistent feeding assessments specific to children with ASD and collect information on medical diagnoses that can impact feeding in order to report on feeding more holistically in this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21453909.
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Affiliation(s)
- Heba E Elsayed
- Kessler Foundation, East Hanover, NJ
- Rutgers New Jersey Medical School, Newark
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Kelsey L Thompson
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill
| | - Linda R Watson
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Thorsteinsdottir S, Njardvik U, Bjarnason R, Olafsdottir AS. Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial. Nutrients 2022; 14:4000. [PMID: 36235654 PMCID: PMC9571701 DOI: 10.3390/nu14194000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
| | - Urdur Njardvik
- Faculty of Psychology, School of Health Sciences, University of Iceland, Saemundargata 12, 102 Reykjavik, Iceland
| | - Ragnar Bjarnason
- Faculty of Medicine, School of Health Sciences, University of Iceland, Laeknagardur 4th Floor, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland
- Department of Pediatrics, National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
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Taylor H, Pennington L, Morris C, Craig D, McConachie H, Cadwgan J, Sellers D, Andrew M, Smith J, Garland D, McColl E, Buswell C, Thomas J, Colver A, Parr J. Developing the FEEDS toolkit of parent-delivered interventions for eating, drinking and swallowing difficulties in young children with neurodisability: findings from a Delphi survey and stakeholder consultation workshops. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001425. [PMID: 36053594 PMCID: PMC9058804 DOI: 10.1136/bmjpo-2022-001425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Young children with neurodisability commonly experience eating, drinking and swallowing difficulties (EDSD). Little is documented about which interventions and outcomes are most appropriate for such children. We aimed to seek consensus between parents of children with neurodisability and health professionals on the appropriate interventions and outcomes to inform future clinical developments and research studies. METHODS Two populations were sampled: parents of children aged up to 12 years with neurodisability who experienced EDSD; health professionals working with children and young people (aged 0-18 years) with neurodisability with experience of EDSD. Participants had taken part in a previous national survey and were invited to take part in a Delphi survey and/or consultation workshops. Two rounds of this Delphi survey sought agreement on the appropriate interventions and outcomes for use with children with neurodisability and EDSD. Two stakeholder consultation workshops were iterative, with the findings of the first discussed at the second, and conclusions reached. RESULTS A total of 105 parents and 105 health professionals took part. Parents and health professionals viewed 19 interventions and 10 outcomes as essential. Interventions related to improvement in the physical aspects of a child's EDSD, behavioural changes of the child or parent, and changes in the child or family's well-being. Both parents and health professionals supported a 'toolkit' of interventions that they could use together in shared decision making to prioritise and implement timely interventions appropriate to the child. CONCLUSIONS This study identified interventions viewed as essential to consider for improving EDSD in children with neurodisability. It also identified several key outcomes that are valued by parents and health professionals. The Focus on Early Eating, Drinking and Swallowing (FEEDS) Toolkit of interventions to improve EDSD in children with neurodisability has been developed and now requires evaluation regarding its use and effectiveness.
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Affiliation(s)
- Helen Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Cadwgan
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Diane Sellers
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Lewes, UK
| | - Morag Andrew
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Johanna Smith
- Patient and Public Involvement, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Buswell
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Julian Thomas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Allan Colver
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK .,Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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11
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Billich N, Maugeri I, Calligaro L, Truby H, Davidson ZE. Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review. Nutr Diet 2022; 79:94-109. [PMID: 34369055 DOI: 10.1111/1747-0080.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight. METHODS Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively. RESULTS The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies. CONCLUSIONS There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.
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Affiliation(s)
- Natassja Billich
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Weight Management Service, Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Isabella Maugeri
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Lara Calligaro
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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12
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Caldwell AR, Skidmore ER, Terhorst L, Raina KD, Rogers JC, Danford CA, Bendixen RM. Promoting Routines of Exploration and Play during Mealtime: Estimated Effects and Identified Barriers. Occup Ther Health Care 2022; 36:46-62. [PMID: 34338588 PMCID: PMC9745914 DOI: 10.1080/07380577.2021.1953205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/21/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
Promoting Routines of Exploration and Play during Mealtime (Mealtime PREP) is an intervention designed to support healthy dietary variety in children. To estimate the effects of this intervention, we recruited 20 parents and children (aged 1-5 years) with sensory food aversions to participate in a pilot study. Parents were coached to enhance daily child meals using Mealtime PREP. Our primary outcome was acceptance of targeted food (number of bites) over time. Descriptive statistics and effect sizes are reported. Moderate effects were observed for acceptance of targeted food. Mealtime PREP warrants additional research to examine effects in larger, more diverse samples.
