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Simeon R, Galeoto G, Cracolici S, Panuccio F, Berardi A. Treatments for Eating Disorders in People with Autism Spectrum Disorder: A Scoping Review. Pediatr Rep 2025; 17:35. [PMID: 40126234 PMCID: PMC11932270 DOI: 10.3390/pediatric17020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 02/18/2025] [Accepted: 02/27/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND This scoping review aims to synthesize existing evidence on non-pharmacological interventions for managing food selectivity in individuals with autism spectrum disorder (ASD). Specifically, it explores sensory, behavioral, and environmental factors influencing intervention outcomes and examines the role of occupational therapists (OTs) within multidisciplinary teams. METHODS A search was conducted across MEDLINE, EBSCO, Web of Science, OTseeker, and SCOPUS from August 2023 to October 2023. Only experimental studies published in English were included, focusing on behavioral treatments and/or occupational therapy interventions. RESULTS A total of 1618 studies were identified. After removing duplicates (170 records), 259 full-text articles were assessed for eligibility, resulting in 61 studies included for qualitative synthesis. CONCLUSIONS The findings highlight a wide range of interventions, yet methodological inconsistencies and small sample sizes limit the strength of the evidence. While occupational therapists play an increasing role in feeding interventions, their specific impact remains underexplored. Future research should focus on larger, well-designed studies with standardized outcome measures to better define the effectiveness of interventions and the role of OTs within multidisciplinary teams.
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Affiliation(s)
- Rachele Simeon
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy;
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (F.P.)
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (F.P.)
| | - Serena Cracolici
- School of Occupational Therapy, Sapienza University of Rome, 00185 Rome, Italy;
| | | | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (F.P.)
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Hladik L, St John BM, Korbel A, Nelson N, Umana M, Kant S, Ausderau KK. "Giving Me the Self-Confidence to Tackle It": Mothers' Experiences Participating In The Engaged Eaters Program, A Caregiver-Mediated Feeding Intervention. J Autism Dev Disord 2025; 55:1045-1056. [PMID: 38400894 DOI: 10.1007/s10803-024-06250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/26/2024]
Abstract
The purpose of this study was to understand caregivers' experience of participating in a caregiver-mediated in-home feeding intervention, the Engaged Eaters Program, for their young autistic child. This qualitative study utilized a thematic approach to analyze post-intervention semi-structured interviews with thirteen mothers of autistic children between the ages of 2 to 7 years after they participated in the intervention. Interview questions focused on the child and family experience, what worked well, what could be improved, and how the intervention integrated into family routines. Four major themes were identified: In-Home Intervention, Parent Skill and Knowledge, Increased Social Participation, and Parent Responsibilities and Challenges. Sub-themes provided descriptions of learning practical tools to support their child, increasing self-efficacy, and impacts on family life. Mothers described an increase in tangible skills that were easily practiced in the home environment that improved their confidence and self-efficacy in feeding their children. They also described how participation did require more work and time commitment for them beyond their regular responsibilities. The caregiver experience is essential to understand for intervention effectiveness while simultaneously addressing child, caregiver, and family needs. By focusing on the mothers' experiences, individualized needs, and self-efficacy, we were able to better understand how integrating an intervention into the family context and daily routines may be beneficial for the whole family.
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Affiliation(s)
- Libby Hladik
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Brittany M St John
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Allie Korbel
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Nicole Nelson
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Molly Umana
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Shannon Kant
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA
| | - Karla K Ausderau
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin at Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin at Madison, Madison, WI, USA.
