Behavioral Parent Training to Address Feeding Problems in Children with Autism Spectrum Disorder: A Pilot Trial

Abstract

The purpose of this study was to pilot a newly developed manualized behavioral parent training program (PT-F) for parents of children with Autism Spectrum Disorder (ASD) and feeding problems, and test the feasibility and initial efficacy of the treatment in a small open trial. Parents of a sample of 14 young children diagnosed with ASD, with an average age of 4 years, were enrolled in this study. Parents participated in a 9-session program delivered individually over the 16 weeks of the study. Outcome measures of feasibility, fidelity, and efficacy were collected. Parent attendance and satisfaction were high as was treatment fidelity. The Brief Autism Mealtime Behavior Inventory was significantly reduced over the trial as were disruptive behaviors. Finally, significant reduction in parenting stress was observed over the course of the study. Results support the feasibility and initial efficacy of this PT-F program for children with ASD and feeding problems. Additional research to include randomized trials are necessary to confirm these initial findings.In addition to the core features of Autism Spectrum Disorder (ASD) which include social communication deficits; repetitive and restrictive behaviors, an estimated 46-89 % of children with ASD exhibit problematic feeding and eating habits (Seiverling et al. 2011). These problematic feeding habits fall into three categories: 1) food selectivity based on type, J Dev Phys Disabil (2015) 27:591-607

Parent Training for Feeding Problems in Children With Autism Spectrum Disorder: Initial Randomized Trial

“…Treatment Fidelity Checklist. Consistent with our prior PT studies (Aman et al, 2009;Bearss et al, 2015;Johnson et al, 2013;Johnson et al, 2015), we measured treatment fidelity as (a) therapist integrity in the delivery of treatment as intended and (b) parent adherence to the delivered treatment. Sessions were all video-recorded.…”

“…Hence, the level of intensity of intervention can be naturally increased if parents play the role of change agent. Furthermore, as a child's disruptive mealtime behaviors, selective eating, and rigidity have been shown to be correlated with stress and family burden (Thullen & Bonsall, 2017), teaching parents strategies to improve eating and decrease disruptive mealtimes behaviors could result in decreased parental stress as previously suggested (Johnson, Foldes, DeMand, & Brooks, 2015;Sharp et al, 2014). Parent training as an intervention model has been successfully applied to target core social communication deficits, disruptive behaviors, adaptive skills, and sleep problems in ASD (Aman et al, 2009;Bearss et al, 2015;Dawson et al, 2010;Johnson et al, 2013;Scahill et al, 2016).…”

“…Research Unit on Behavioral Research (RUBI) Autism Network Parent Training programs (Aman et al, 2009;Bearss et al, 2015) but dedicated specifically to feeding issues (Johnson et al, 2015), particularly food selectivity, food refusal, disruptive mealtime behaviors (not sitting at table, tantrums, aggression, and table swiping), and teaching adaptive feeding skills (using utensils and preparing a simple meal). The therapist also made a home visit after the first session to observe the home environment and held up to three parentchild coaching appointments over the course of the intervention via VSEE.…”

“…In prior work, we drafted a structured parent training manual that integrated behavior change strategies developed and tested in single-subject studies for feeding problems in children with ASD, and we conducted a case series that provided initial evidence of the promise of this parent training for feeding (PT-F) (Johnson et al, 2015). To our knowledge, the study was the first to examine an intervention delivered individually to families for feeding problems in ASD.…”

Visual and Hedonic Perception of Food Stimuli in Children with Autism Spectrum Disorders and their Relationship to Food Neophobia

“…According to the typology established by Johnson, Foldes, Demand, and Brooks (2015), dietary behavior particular to children with ASD comprises certain forms of (a) food selectivity, which may be related to the texture or the way in which the food is presented (food selectivity based on type, texture, and presentation), (b) food refusal, and (c) behavioral problems during meals (e.g., “does not stay seated” ; Nadon et al., 2011b). Among the sensory modalities involved in the appreciation of food, sight plays a predominant role.…”