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Affiliation(s)
- Angela R. Caldwell
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ketki D. Raina
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joan C. Rogers
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia A. Danford
- Department of Health Promotion & Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roxanna M. Bendixen
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Adams SN. Feeding and Swallowing Issues in Autism Spectrum Disorders. Neuropsychiatr Dis Treat 2022; 18:2311-2321. [PMID: 36276431 PMCID: PMC9579053 DOI: 10.2147/ndt.s332523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Abstract
Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children's adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children's restrictive diets supplant more healthy food options. When this is combined with the children's noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices - aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.
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Affiliation(s)
- Skye Nandi Adams
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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14
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Thorsteinsdottir S, Njardvik U, Bjarnason R, Olafsdottir AS. Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial. Appetite 2021; 167:105623. [PMID: 34371121 DOI: 10.1016/j.appet.2021.105623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/10/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.
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Affiliation(s)
| | - Urdur Njardvik
- School of Health Sciences, University of Iceland, Iceland.
| | - Ragnar Bjarnason
- School of Health Sciences, University of Iceland, Iceland; Department of Paediatrics, National University Hospital, Iceland.
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15
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Restricted Eating in Preschoolers with Autism: Mother Stressors and Solutions. J Autism Dev Disord 2021; 52:2589-2597. [PMID: 34189684 DOI: 10.1007/s10803-021-05078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Feeding interventions for children with Autism Spectrum Disorder (ASD) focus solely on the child, not the family milieu. This qualitative study aimed to understand mothers' perspectives on managing restricted eating among preschoolers with ASD. Focus groups were conducted with eleven mothers of preschoolers with ASD. Audio recordings were transcribed, and data analyzed for themes. Mothers experienced stressors balancing priorities of adequate nutrition with family mealtime demands and found solutions in support from other mothers, strategies from a wide array of sources, and resorting to trial and error to improve eating. Healthcare practitioners should explore and consider family stressors, competing demands, and coping skills when recommending mealtime interventions for optimal child and family well-being.
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16
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Effects of Mini-Basketball Training Program on Social Communication Impairment and Executive Control Network in Preschool Children with Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105132. [PMID: 34066139 PMCID: PMC8150962 DOI: 10.3390/ijerph18105132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022]
Abstract
This study evaluated the effect of a 12-week mini-basketball training program (MBTP) on social communication (SC) and the executive control network (ECN) in preschool children with autism spectrum disorders (ASD). We finally assigned 30 preschool children with ASD to an experiment group (n = 15, 12 males, 3 females) or a control group (n = 15, 13 males, 2 females). The experiment group participated in a 12-week MBTP (40-min sessions per day, 5 days a week), while the control group only received the institutional routine behavioral rehabilitation intervention. The SC of preschool children with ASD was measured using the Social Responsiveness Scale, Second Edition (SRS-2), whereas functional connectivity (FC) of the ECN was assessed using resting-state functional magnetic resonance imaging (rs-fMRI) at pre-and post-test. Our results showed that SC exhibited significant improvement in the intervention group, especially in SRS-2 total score, social cognition, and social communication. We found significantly enhanced functional connectivity between the right cerebellum and left inferior frontal gyrus in the experimental group, while functional connectivity between the left middle temporal gyrus and right cerebellum were decreased in the control group. Furthermore, there were no significant correlations between the change in SC scores and FC of the ECN. Altogether, this study provides valuable insights that a 12-week MBTP improves SC and functional connectivity of the ECN in preschool children with ASD. We further inferred that neural mechanisms might be associated with changing the ECN of preschool ASD children caused by the 12-week MBTP.