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Nogueira-de-Almeida CA, de Araújo LA, da V. Ued F, Contini AA, Nogueira-de-Almeida ME, Martinez EZ, Ferraz IS, Del Ciampo LA, Nogueira-de-Almeida CCJ, Fisberg M. Nutritional Factors and Therapeutic Interventions in Autism Spectrum Disorder: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2025; 12:202. [PMID: 40003304 PMCID: PMC11854579 DOI: 10.3390/children12020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 02/05/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025]
Abstract
Objective: To explore recent findings on how nutritional, gastrointestinal, social, and epigenetic factors interact in autism spectrum disorder, highlighting their implications for clinical management and intervention strategies that could improve development and quality of life of affected children. Sources: Studies published from 2000 to 2024 in the PubMed, Web of Science, Scopus, Scielo, Lilacs, and Google Scholar databases were collected. The process for the review adhered to the Search, Appraisal, Synthesis, and Analysis framework. Summary of the findings: Children with autism spectrum disorder have restrictive eating habits and often exhibit food selectivity with either hyper- or hypo-sensory characteristics. This review provides an overview of the literature on diagnosis and intervention strategies for selectivity in autism spectrum disorder, including the involvement of family members in meals, sharing a healthy diet and positive relationship with food, and the importance of exploring visual, olfactory, and tactile experiences of food and introducing new foods through play activities to expand the food repertoire. Modifications in the microbiota and gastrointestinal disorders may also be present in autism spectrum disorder and are presented due to their frequent nutritional repercussions. The medium and long-term implications of food preferences and behavior issues for nutritional status are also discussed, given the tendency for children with autism spectrum disorder to consume low-quality and energy-dense foods, leading to nutritional problems. Conclusions: Children with autism spectrum disorder have feeding difficulties, especially selectivity, gastrointestinal problems, changes in the microbiota and can evolve with micronutrient deficiencies, malnutrition and obesity. This review describes the evidence for possible targets for interventions aiming to improve nutritional health for children with autism spectrum disorder.
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Affiliation(s)
- Carlos A. Nogueira-de-Almeida
- Medical Department, Federal University of São Carlos, Brazil—DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos 13565-905, Brazil;
| | - Liubiana A. de Araújo
- Pediatric Department, Federal University of Minas Gerais, Minas Gerais, UFMG, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil;
| | - Fábio da V. Ued
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Brazil—FMRP-USP, Av Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil;
| | - Andrea A. Contini
- Medical Department, Federal University of São Carlos, Brazil—DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos 13565-905, Brazil;
| | - Maria E. Nogueira-de-Almeida
- Nutrition School, University of São Paulo, Brazil—FMRP-USP, Av, Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil; (M.E.N.-d.-A.); (C.C.J.N.-d.-A.)
| | - Edson Z. Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil—FMRP-USP, Av, Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil;
| | - Ivan S. Ferraz
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil—FMRP-USP, Av Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil; (I.S.F.); (L.A.D.C.)
| | - Luiz A. Del Ciampo
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil—FMRP-USP, Av Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil; (I.S.F.); (L.A.D.C.)
| | - Carla C. J. Nogueira-de-Almeida
- Nutrition School, University of São Paulo, Brazil—FMRP-USP, Av, Bandeirantes, 3.900, Ribeirao Preto 14049-900, Brazil; (M.E.N.-d.-A.); (C.C.J.N.-d.-A.)
| | - Mauro Fisberg
- Pediatric Department, Federal University of São Paulo, UNIFESP, R. Sena Madureira, 1500, São Paulo 04021-001, Brazil;
- Feeding Dificulties Department, PENSI Institute, PENSI, Av. Angélica, 2.071, São Paulo 01227-200, Brazil
