Feeding difficulties are frequent in children with Autism Spectrum Disorder (ASD). The main goal of this project was to develop TEAlimento, a behavioral program for children ages 3-8 with ASD and feeding difficulties. The intervention combines parent training in group and individual sessions, as well as group sessions with children. The second goal was to conduct a pilot study to evaluate the effect of the program.
It was hypothesized that the intervention would decrease food rejection and disruptive behavior during meals, as well as increase the number of foods tried. A decrease in parent stress was also expected.
age range between 3 and 8 years old
confirmed diagnosis of cut-off at the Autism Diagnostic Observation Schedule-2 (ADOS-2, Lord et al., 2000)
presence of significant feeding difficulties, defined as one or more of the following issues: significant food rejection, significant disruptive behavior at meals, significant selectivity based on type, texture, and presentation, and significant stress to family caused by these feeding difficulties.
acquired oral-motor abilities to chew food
severe intellectual disability (intellectual or adaptive functioning below 35)
severe behavioral problems
medical risk situation that required more intensive intervention.
Parallel
TEAlimento : a multicomponent parent training behavioral program to treat feeding difficulties in children with Autism Spectrum Disorder
BehavioralThe program focuses on parent training. Additionally, intervention on sensory integration is implemented directly with children. The program is made up of 12 sessions, which are held weekly, combining group (1.5 hour parent training and child sensory desensitization) with individual sessions. Parent training group sessions (1,3,4,5,7,8), are focused on teaching strategies based on the principles of behavior intervention and specific techniques related to eating. Strategies involve functional behavioral assessment, antecedent-based interventions, extinction of disruptive behaviors, positive reinforcement, modeling and visual supports. Additionally, parents were trained in methods of introducing new foods, such as modifying food presentation or textures. Simultaneously, children attend a group session in a separate room to target sensory issues and receive oral-facial stimulation. Individual sessions (2,6,9) are focused on specific characteristics of each child.
Change in Brief Assessment of Mealtime Behavior In Children (BAMBIC; Hendy et al. 2013).
This questionnaire consists of 11 items that evaluate, on a 5-point Likert scale, three areas: limited variety, food refusal and disturbing behavior, in the last 6 months. Higher scores reflect more difficulties. The limited variety subscale assesses the child's willingness to try new foods or new types of preparation or textures. The food refusal subscale evaluates problem behaviors during meals, such as crying or closing his/her mouth tightly when food is presented. The disruptive behavior subscale includes items that assess aggressive behavior, self-injurious behaviors or disruptive conducts during meals, such as pushing or throwing utensils or food.
Change in Parenting Stress Index, short version (PSI-SF; Abidin 1995).
The PSI-SF includes three subscales, comprising 12 items each, rated from 1 to 5. The subscale Paternal Distress assesses the discomfort experienced by parents, such as poor sense of competence, lack of social support or depressive symptoms. The subscale Parent-Child Dysfunctional Interaction evaluates the degree in which the child meets the expectations that parents have and the reinforcement that the child offers to his/her parents. The subscale Difficult Child assesses the degree in which parents perceive how difficult it is to control their child, according to his/her behaviors. Finally, the instrument includes a total scale score, which is calculated by summing the three subscales' scores, ranging from 36 to 180. Scores of 90 or above may indicate a clinical level of stress.
Change in Qualitative questionnaire (ad hoc)
To collect information about the amount of new accepted foods and new categories of food accepted before and after the intervention, we conducted interviews with parents at the beginning of each session and filled a specific food questionnaire (ad hoc/qualitative data)., with different categories of food: dairy products (milk, cheese); eggs, meat and fish; vegetables (green beans, tomatoes, lettuce); fruit (apple, banana, almonds, peanuts); beans (lentils, beans) and cereals (rice, bread); pastry (croissants, cakes, chocolate); miscellany (mayonnaise, spicy, fritters, snacks); and drinks (juices, soft drinks, water). Additionally, the questionnaire registered the tastes that the child accepted (salty, sweet, acid or sour) and the accepted colors for meals (red, green, white).
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