Date Presented 03/27/20
The purpose of this study is to describe the effects of the Mealtime PREP feeding intervention for a child with ASD. We observed improved mealtime behaviors, including a higher percentage of time spent at the table during meals and increased mealtime overall. Our study highlights the potential benefits of structured mealtime routines and positive behavior management for young children with ASD.
Primary Author and Speaker: Gabriella Mazzeo
Contributing Authors: Angela Caldwell
PURPOSE: Children with Autism Spectrum Disorder (ASD) often demonstrate frequent inappropriate mealtime behaviors including resistance sitting at the table and throwing food (Provost et al., 2010). Problematic mealtime behaviors are positively associated with nutritional deficiencies in children with ASD (Johnson et al., 2014) and higher levels of spousal stress for their parents (Curtin et al., 2015). The purpose of this study is to describe the effects of the Promoting Routines of Exploration and Play during Mealtime (Mealtime PREP) intervention for one child with ASD.
DESIGN: This single-case experimental design consisted of two phases: A) baseline – nine child meals were video-recorded in the home over a 2-week period; and B) intervention – ten child meals were video-recorded in the home over a 6-week period as parents were coached to embed Mealtime PREP strategies into mealtimes.
PARTICIPANT: We recruited one child with ASD for participation in a larger trial through social media advertisement. To be eligible, child participants were between the ages of 18 months and five years and met all four criteria for Sensory Food Aversions: 1) refuses foods based on sensory characteristics; 2) food refusal occurs when novel foods are introduced; 3) eats preferred foods without difficulty; and 4) food refusal causes nutritional deficiencies OR oral motor delay.
MEASURES: A coding scheme was developed to identify different types of inappropriate mealtime behaviors observed using the Observer® XT software from Noldus. One research assistant was trained to be a reliable coder and coded child behaviors (e.g. time away from table, crying) and parental use of intervention strategies. The Behavioral Pediatric Feeding Assessment (BPFAS) was also used to measure child behavior and mealtime problems prior to the baseline phase, directly following intervention, and at a 2-week follow-up time point.
ANALYSIS: The celeration line method and standard mean difference (Cohen’s d) was calculated for the most frequently observed inappropriate behavior for this child, percentage of mealtime away from table. We also used descriptive statistics to describe the change in child and parental behavior over time.
RESULTS: Our participant was a 48-month (3 years, 10 months) old male with ASD and high risk for nutritional deficiency based on the Nutrition Screening for Every Preschooler. We observed significant, moderate effects for increases in both mealtime length (d = .72; p<.05) and percentage of mealtime spent at the table (d = .60; p<.05). Average meal length increased from 16.9 minutes during baseline to 23.1 minutes during intervention. Average percentage of mealtime spent at the table improved from 84% to 92%. Parental use of strategies improved from an average of 1 strategy per meal during baseline to 3 strategies per meal during intervention. Child behavior score on the BPFAS improved from 73 at baseline to 58 at follow-up. Number of parent-reported mealtime child behavior problems decreased from 14 at baseline to 6 at follow-up.
CONCLUSION: The Mealtime PREP feeding intervention improved child mealtime behavior for one child with ASD over a six-week intervention period. This child demonstrated a clinically relevant shift from being categorized as having a clinical feeding problem (>61 on BPFAS) to no longer falling within this range after intervention. Future studies will continue to examine the effects of the Mealtime PREP in children with ASD.
IMPACT STATEMENT: This proposal provides valuable information about the way a child with Autism Spectrum Disorder responds to a parent-mediated mealtime intervention. Clinicians can use this information to guide caregiver training and treatment for mealtime behaviors observed in children with ASD.
References
Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children: Comparison of children with autism spectrum disorder and children with typical development. Physical & occupational therapy in pediatrics, 30(3), 220-233.
Johnson, C. R., Turner, K., Stewart, P. A., Schmidt, B., Shui, A., Macklin, E., ... & Hyman, S. L. (2014). Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. Journal of Autism and Developmental Disorders, 44(9), 2175-2184.
Curtin, C., Hubbard, K., Anderson, S. E., Mick, E., Must, A., & Bandini, L. G. (2015). Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. Journal of autism and developmental disorders, 45(10), 3308-3315.