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Al-Beltagi M. Nutritional management and autism spectrum disorder: A systematic review. World J Clin Pediatr 2024; 13:99649. [PMID: 39654662 PMCID: PMC11572612 DOI: 10.5409/wjcp.v13.i4.99649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/21/2024] [Accepted: 10/15/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) presents unique challenges related to feeding and nutritional management. Children with ASD often experience feeding difficulties, including food selectivity, refusal, and gastrointestinal issues. Various interventions have been explored to address these challenges, including dietary modifications, vitamin supplementation, feeding therapy, and behavioral interventions. AIM To provide a comprehensive overview of the current evidence on nutritional management in ASD. We examine the effectiveness of dietary interventions, vitamin supplements, feeding therapy, behavioral interventions, and mealtime practices in addressing the feeding challenges and nutritional needs of children with ASD. METHODS We systematically searched relevant literature up to June 2024, using databases such as PubMed, PsycINFO, and Scopus. Studies were included if they investigated dietary interventions, nutritional supplements, or behavioral strategies to improve feeding behaviors in children with ASD. We assessed the quality of the studies and synthesized findings on the impact of various interventions on feeding difficulties and nutritional outcomes. Data extraction focused on intervention types, study designs, participant characteristics, outcomes measured, and intervention effectiveness. RESULTS The review identified 316 studies that met the inclusion criteria. The evidence indicates that while dietary interventions and nutritional supplements may offer benefits in managing specific symptoms or deficiencies, the effectiveness of these approaches varies. Feeding therapy and behavioral interventions, including gradual exposure and positive reinforcement, promise to improve food acceptance and mealtime behaviors. The findings also highlight the importance of creating supportive mealtime environments tailored to the sensory and behavioral needs of children with ASD. CONCLUSION Nutritional management for children with ASD requires a multifaceted approach that includes dietary modifications, supplementation, feeding therapy, and behavioral strategies. The review underscores the need for personalized interventions and further research to refine treatment protocols and improve outcomes. Collaborative efforts among healthcare providers, educators, and families are essential to optimize this population's nutritional health and feeding practices. Enhancing our understanding of intervention sustainability and long-term outcomes is essential for optimizing care and improving the quality of life for children with ASD and their families.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
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Scheier ZA, Sturm KL, Colavecchio JA, Pradhan A, Otazu GH. Role of Odor Novelty on Olfactory Issues in Autism Spectrum Disorder. GENES, BRAIN, AND BEHAVIOR 2024; 23:e70008. [PMID: 39723617 DOI: 10.1111/gbb.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 11/18/2024] [Accepted: 12/02/2024] [Indexed: 12/28/2024]
Abstract
Sensory processing abnormalities are a hallmark of autism spectrum disorder (ASD) and are included in its diagnostic criteria. Among these challenges, food neophobia has garnered attention due to its prevalence and potential impact on nutritional intake and health outcomes. This review describes the correlation between novel odor perception and feeding difficulties within the context of ASD. Moreover, this review underscores the role of odor processing in shaping feeding behaviors within the ASD population. It examines the psychophysics of odor perception in individuals with ASD and evaluates the behavioral and neurophysiological assessments conducted using novel odor stimuli in mouse models relevant to autism and wild-type mice. Additionally, we explore the mechanism on how odor novelty affects neuronal circuitry, shedding light on potential underlying mechanisms for the effect of odor novelty on ASD.
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Affiliation(s)
- Zoe A Scheier
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Kassandra L Sturm
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - John A Colavecchio
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Apekchha Pradhan
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Gonzalo H Otazu
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
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Slater CN, Schroeder K, Fultz A, Kuschner ES, O'Malley L, Johnson K, Benvenuti T, Chittams J, Quinn RJ, Graham Thomas J, Pinto-Martin J, Levy SE, Kral TVE. Insights from user experience and evaluation of a mobile health nutrition intervention for children with autism: A qualitative study. J Hum Nutr Diet 2024; 37:1439-1453. [PMID: 39248190 DOI: 10.1111/jhn.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/17/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD. METHODS The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent-child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open-ended questions. Data analysis of the interview transcripts and open-ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data. RESULTS Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals ("Nutrition Ninja") were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application. CONCLUSIONS Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention.