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Parr J, Pennington L, Taylor H, Craig D, Morris C, McConachie H, Cadwgan J, Sellers D, Andrew M, Smith J, Garland D, McColl E, Buswell C, Thomas J, Colver A. Parent-delivered interventions used at home to improve eating, drinking and swallowing in children with neurodisability: the FEEDS mixed-methods study. Health Technol Assess 2021; 25:1-208. [PMID: 33769272 PMCID: PMC8020453 DOI: 10.3310/hta25220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Eating, drinking and swallowing difficulties are common in young children with neurodisability. These difficulties may lead to inadequate calorie intake, which affects a child's nutrition, growth and general physical health. OBJECTIVE To examine which interventions are available that can be delivered at home by parents to improve eating, drinking and swallowing in young children with neurodisability and are suitable for investigation in pragmatic trials. DESIGN This was a mixed-methods study that included focus groups, surveys, an update of published systematic reviews of interventions, a systematic review of measurement properties of existing tools, evidence mapping, evidence synthesis, a Delphi survey and stakeholder workshops. SETTING The study was carried out in NHS hospitals, community services, family homes and schools. PARTICIPANTS Parents of children who had neurodisability and eating, drinking and swallowing difficulties. Professionals from health and education. Young people with eating, drinking and swallowing difficulties or young people who had previously experienced eating, drinking and swallowing difficulties. DATA SOURCES Literature reviews; national surveys of parents and professionals; focus groups with parents, young people and professionals; and stakeholder consultation workshops. REVIEW METHODS An update of published systematic reviews of interventions (searched July-August 2017), a mapping review (searched October 2017) and a systematic review of measurement properties using COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) methodology (searched May 2018). RESULTS Significant limitations of the available research evidence regarding interventions and tools to measure outcomes were identified. A total of 947 people participated: 400 parents, 475 health professionals, 62 education professionals and 10 young people. The survey showed the wide range of interventions recommended by NHS health professionals, with parents and professionals reporting variability in the provision of these interventions. Parents and professionals considered 19 interventions as relevant because they modified eating, drinking and swallowing difficulties. Parents and professionals considered 10 outcomes as important to measure (including Nutrition, Growth and Health/safety); young people agreed that these were important outcomes. Stakeholder consultation workshops identified that project conclusions and recommendations made sense, were meaningful and were valued by parents and professionals. Parents and health professionals were positive about a proposed Focus on Early Eating, Drinking and Swallowing (FEEDS) toolkit of interventions that, through shared decision-making, could be recommended by health professionals and delivered by families. LIMITATIONS The national surveys included large numbers of parents and professionals but, as expected, these were not representative of the UK population of parents of children with eating, drinking and swallowing difficulties. Owing to the limitations of research evidence, pragmatic decisions were made about interventions that might be included in future research and outcomes that might be measured. For instance, the reviews of research found only weak or poor evidence to support the effectiveness of interventions. The review of outcome measures found only limited low-level evidence about their psychometric properties. CONCLUSIONS Opportunities and challenges for conducting clinical trials of the effectiveness of the FEEDS toolkit of interventions are described. Parents and professionals thought that implementation of the toolkit as part of usual NHS practice was appropriate. However, this would first require the toolkit to be operationalised through development as a complex intervention, taking account of constituent interventions, delivery strategies, implementation and manualisation. Subsequently, an evaluation of its clinical effectiveness and cost-effectiveness could be undertaken using appropriate research methods. FUTURE WORK Initial steps include FEEDS toolkit development and evaluation of its use in clinical practice, and identification of the most robust methods to measure valued outcomes, such as Nutrition and Growth. TRIAL REGISTRATION Current Controlled Trials ISRCTN10454425. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Cadwgan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Diane Sellers
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Lewes, UK
| | - Morag Andrew
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Johanna Smith
- Patient and Public Involvement, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Buswell
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian Thomas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Allan Colver
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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18
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A Comparative Analysis of Chewing Function and Feeding Behaviors in Children with Autism. Dysphagia 2021; 36:993-998. [PMID: 33427955 DOI: 10.1007/s00455-020-10228-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/13/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
The present study was aimed to compare chewing performance level and feeding behaviors of children with autism to their typically developing peers. A total of 56 children (37 children with autism, 19 typically developing children) participated in the study. Feeding-related characteristics and observational oral-motor characteristics of children were recorded. The Karaduman Chewing Performance Scale (KCPS) was used to assess chewing performance level, the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to assess feeding behaviors of children, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to evaluate the effect of the child's feeding and swallowing problem on their parents. Results showed that transition time to solid food intake for children with autism was later than typically developing children (p = 0.014), and they had more tongue thrusting (p = 0.009). There were differences between groups in terms of KCPS (p = 0.002), BPFAS (Total frequency score, p = 0.008; Child frequency score, p = 0.017; Parent frequency score, p = 0.021; Restriction score, p = 0.004), and T-FS-IS (Daily activities, p = 0.004; Worry, p = 009; Feeding difficulties, p = 0.031; Total score, p = 0.001). The present study shows that children with autism had worse chewing function and worse mealtime functioning compared to typically developing children. Their parents perceived mealtime behavior as more problematic, and parents' quality of life related to feeding/swallowing disorders was worse compared to parents of typically developing children. The study results reveal the importance of early assessment and intervention of chewing function and feeding behaviors in children with autism.
