Realist evaluation of a transdisciplinary mealtime management service for autistic children

Abstract

Autistic children commonly experience mealtime difficulties; however, it is unknown what makes an effective transdisciplinary mealtime service for autistic children. This study used a realist evaluation framework to explore caregivers’ and therapists’ perceptions of the contexts, mechanisms and associated outcomes of a transdisciplinary mealtime management service for autistic children. Semi-structured interviews were conducted with six caregivers of autistic children engaged in a transdisciplinary mealtime service and 10 therapists providing the service, with interview data analysed using a realist evaluation approach. Four-context (child factors, family factors, therapist factors and institutional parameters), three-mechanism (transdisciplinary collaboration, child-centred approach and managing caregiver expectations) and two-outcome (impact on the child and impact on the caregiver) themes were identified. Findings highlighted that transdisciplinary collaboration, a child- and family-centred approach and managing caregiver expectations are key mechanisms providing a foundation for the development of evidence-based mealtime services for autistic children. Lay abstract Mealtimes and eating can be difficult for autistic children. A service where different professions work together is required to address the varied and complex mealtime difficulties of autistic children. Little is known about what is needed for such services to be effective. We interviewed six caregivers of autistic children who were engaged in a mealtime service and 10 therapists who are involved in delivering the service to understand their perspectives on the factors that were driving the effectiveness of the mealtime service. We found that different health professionals from different disciplines working together, focusing on adapting intervention to the child and family and managing expectations of the caregiver were important in contributing to outcomes of the mealtime service. The findings of this study can be used to inform the development of more effective interventions and services to support the well-being and development of autistic children.

The Efficacy of the Global Intensive Feeding Therapy on Feeding and Swallowing Abilities in Children with Autism Spectrum Disorder: A Pilot Study

“…The caregiver's use of rehabilitation techniques in the normal daily life activity of the meal increases the number of eating sessions and promotes the generalization of learning. The results show that caregivers' presence in rehabilitation treatment is a key factor for successful treatment, in agreement with the current literature [46].…”

“…Chan and colleagues [46] revealed that most of the children with ASD who participated in their study had feeding disorders due to organic reasons, such as chewing disorders, choking, and oral motor and sensory disorders, which are all part of a speech-language pathologist's competence. There are various approaches to support feeding in children with ASD, which include systematic desensitization, escape extinction, and reinforcement.…”

“…There are various approaches to support feeding in children with ASD, which include systematic desensitization, escape extinction, and reinforcement. Although these approaches are considered appropriate from a cognitive-behavioral point of view, they only address certain aspects of feeding disorders in children with ASD [46].…”