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Affiliation(s)
- Courtney N Slater
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Krista Schroeder
- Department of Nursing, Temple University College of Public Health, Philadelphia, PA, USA
| | - Amanda Fultz
- Center for Health Behavior Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emily S Kuschner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Departments of Psychiatry and Radiology, Children's Hospital of Philadelphia, PA, USA
| | - Lauren O'Malley
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Jesse Chittams
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ryan J Quinn
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Brown University School of Medicine and The Miriam Hospital, Providence, RI, USA
| | - Jennifer Pinto-Martin
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan E Levy
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Gray HL, Jimenez C, Pang T, Kim E, Shaffer-Hudkins E, Agazzi H, Rosado A, Klinger A, Young C, Kandil J, Won S, Perez A, Sayre WD, Waters KA, Miltenberger RG, Stern M. Recruitment feasibility and dietary and behavioral patterns in toddlers with ASD: Preliminary results from the Autism Eats program. Contemp Clin Trials 2024; 146:107688. [PMID: 39270747 PMCID: PMC11531375 DOI: 10.1016/j.cct.2024.107688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Problematic mealtime behaviors and inadequate diet quality are pressing concerns for children with autism spectrum disorder (ASD). This study aimed to evaluate recruitment feasibility and baseline outcomes of the Autism Eats program for children under 3 years with ASD. METHODS Recruitment feasibility was assessed through reach and participation rates. The Healthy Eating Index (HEI-2015) scores were calculated from 3-day food records. Problematic mealtime behaviors were assessed with the Brief Autism Mealtime Behavior Inventory. Parental feeding practices were assessed using the Child Feeding Questionnaire. Anthropometric measurements of children and parents were taken. Weight-for-length percentiles were calculated based on the CDC growth charts. Descriptive statistics, one-sample t-tests, and Spearman's rho correlations were used for data analysis. RESULTS Of the contacted dyads, 74 % agreed to participate. All 51 enrolled dyads completed baseline survey (100 %), and 98 % completed 3-day food records and anthropometric measurements. Significantly higher problematic mealtime behaviors were observed, compared to the reference (e.g., Total score 55.7 vs. 32.5; p < .001). Children with ASD exhibited lower HEI-2015 scores than national data (e.g., Total score 59 vs. 62). A large proportion of the children (29 %) had a weight-for-length ≥ 95th percentile. Several significant associations were found among mealtime behaviors, diet quality, parental feeding practices, and weight status. CONCLUSION Recruitment was highly feasible, and the findings suggest that early nutrition intervention may hold promise in addressing problematic mealtime behaviors and promoting healthier dietary habits in young children with ASD. CLINICAL TRIAL REGISTRATION This trial has been registered at www. CLINICALTRIALS gov (NCT05194345).
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Claudia Jimenez
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Eunsook Kim
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL, USA
| | - Emily Shaffer-Hudkins
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Heather Agazzi
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Alanis Rosado
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Ankeeta Klinger
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Carissa Young
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jana Kandil
- Biomedical Sciences, University of South Florida, Tampa, FL, USA
| | - Samuel Won
- Biomedical Sciences, University of South Florida, Tampa, FL, USA
| | - Amanda Perez
- Biomedical Sciences, University of South Florida, Tampa, FL, USA
| | - William D Sayre
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Karah A Waters
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Raymond G Miltenberger
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Grot M, Białek-Dratwa A, Krupa-Kotara K, Grajek M, Nigowski M, Szczepańska E, Kowalski O. Negative Aspects of Dietary Habits in Children and Adolescents with Autism Spectrum Disorders. Nutrients 2024; 16:3059. [PMID: 39339659 PMCID: PMC11434785 DOI: 10.3390/nu16183059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Diet therapy is a key component of a holistic approach to the physiological and psychological health of children with autism spectrum disorders. A personalized diet, tailored to clinical symptoms, yields positive therapeutic effects. The aim of this study was to assess the intake of specific food groups and the dietary methods used among children and adolescents with autism. METHODS This study included 141 patients from neuropediatric centers diagnosed with autism spectrum disorders. Inclusion criteria were parental consent for the study, age of the child, and autism diagnosis. The research tool was a custom questionnaire covering patients' demographic data, type of disorder, and a qualitative analysis of the dietary habits of selected products. RESULTS The predominant dietary models were the basic diet (n = 26; 72.22%) and the elimination diet (n = 9; 25%), with a higher application rate among children with autism spectrum disorders. Aversion to specific foods/products was more prevalent in children with autism (n = 79; 75.24%) compared to those with other neurodevelopmental disorders (n = 10; 27.78%). Snacking between meals was significantly more common among the overall neuropediatric patient group (n = 140; 99.29%), with fruit purees (n = 33; 23.57%) and fruits (n = 28; 20%) being the most frequently consumed snacks. CONCLUSIONS The qualitative analysis of dietary habits revealed selective food aversions and eating disorders due to a narrow range of frequently consumed products within dietary groups.