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19
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Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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20
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Caldwell AR, Skidmore ER, Bendixen RM, Terhorst L. Examining child mealtime behavior as parents are coached to implement the Mealtime PREP intervention in the home: Findings from a pilot study. Br J Occup Ther 2020. [DOI: 10.1177/0308022620920086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The purpose of this study was to examine parental use of evidence-based mealtime strategies, child mealtime behavior, and parental identification of mealtime problems over time as parents were coached to implement the Promoting Routines of Exploration and Play during Mealtime intervention as part of a pilot study. Method This repeated measures study included data collection during three phases: (a) pre-intervention; (b) intervention; (c) post-intervention. Primary outcome measures included a parental strategy use checklist (parental strategy use) and the Behavioral Pediatric Feeding Assessment (problematic child behavior and parental identification of mealtime problems). Linear mixed models were fitted to assess change over time. Results We observed significant improvements in parental strategy use ( p < .001), child mealtime behavior ( p < .001), and parental perception of mealtime problems ( p = .002) over time. Conclusions The results of these analyses signal that empowering parents to integrate evidence-based strategies into child mealtimes is a promising approach to managing child mealtime behavior. More research is needed to determine the true relationship between parental strategy use and child behavior over time.
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Affiliation(s)
- Angela R Caldwell
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, USA
| | | | - Roxanna M Bendixen
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, USA
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21
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Family-centered Outcomes that Matter Most to Parents: A Pediatric Feeding Disorders Qualitative Study. J Pediatr Gastroenterol Nutr 2020; 71:270-275. [PMID: 32304556 PMCID: PMC8204401 DOI: 10.1097/mpg.0000000000002741] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the perspectives of caregivers of children with feeding disorders. We sought to understand their child's feeding impairment through the lens of caregivers, including the impact impairments had on daily life and social participation, what outcomes matter most to caregivers, contextual determinants that affect achieving desired outcomes, and how treatment approaches can optimally support families. METHODS We interviewed caregivers of children, ages 2 to 5 years, who received care at the Center for Feeding and Nutrition at MassGeneral Hospital for Children in Boston, MA. All children had a feeding disorder diagnosis, defined as an impairment in oral intake. We analyzed interview transcripts using principles of immersion-crystallization. RESULTS We reached thematic saturation after interviewing 30 caregivers (25 female). 66.7% of the children were white, 13.3% Asian, 10.0% black, and 10.0% were more than 1 race. Thirty percent were Hispanic. We identified four themes: feeding impairments impact the daily life and social participation of children; improving their child's health and quality of life is most important to caregivers; child, caregiver, and community factors are facilitators of achieving desired outcomes; whereas time, financial, access, and knowledge factors are barriers; and caregivers prefer treatment approaches that incorporate principles of family-centered care. CONCLUSIONS Given the daily life and social participation impacts of pediatric feeding disorders, treatment approaches should be family-centered, focus on functional and meaningful outcomes to improve the health and quality of life of children and their families, and address modifiable sociocontextual determinants.
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22
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SoundFields: A Virtual Reality Game Designed to Address Auditory Hypersensitivity in Individuals with Autism Spectrum Disorder. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10092996] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Individuals with autism spectrum disorder (ASD) are characterised as having impairments in social-emotional interaction and communication, alongside displaying repetitive behaviours and interests. Additionally, they can frequently experience difficulties in processing sensory information with particular prevalence in the auditory domain. Often triggered by everyday environmental sounds, auditory hypersensitivity can provoke self-regulatory fear responses such as crying and isolation from sounds. This paper presents SoundFields, an interactive virtual reality game designed to address this area by integrating exposure based therapy techniques into game mechanics and delivering target auditory stimuli to the player rendered via binaural based spatial audio. A pilot study was conducted with six participants diagnosed with ASD who displayed hypersensitivity to specific sounds to evaluate the use of SoundFields as a tool to reduce levels of anxiety associated with identified problematic sounds. During the course of the investigation participants played the game weekly over four weeks and all participants actively engaged with the virtual reality (VR) environment and enjoyed playing the game. Following this period, a comparison of pre- and post-study measurements showed a significant decrease in anxiety linked to target auditory stimuli. The study results therefore suggest that SoundFields could be an effective tool for helping individuals with autism manage auditory hypersensitivity.
