Abstract
This study compared the effectiveness of multimodal and sensory integration approaches in expanding children's limited diets, increasing positive mealtime behaviors, and decreasing negative mealtime behaviors.
Primary Author and Speaker: Carolyn Murphy
Additional Authors and Speakers: Nicole Byrd, Sydney Bordelon
Contributing Authors: Seth Hilburn, Jacqueline Henderson, Stephanie Razon
The objective of this non-randomized, two group, pre-test/post-test study was to compare the effectiveness of multi-modal (MM) and sensory integration (SI) approaches in treating pediatric clients with feeding difficulties.
Mealtimes are an important social aspect of family relationships and revolve around societal expectations (Benson, Parke, Gannon, & Muñoz, 2013). Mealtime can be unpleasant for the child and the family when the child’s food selectivity and associated behavioral issues create disruption. Children are often referred to occupational therapy (OT) for these two issues and have been treated with a variety of approaches. Available evidence on this subject is limited and existing studies tend to be single subject designs, hence prompting the need for this study.
A convenience sample of participants (N=11) meeting the inclusion criteria was recruited from three outpatient pediatric clinics. The inclusion criteria were that the child must be between the ages of 3 and 10 years old, receiving outpatient OT services, and identified by a parent, physician, or therapist as having feeding difficulties.
Following acceptance to participate in the 4-week study, the parent of the participants completed the Sensory Profile 2 (SP-2) to determine homogeneity of the participants regarding sensory processing. The pre-test feeding survey was completed by the parent to obtain a baseline of current feeding habits, behaviors, and food acceptance levels. Clients were assigned to the MM or the SI intervention group based on the facility where the child was receiving therapy. Interventions were provided in weekly 60-minute sessions and the treatment activities were dictated by the group assignment. The MM group was taken through a hierarchy of desensitization to foods and engaged in sensorimotor activities. The SI group participated in activities providing input to multiple sensory systems, as well as being presented with aversive foods with no added techniques to assist in food acceptance. After four weeks, the parent was given a post-feeding survey to report any changes associated with intervention.
A one-tailed t-test was used to determine the homogeneity of the groups based on the SP-2 scores which were compared by the categories: Seeking/Seeker (SS1), Avoiding/Avoider (AA), Sensitivity/Sensor (SS2), and Registration/Bystander (RB). Questions from the feeding survey were grouped and analyzed as positive or negative mealtime behaviors. Percent change and mean scores were calculated for each question for both groups. A paired t-test was used to compare the mean scores from pre- to post-test between groups.
There was no statistically significant difference (p≤05) between the participants in the four areas of the SP-2: SS1 (p=0.44), AA (p=0.38), SS2 (p=0.27), and RB (p=0.47). In two of the three positive mealtime behaviors examined from the feeding survey, the MM group showed a greater improvement than the SI group from pre- to post-test (p=0.04, p=0.02, p=.09). In three of the four negative mealtime behaviors examined, both groups showed a decrease from the pre- to post-test; however, there was no statistically significant difference between groups (p=.27, p=.23, p=.19, p=.09).
The results indicate that the MM approach is more effective than the SI approach at improving positive mealtime behaviors. Both approaches were equally effective in decreasing negative mealtime behaviors. Based on these results, OT clinicians should employ both approaches, with an emphasis on the MM approach for improving positive mealtime behaviors.
This study contributes to the limited evidence regarding OT interventions related to feeding, an essential activity of daily living. Evidence supporting skilled OT intervention is needed for best practice and reimbursement.
Benson, J. D., Parke, C. S., Gannon, C., & Muñoz, D. (2013). A Retrospective analysis of the sequential oral sensory feeding approach in children with feeding difficulties. Journal of Occupational Therapy, Schools & Early Intervention, 6(4), 289-300. doi:10.1080/19411243.2013.860758
Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13(4), 348-365. doi:10.1007/s10567-010-0079-7
Dodrill, P., Hill, R. J., Marshall, J., Ware, R., & Ziviani, J. (2014). Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: A systematic review and meta-analysis. Child: Care, Health and Development, 41(2), 278-302. doi:10.1111/cch.12157