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Affiliation(s)
- Martina Grot
- Doctoral School, Silesian Medical University in Katowice, 15 Poniatowskiego St., 40-055 Katowice, Poland
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 19 Jordana St., Zabrze-Rokitnica, 41-808 Katowice, Poland; (A.B.-D.); (E.S.); (O.K.)
| | - Agnieszka Białek-Dratwa
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 19 Jordana St., Zabrze-Rokitnica, 41-808 Katowice, Poland; (A.B.-D.); (E.S.); (O.K.)
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 41-902 Bytom, Poland;
| | - Mateusz Grajek
- Department of Public Health, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 41-902 Bytom, Poland;
| | - Maciej Nigowski
- Student Scientific Circle, Department of Public Health, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 41-902 Katowice, Poland
| | - Elżbieta Szczepańska
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 19 Jordana St., Zabrze-Rokitnica, 41-808 Katowice, Poland; (A.B.-D.); (E.S.); (O.K.)
| | - Oskar Kowalski
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Silesian Medical University in Katowice, 19 Jordana St., Zabrze-Rokitnica, 41-808 Katowice, Poland; (A.B.-D.); (E.S.); (O.K.)
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9
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Madonna M, Jeffers E, Harding KE. Caregiver training improves child feeding behaviours in children with paediatric feeding disorder and may reduce caregiver stress: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 39238160 DOI: 10.1080/17549507.2024.2381459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to synthesise the evidence from randomised controlled trials for caregiver training on child and family outcomes for children with paediatric feeding disorder. METHOD A systematic review was conducted in accordance with PRISMA guidelines. Searches of Medline, CINAHL, PsychInfo, and EMBASE were conducted using the key concepts of paediatrics, feeding disorders, parents/caregivers, and training. Eligible studies included randomised controlled trials published in peer-reviewed articles, testing the impact of caregiver training on outcomes for children with paediatric feeding disorder. RESULT Eight articles met the inclusion criteria, involving 575 participants from three countries. Seven articles were included in the meta-analyses, providing high certainty evidence that caregiver training improves child feeding behaviours and reduces unhelpful caregiver mealtime strategies compared with no intervention. Uncertainty remains in regard to impact on caregiver stress and intervention intensity. CONCLUSION Caregiver training is an effective strategy for improving outcomes in children with paediatric feeding disorder. Further research is required to determine the most effective methods of caregiver training, including the intensity of treatment required to attain clinically important benefits for families with different levels of need.
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Affiliation(s)
- Megan Madonna
- Eastern Health, Victoria, Australia
- La Trobe University, Bundoora, Australia
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10
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Castro K, Frye RE, Silva E, Vasconcelos C, Hoffmann L, Riesgo R, Vaz J. Feeding-Related Early Signs of Autism Spectrum Disorder: A Narrative Review. J Pers Med 2024; 14:823. [PMID: 39202014 PMCID: PMC11355084 DOI: 10.3390/jpm14080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Feeding difficulties are prevalent among individuals with autism spectrum disorder (ASD). Nevertheless, the knowledge about the association between feeding-related early signs and child development remains limited. This review aimed to describe the signs and symptoms related to feeding during child development and to explore their relevance to the diagnosis of ASD. Specialists in nutrition and/or ASD conducted a search of MEDLINE, PsycINFO, and Web of Science databases. Although studies in typically developing children demonstrate age-related variations in hunger and satiety cues, the literature about early feeding indicators in ASD is scarce. Challenges such as shortened breastfeeding duration, difficulties in introducing solid foods, and atypical mealtime behaviors are frequently observed in children with ASD. The eating difficulties experienced during childhood raise concerns for caregivers who base their feeding practices on their perceptions of food acceptance or refusal. Considering the observed associations between feeding difficulties and ASD, the importance of recognizing feeding-related signs according to developmental milestones is emphasized to alert medical professionals that deviation in the formation of feeding habits and skills could indicate the need for ASD diagnostic investigation.