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23
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Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child Adolesc Psychiatr Clin N Am 2020; 29:409-417. [PMID: 32169270 DOI: 10.1016/j.chc.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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24
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Padmanabhan PS, Shroff H. Addressing mealtime behaviours of children with autism spectrum disorders in schools: a qualitative study with educators in Mumbai, India. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:198-206. [PMID: 35309705 PMCID: PMC8928840 DOI: 10.1080/20473869.2020.1738794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 06/14/2023]
Abstract
This study was conducted to explore the experiences of educators with mealtime behaviours of children with a diagnosis of Autism Spectrum Disorders (ASD) in schools, and to explore the strategies undertaken in schools to improve nutrition among these children. In-depth interviews were conducted with 13 educators of various special schools across Mumbai. They described their experiences with 3-11 year-old children with a diagnosis of ASD. Four themes emerged from this study: reasons for disruptive mealtime behaviours, using mealtimes as opportunities for indirect learning, strategies used to avoid disruptive mealtime behaviours, and school policies regarding food and nutrition. The presence of sensory stressors, changes in break-time schedules, and inability to communicate hunger were identified as main reasons for disruptive mealtime behaviours in the classroom. Strategies to tackle these behaviours were discussed. Most educators reported that their school followed a strict 'no junk-food' policy. The perspective of educators is important to understand the mealtime behaviours of children with ASD in school settings. The initiatives taken at the school-level are valuable as they provide a different approach and diverse strategies that may work to improve the food intake and nutrition of children with ASD.
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Affiliation(s)
| | - Hemal Shroff
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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25
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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26
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Zhu V, Dalby-Payne J. Feeding difficulties in children with autism spectrum disorder: Aetiology, health impacts and psychotherapeutic interventions. J Paediatr Child Health 2019; 55:1304-1308. [PMID: 31576627 DOI: 10.1111/jpc.14638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/16/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
Feeding difficulties are common and significant issues for children with autism spectrum disorder and their families. Key features of autism are intrinsically linked with factors contributing to these children's feeding difficulties. Following a multidisciplinary assessment to exclude non-behavioural reasons for the feeding difficulty, there are two mainstay modalities of treatment: operant conditioning and systematic desensitisation. Currently, evidence points towards operant conditioning as the most efficacious psychotherapy. However, recent research into cognitive behavioural therapy for older children with feeding difficulties has shown promising results and will be an area to monitor in the coming years. This review outlines the causes and health impacts and evaluates current evidence supporting the available psychotherapeutic interventions for children with autism spectrum disorder experiencing feeding difficulties.
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Affiliation(s)
- Vincent Zhu
- Department of General Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jacqueline Dalby-Payne
- Department of General Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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27
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Saini V, Kadey HJ, Paszek KJ, Roane HS. A systematic review of functional analysis in pediatric feeding disorders. J Appl Behav Anal 2019; 52:1161-1175. [PMID: 31523816 DOI: 10.1002/jaba.637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/16/2019] [Indexed: 11/07/2022]
Abstract
We conducted a systematic review of the functional analysis of inappropriate mealtime behavior in peer-reviewed studies in PsycINFO, ERIC, PubMed, and the Journal of Applied Behavior Analysis between 2000-2016. We identified 18 studies involving 86 functional analyses. We coded descriptive data and calculated summary statistics in addition to conducting a quality appraisal of the literature. We identified escape, exclusively or in part, as the maintaining reinforcer for inappropriate mealtime behavior in 92% of cases. Results indicate that differentiated functional analyses of inappropriate mealtime behavior can be obtained, and outcomes are consistent with etiological theories of food refusal behavior. We discuss procedural differences across studies as well as directions for future research.
