Date Presented 03/26/20
This systematic review evaluates the effectiveness of intervention at improving dietary intake in children with autism. Overall, limited to moderate evidence supported behavior modification and desensitization practices within interdisciplinary feeding teams to increase food variety directed at improving dietary status. The impact of intervention on a child’s dietary status in addition to feeding behaviors should be considered when working with children with autism and feeding challenges.
Primary Author and Speaker: Amanda Malzacher
Additional Authors and Speakers: Sophia Slocum
Contributing Authors: Karla Ausderau
PURPOSE: As many as 46-89% of children with autism spectrum disorder (ASD) have difficulty with feeding, leading to increased risk of inadequate nutrition and associated developmental and medical issues. This can lead to increased risks for diseases, bone health problems, obesity, and more. The purpose of this systematic review was to assess the effectiveness of interventions to improve dietary intake in children with ASD.
DESIGN: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to conduct this systematic review.
METHOD: Following the PRISMA guidelines, a systematic review was conducted using a systematic search of relevant academic databases and relevant reference lists using terms such as autism, feeding, diet, food, eat, nutrition, intervention, program, and treatment. Academic databases searched included PubMed, CINAHL Plus, PsychINFO and Web of Science. Inclusion criteria included child diagnosis of ASD and between birth to 25 years old. Studies that considered behavior outcomes only rather than dietary outcomes were excluded. The search resulted in 1,409 articles. After screening titles and abstracts, 82 articles were selected for full-text review. Eleven studies were included in the final analysis.
RESULTS: Levels and strength of evidence were identified based on the AOTA guidelines and U.S. Preventive Services Task Force levels of certainty. The 11 studies included seven with Level I and four with Level III evidence. Studies were categorized into types of interventions: behavioral and desensitization, school based, vitamins, and minerals. Limited to moderate evidence supported behavior modification and desensitization practices when delivered by an interdisciplinary team to increase food consumption in children with ASD to improve a child’s overall dietary status. Strong evidence supported supplements to increase levels of specific vitamins and minerals, although not necessarily targeted at an identified deficiency in a child.
CONCLUSION: Behavior and sensory focused interventions increased quantity, texture, and variety of food consumption, including fruits, vegetables, and proteins for children with ASD. Although nutrition supplements were effective at increasing targeted vitamins and minerals, they were often implemented to target behavioral changes versus nutrient deficiencies. While this systematic review suggest moderate to strong evidence to support intervention for children with ASD to improve their ADL skills, interventions were heterogenous and included a range of outcomes. Future research should examine if specific types of interventions may be more effective for certain outcomes or possibly different approaches (family-centered or individual) may be more effective for different age ranges. In addition, few studies provided long-term follow-up to determine if ADL skills were maintained overtime or supported increased independence in occupational performance.
IMPACT STATEMENT: As participation in mealtime is an essential occupation which impacts many areas of a child’s occupational performance, OTs are well situated to address feeding challenges in children with ASD as well as overall dietary status. Results from this systematic support that OTs, working in conjunction with a multidisciplinary team, can have significant impact on nutrition intake through a variety of feeding interventions.
References
Adams, J. B., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E. L., … Quig, D.W. (2018). Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial. Nutrients, 10(3). https://doi.org/10.3390/nu10030369
Laud, R. B., Girolami, P. A., Boscoe, J. H., & Gulotta, C. S. (2009). Treatment outcomes for severe feeding problems in children with autism spectrum disorder. Behavior Modification, 33(5), 520–536. https://doi.org/10.1177/0145445509346729
Marshall, J., Hill, R. J., Ware, R. S., Ziviani, J., & Dodrill, P. (2015). Multidisciplinary intervention for childhood feeding difficulties. Journal of Pediatric Gastroenterology and Nutrition, 60(5), 680–687. https://doi.org/10.1097/MPG.0000000000000669
Taylor, T., Kozlowski, A. M., & Girolami, P. A. (2017). Comparing behavioral treatment of feeding difficulties and tube dependence in children with cerebral palsy and autism spectrum disorder. NeuroRehabilitation, 41(2), 395–402. https://doi.org/10.3233/NRE-162071