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Affiliation(s)
- Kamila Castro
- Serviço de Neuropediatria do Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil;
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil;
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas 96010-610, RS, Brazil; (E.S.); (L.H.); (J.V.)
| | - Richard E Frye
- Autism Discovery and Treatment Foundation and Rossignol Medical Center, 4045 E Union Hills Rd, Phoenix, AZ 85050, USA;
| | - Eduarda Silva
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas 96010-610, RS, Brazil; (E.S.); (L.H.); (J.V.)
| | - Cristiane Vasconcelos
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil;
| | - Laura Hoffmann
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas 96010-610, RS, Brazil; (E.S.); (L.H.); (J.V.)
| | - Rudimar Riesgo
- Serviço de Neuropediatria do Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil;
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, RS, Brazil;
| | - Juliana Vaz
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas 96010-610, RS, Brazil; (E.S.); (L.H.); (J.V.)
- Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas 96010-610, RS, Brazil
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11
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Chung LMY, Fang Y, Or PPL, Sun F, Poon ETC, Chan CKM. "Still work?" Design and effect of interventions used to modify feeding problems in children with autism: A systematic review of studies employing group designs. Child Care Health Dev 2024; 50:e13307. [PMID: 39014987 DOI: 10.1111/cch.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/09/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Feeding problems in children with autism jeopardize the well-being of both children with autism and their families. Mixed findings were reported from previous interventions, which were mostly evaluated by single subject research design (SSRD) studies. Moreover, feasibility assessment and social validity measurement were unaddressed by these SSRD studies. To fill this substantial knowledge gap, the present review systematically summarized and evaluated feeding interventions implemented in children with autism, which were assessed by studies employing group designs. METHOD An extensive literature search in eight established online databases was conducted, and a total of 17 eligible studies published in 2009-2021 were included for further analysis. A descriptive account of the features of the investigations is provided, including assessment of study quality. RESULTS A total of 449 children with autism and 203 parents/caregivers participated in the included studies. The multiple use of five strategic intervention components were highlighted in this review, including nutrition education/consultations, environmental modifications, sensory exposure, cognitive components, and behaviour interventions. The reviewed interventions showed a preliminarily positive effect for modifying feeding problems in children with autism. Furthermore, the evaluation based on the RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) demonstrated that an interdisciplinary multi-component intervention strategy may achieve high effectiveness and feasibility in improving feeding problems in a wide range of children with autism. CONCLUSIONS This review found that interventions achieved and maintained a positive effect on modification of feeding problems in groups of children with autism. Information and gaps identified and summarized in the implementation process may assist both researchers and stakeholders to further support these vulnerable children.
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Affiliation(s)
- Louisa Ming Yan Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Peggy Pui Lai Or
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Eric Tsz Chun Poon
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen Ka Man Chan
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
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12
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Patten KK, Murthi K, Onwumere DD, Skaletski EC, Little LM, Tomchek SD. Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan. Am J Occup Ther 2024; 78:7803397010. [PMID: 38758762 DOI: 10.5014/ajot.2024.078301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. OBJECTIVE These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. METHOD These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. RESULTS A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.