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Chawner LR, Blundell-Birtill P, Hetherington MM. Interventions for Increasing Acceptance of New Foods Among Children and Adults with Developmental Disorders: A Systematic Review. J Autism Dev Disord 2019; 49:3504-3525. [PMID: 31124025 PMCID: PMC6667424 DOI: 10.1007/s10803-019-04075-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
People with developmental disorders (DD) often display high levels of selective eating, which can result in micronutrient deficiencies. It is therefore essential to explore ways to increase dietary variety in this population. To identify different types of interventions promoting increased acceptance of new foods or dietary variety for DD populations and to determine their effectiveness. Thirty-six studies met criteria for inclusion in the review. Twenty-two types of intervention were identified with 34 studies being reported as effective and 33 of these incorporating components drawn from learning theory. Multi-component interventions centred on operant conditioning, systematic desensitisation and changes to environment and familial practices were reported as effective for individuals.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
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29
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Saini V, Jessel J, Iannaccone JA, Agnew C. Efficacy of functional analysis for informing behavioral treatment of inappropriate mealtime behavior: A systematic review and meta‐analysis. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Valdeep Saini
- Department of Applied Disability StudiesBrock University St. Catharines Canada
| | - Joshua Jessel
- Department of PsychologyQueens College New York NY United States of America
| | | | - Charlene Agnew
- Department of PsychologyQueens College New York NY United States of America
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Caldwell AR, Skidmore ER, Raina KD, Rogers JC, Terhorst L, Danford CA, Bendixen RM. Behavioral Activation Approach to Parent Training: Feasibility of Promoting Routines of Exploration and Play During Mealtime (Mealtime PREP). Am J Occup Ther 2019; 72:7206205030p1-7206205030p8. [PMID: 30760395 DOI: 10.5014/ajot.2018.028365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Systematic approaches are needed to help parents with young children adopt healthy routines. This study examined the feasibility (home data collection, protocol adherence, intervention acceptance) of using a behavioral activation (BA) approach to train parents of children with sensory food aversions. METHOD Parents of young children (18-36 mo) were trained using the novel Promoting Routines of Exploration and Play During Mealtime intervention. Measures included video-recorded meals, Fidelity Checklist, Treatment Acceptability Questionnaire, and Behavioral Pediatrics Feeding Assessment Scale. Descriptive statistics were used. RESULTS Eleven children and their parents completed the study. Two of three feasibility benchmarks were met. Intervention acceptance was high (mean score = 43/48). On average, parents used three more intervention strategies after training than at baseline. CONCLUSION Using a BA approach to parent training shows promise for altering daily mealtime routines. Delivering this intervention in the home is feasible and received acceptable ratings among this sample.
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Affiliation(s)
- Angela R Caldwell
- Angela R. Caldwell, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA;
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, FAOTA, is Professor and Chair, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Ketki D Raina
- Ketki D. Raina, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Toledo, Toledo, OH
| | - Joan C Rogers
- Joan C. Rogers, PhD, OTR/L, FAOTA, is Professor Emeritus, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Cynthia A Danford
- Cynthia A. Danford, PhD, RN, PNP-BC, CPNP-PC, is Assistant Professor, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Roxanna M Bendixen
- Roxanna M. Bendixen, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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31
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Affiliation(s)
- Alka A Subramanyam
- Associate Professor, Autism Dynamic Interventions, Department of Psychiatry, TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Abir Mukherjee
- Senior Consultant Psychiatrist, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Malay Dave
- Hon. Psychiatrist, Jagjivanram Hospital & Consultant Psychiatrist, Mumbai, Maharashtra, India
| | - Kersi Chavda
- Consultant Psychiatrist, P.D. Hinduja National & Hinduja Healthcare Hospitals, Mumbai, Maharashtra, India
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32
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Early History, Mealtime Environment, and Parental Views on Mealtime and Eating Behaviors among Children with ASD in Florida. Nutrients 2018; 10:nu10121867. [PMID: 30513809 PMCID: PMC6315880 DOI: 10.3390/nu10121867] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 11/21/2022] Open
Abstract
This study was a cross-sectional study to examine problematic mealtime behaviors among children with autism spectrum disorder (ASD) in Florida. Forty-one parents completed a 48-item survey. The mean age of their children was 8.1 years and 73% were male. The data were divided and compared by age group: Ages 2–6, 7–11, and 12–17. Data from the 3- to 6-year-old children were extracted and compared with the references from Provost et al. (2010). There were age differences in eating difficulties at home (p = 0.013), fast food restaurants (p = 0.005), and at regular restaurants (p = 0.016). The total mealtime behavior score was significantly higher in early childhood (p < 0.001) and mid-childhood (p = 0.005) than adolescents. More parents of ages 3–6 with ASD reported difficulties with breastfeeding (p < 0.01); concerns about eating (p < 0.001); difficulties related to mealtime locations (p < 0.05), craving certain food (p < 0.05), and being picky eaters (p < 0.01) compared to typically developing children. The total mealtime behavior score was significantly higher in children with ASD than typically developing children (p < 0.001). The results indicate that early childhood interventions are warranted and further research in adolescents is needed.
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Aponte CA, Brown KA, Turner K, Smith T, Johnson C. Parent training for feeding problems in children with autism spectrum disorder: A review of the literature. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1510329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Courtney A. Aponte
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Kimberly A. Brown
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Kylan Turner
- Division of Ed Leadership and Innovation, Arizona State University, Tempe, AZ
| | - Tristram Smith
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Cynthia Johnson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Su Maw S, Haga C. Effectiveness of cognitive, developmental, and behavioural interventions for Autism Spectrum Disorder in preschool-aged children: A systematic review and meta-analysis. Heliyon 2018; 4:e00763. [PMID: 30211331 PMCID: PMC6129682 DOI: 10.1016/j.heliyon.2018.e00763] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/04/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is characterised by significant impairment in social communication and the presence of restrictive and repetitive behaviour or interest. Intervention during early childhood could decrease ASD symptoms. We aimed to identify the most effective intervention based on cognitive, developmental, and behavioural approaches and the factors that impact the effectiveness of the intervention. METHODS We performed a systematic review and meta-analysis of existing interventions for ASD in preschool-aged children. Electronic databases were searched for related articles with randomised controlled trial (RCT) designs published between 2001 to 2015. Outcome measures were communication, behavioural and cognitive skills, reported as standardised mean differences (SMD) compared to a control group. A Random-effects model was utilised to calculate the pooled estimate effect. Between-study variability was also assessed. The registering number of this study is CRD42017035354. FINDINGS Out of the initial 5174 studies that were identified, there were 14 RCTs (746 children) that were included in the final systematic review and meta-analysis. Pooled estimate effect provided by random-effects model was 0.23 (95% confidence interval, CI [0.08-0.37]) with no between-study heterogeneity (I2 = 0.00%, p = 0.0018). Three studies of music therapy interventions provided the greatest outcome effects with a shorter duration and lower intensity. SMD for music therapies ranged from 0.40 to 0.62 with 95% CI [0.22 to 1.85]. The quality of the health care provider, the duration, and the intensity of intervention played an important role in the effectiveness of the intervention. INTERPRETATION Music therapy appears to be an effective tool for improving social interaction in preschool-aged children with ASD. However, more evidence-based trials are required to further validate the effectiveness of music therapy in ASD.
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Affiliation(s)
- Su Su Maw
- Graduate School of Health Sciences, Okayama University, Shikata cho, Kita-ku, 700-8558, Okayama city, Japan
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Diaz J, Cosbey J. A Systematic Review of Caregiver-Implemented Mealtime Interventions for Children With Autism Spectrum Disorder. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 38:196-207. [PMID: 29592605 DOI: 10.1177/1539449218765459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Julie Diaz
- 1 The University of New Mexico, Albuquerque, USA
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36
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Hodges A, Davis T, Crandall M, Phipps L, Weston R. Using Shaping to Increase Foods Consumed by Children with Autism. J Autism Dev Disord 2018; 47:2471-2479. [PMID: 28536958 DOI: 10.1007/s10803-017-3160-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study used differential reinforcement and shaping to increase the variety of foods accepted by children with autism who demonstrated significant feeding inflexibility. Participants were introduced to four new food items via a hierarchical exposure, which involved systematically increasing the desired response with the food item. Level of food consumption was evaluated using a combined multiple baseline plus changing criterion design. Following intervention, all participants accepted all foods targeted, expanding upon the number of foods consumed.
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Affiliation(s)
- Abby Hodges
- Baylor University, One Bear Place #97031, Waco, TX, 76798-3701, USA.
| | - Tonya Davis
- Baylor University, One Bear Place #97031, Waco, TX, 76798-3701, USA
| | - Madison Crandall
- Baylor University, One Bear Place #97031, Waco, TX, 76798-3701, USA
| | - Laura Phipps
- Baylor University, One Bear Place #97031, Waco, TX, 76798-3701, USA
| | - Regan Weston
- Baylor University, One Bear Place #97031, Waco, TX, 76798-3701, USA
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37
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Intervention for Feeding Difficulties in Children With a Complex Medical History: A Randomized Clinical Trial. J Pediatr Gastroenterol Nutr 2018; 66:152-158. [PMID: 28753179 DOI: 10.1097/mpg.0000000000001683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study aimed to compare outcomes of different multidisciplinary feeding therapy approaches in children with feeding difficulties. METHODS Children aged 2 to 6 years with feeding difficulties and a medically complex history (MC) were recruited. Children with feeding difficulties and a nonmedically complex history (NMC) were included as a comparison group. Participants attended a clinical assessment, and eligible participants were randomized to receive targeted feeding intervention incorporating either operant conditioning or systematic desensitization. Parents could elect to receive intervention in an intensive (10 sessions in a week) or weekly (10 sessions during 10 weeks) format. Both groups received immersive parent training. A review was completed 3 months post-intervention. RESULTS In total, 98 participants were eligible to participate (MC, n = 43; NMC, n = 55). Data from 20 children from the MC group (47%) and 41 children from the NMC group (75%) were included in the final analysis. Clinically significant improvements were observed following both arms of therapy, consistent with previous research. Parents of children in the MC arm were significantly more likely to elect for intensive intervention than weekly (MC = 12/20, 60%; 12/41, 29%; P = 0.02). CONCLUSIONS Both therapy protocols were considered clinically effective. The difference in attrition rates between the etiological groups suggests primary differences in how service delivery should be managed. Progress for the medically complex child may be slower while medical issues are stabilized, or while the focus for parents shifts to other developmental areas. In planning services for a medically complex group, therefore, it is essential that consideration be given to medical and family needs.