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Affiliation(s)
- Kristie K Patten
- Kristie K. Patten, PhD, OT/L, FAOTA, is Counselor to the President and Professor, Department of Occupational Therapy, New York University, New York, NY
| | - Kavitha Murthi
- Kavitha Murthi, MSc(OT), FHEA(UK), OTR, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Dora D Onwumere
- Dora D. Onwumere, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Emily C Skaletski
- Emily C. Skaletski, MOT, OTR/L, is PhD Candidate, Department of Kinesiology, University of Wisconsin-Madison
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, FAOTA, is Associate Dean of Research, College of Health Sciences, and Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, School of Medicine, University of Louisville, Louisville, KY
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13
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Buro AW, Shurack RH, Garcia JM, Gray HL. Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic. Nutr Health 2024; 30:15-19. [PMID: 36694436 PMCID: PMC9902800 DOI: 10.1177/02601060231151985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Jeanette M Garcia
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, USA
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14
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Breda C, Santero S, Conti MV, Cena H. Programmes to manage food selectivity in individuals with autism spectrum disorder. Nutr Res Rev 2024:1-14. [PMID: 38385245 DOI: 10.1017/s0954422424000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders characterised by impaired social communication and restricted interests/repetitive behaviours. In this regard, sensory processing difficulties and delayed oral motor skills often predispose individuals with ASD to food selectivity (FS). It is usually associated with repetitive eating patterns that can lead to multiple malnutrition conditions. The objective of this narrative review is to present an overview about the existing nutritional interventions aiming at promoting a healthy eating pattern and addressing food selectivity among individuals with ASD. Regarding the interventions targeting nutrition education, the majority of the analysed studies failed to demonstrate their effectiveness. On the other hand, many educational interventions involving taste or cooking sessions, as well as behavioural interventions for FS, demonstrated effective results. Moreover, multidisciplinary in tailoring such programmes, including psychology speech therapy and nutritional skills, is acknowledged as a key approach.
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Affiliation(s)
- Chiara Breda
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Sara Santero
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Maria Vittoria Conti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
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15
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Dufault RJ, Adler KM, Carpenter DO, Gilbert SG, Crider RA. Nutritional epigenetics education improves diet and attitude of parents of children with autism or attention deficit/hyperactivity disorder. World J Psychiatry 2024; 14:159-178. [PMID: 38327893 PMCID: PMC10845225 DOI: 10.5498/wjp.v14.i1.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations, creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder (ADHD). Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream, and the severity of their symptoms correlates with the heavy metal levels measured in their blood. Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education. AIM To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake. METHODS The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD. Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test (n = 11) or control (n = 11) group. The test group participated in the six-week online nutritional epigenetics tutorial, while the control group did not. The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods. Diet intake scores were derived for both ultra-processed and whole/organic foods. Paired sample t-tests were conducted to determine any differences in mean diet scores within each group. RESULTS There was a significant difference in the diet scores of the test group between the pre- and post-intervention periods. The parents in the test group significantly reduced their intake of ultra-processed foods with a pre-intervention diet score of 70 (mean = 5.385, SD = 2.534) and a post-intervention diet score of 113 (mean = 8.692, SD = 1.750) and the paired t-test analysis showing a significance of P < 0.001. The test group also significantly increased their consumption of whole and/or organic foods with a pre-intervention diet score of 100 (mean = 5.882, SD = 2.472) and post-intervention diet score of 121 (mean = 7.118, SD = 2.390) and the paired t-test analysis showing a significance of P < 0.05. CONCLUSION Here we show nutritional epigenetics education can be used to reduce ultra-processed food intake and improve attitude among parents having learning-disabled children with autism or ADHD.
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Affiliation(s)
- Renee J Dufault
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO 63501, United States
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
| | - Katherine M Adler
- Department of Health Sciences, University of New Haven, West Haven, CT 06516, United States
| | - David O Carpenter
- Institute for Health and the Environment, School of Public Health, State University of New York, Albany, NY 12222, United States
| | - Steven G Gilbert
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
- Department of Research, Institute of Neurotoxicology and Neurological Disorders, Seattle, WA 98105, United States
| | - Raquel A Crider
- Department of Statistics, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