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38
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Silbaugh BC, Penrod B, Whelan CM, Hernandez DA, Wingate HV, Falcomata TS, Lang R. A Systematic Synthesis of Behavioral Interventions for Food Selectivity of Children with Autism Spectrum Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0087-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Curtin C, Hubbard K, Anderson SE, Mick E, Must A, Bandini LG. Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. J Autism Dev Disord 2016; 45:3308-15. [PMID: 26070276 DOI: 10.1007/s10803-015-2490-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mealtime behavior problems and family stress occur frequently among families of children with autism spectrum disorder (ASD). However, it is unknown whether food selectivity is an associated factor. The associations of high food selectivity with mealtime behavior problems, spousal stress, and influence on family members were assessed among 53 children with ASD and 58 typically developing (TD) children ages 3-11 years. Compared to TD children, children with ASD were more likely to have high food selectivity, and their parents reported more mealtime behavior problems, higher spousal stress, and influence on what other family members ate. High food selectivity was associated with mealtime behavior problems in both groups. Interventions to reduce food selectivity may lead to decreases in mealtime behavior problems.
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Affiliation(s)
- C Curtin
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, 465 Medford Street, Suite 500, Charlestown, MA, 02129, USA.
| | - K Hubbard
- United States Department of Agriculture, Food & Nutrition Service, Western Regional Office, 90 Seventh Street Suite 10-100, San Francisco, CA, 94103, USA.
| | - S E Anderson
- Division of Epidemiology, College of Public Health, The Ohio State University, 336 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
| | - E Mick
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - A Must
- Department of Public Health & Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - L G Bandini
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, 465 Medford Street, Suite 500, Charlestown, MA, 02129, USA.
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Zobel-Lachiusa J, Andrianopoulos MV, Mailloux Z, Cermak SA. Sensory Differences and Mealtime Behavior in Children With Autism. Am J Occup Ther 2015; 69:6905185050. [PMID: 26379266 DOI: 10.5014/ajot.2015.016790] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined sensory differences and mealtime behaviors in children with autism spectrum disorder (ASD; n=34) and compared the results with those of similarly aged peers who were typically developing (TD; n=34). Results from parent-report and child-report questionnaires indicated that children with ASD scored significantly differently from TD peers on the measures of sensory differences and eating behaviors. Data also supported a correlation between sensory differences and eating difficulties in children with ASD. The results of this study will help caregivers and their children with ASD identify problem eating behaviors that may be associated with sensory differences. Sensory strategies and techniques offered by occupational therapy practitioners may contribute to greater success during mealtimes for children with ASD and their families, with increased comfort and less stress. The findings also support a need to further explore the influence of sensory differences on mealtime behaviors.
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Affiliation(s)
- Jeanne Zobel-Lachiusa
- Jeanne Zobel-Lachiusa, EdD, MA, OTR/L, is Assistant Professor, BayPath University, Longmeadow, MA;
| | - Mary V Andrianopoulos
- Mary V. Andrianopoulos, PhD, is Associate Professor, Department of Communication Disorders, University of Massachusetts, Amherst
| | - Zoe Mailloux
- Zoe Mailloux, OTD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Occupational Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, and Program and Professional Development Consultant in Private Practice, Redondo Beach, CA
| | - Sharon A Cermak
- Sharon A. Cermak, EdD, OTR/L, FAOTA, is Professor of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, and Professor of Pediatrics, USC Keck School of Medicine and Children's Hospital, Los Angeles, CA
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