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Sandbank M, Bottema-Beutel K, Crowley LaPoint S, Feldman JI, Barrett DJ, Caldwell N, Dunham K, Crank J, Albarran S, Woynaroski T. Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis. BMJ 2023; 383:e076733. [PMID: 37963634 PMCID: PMC10644209 DOI: 10.1136/bmj-2023-076733] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To summarize the breadth and quality of evidence supporting commonly recommended early childhood autism interventions and their estimated effects on developmental outcomes. DESIGN Updated systematic review and meta-analysis (autism intervention meta-analysis; Project AIM). DATA SOURCES A search was conducted in November 2021 (updating a search done in November 2017) of the following databases and registers: Academic Search Complete, CINAHL Plus with full text, Education Source, Educational Administration Abstracts, ERIC, Medline, ProQuest Dissertations and Theses, PsycINFO, Psychology and Behavioral Sciences Collection, and SocINDEX with full text, Trials, and ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Any controlled group study testing the effects of any non-pharmacological intervention on any outcome in young autistic children younger than 8 years. REVIEW METHODS Newly identified studies were integrated into the previous dataset and were coded for participant, intervention, and outcome characteristics. Interventions were categorized by type of approach (such as behavioral, developmental, naturalistic developmental behavioral intervention, and technology based), and outcomes were categorized by domain (such as social communication, adaptive behavior, play, and language). Risks of bias were evaluated following guidance from Cochrane. Effects were estimated for all intervention and outcome types with sufficient contributing data, stratified by risk of bias, using robust variance estimation to account for intercorrelation of effects within studies and subgroups. RESULTS The search yielded 289 reports of 252 studies, representing 13 304 participants and effects for 3291 outcomes. When contributing effects were restricted to those from randomized controlled trials, significant summary effects were estimated for behavioral interventions on social emotional or challenging behavior outcomes (Hedges' g=0.58, 95% confidence interval 0.11 to 1.06; P=0.02), developmental interventions on social communication (0.28, 0.12 to 0.44; P=0.003); naturalistic developmental behavioral interventions on adaptive behavior (0.23, 0.02 to 0.43; P=0.03), language (0.16, 0.01 to 0.31; P=0.04), play (0.19, 0.02 to 0.36; P=0.03), social communication (0.35, 0.23 to 0.47; P<0.001), and measures of diagnostic characteristics of autism (0.38, 0.17 to 0.59; P=0.002); and technology based interventions on social communication (0.33, 0.02 to 0.64; P=0.04) and social emotional or challenging behavior outcomes (0.57, 0.04 to 1.09; P=0.04). When effects were further restricted to exclude caregiver or teacher report outcomes, significant effects were estimated only for developmental interventions on social communication (0.31, 0.13 to 0.49; P=0.003) and naturalistic developmental behavioral interventions on social communication (0.36, 0.23 to 0.49; P<0.001) and measures of diagnostic characteristics of autism (0.44, 0.20 to 0.68; P=0.002). When effects were then restricted to exclude those at high risk of detection bias, only one significant summary effect was estimated-naturalistic developmental behavioral interventions on measures of diagnostic characteristics of autism (0.30, 0.03 to 0.57; P=0.03). Adverse events were poorly monitored, but possibly common. CONCLUSION The available evidence on interventions to support young autistic children has approximately doubled in four years. Some evidence from randomized controlled trials shows that behavioral interventions improve caregiver perception of challenging behavior and child social emotional functioning, and that technology based interventions support proximal improvements in specific social communication and social emotional skills. Evidence also shows that developmental interventions improve social communication in interactions with caregivers, and naturalistic developmental behavioral interventions improve core challenges associated with autism, particularly difficulties with social communication. However, potential benefits of these interventions cannot be weighed against the potential for adverse effects owing to inadequate monitoring and reporting.
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Affiliation(s)
- Micheal Sandbank
- Division of Occupational Science and Occupational Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Jacob I Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | | | - Nicolette Caldwell
- Department of Curriculum and Instruction, University of Arkansas, Fayetteville, AR, USA
| | - Kacie Dunham
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | | | - Suzanne Albarran
- Department of Special Education, University of Texas at Austin, Austin, TX, USA
| | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Nashville, TN, USA
- Department of Communication Sciences and Disorders, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
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Pickard K, Burrell TL, Brasher S, Buckley D, Gillespie S, Sharp W, Scahill L. Examining adaptations necessary to support the implementation of a parent-mediated intervention for children with autism spectrum disorder and moderate feeding problems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2434-2445. [PMID: 37062908 DOI: 10.1177/13623613231166181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
LAY ABSTRACT Moderate feeding problems and disruptive mealtime behaviors are common in children with autism spectrum disorder. Although parent-mediated interventions are able to support feeding problems in autistic children, most research has occurred within specialty clinics when delivered by highly trained clinicians. Thus, the fit of these interventions within community settings is not clear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to improve its fit and use within community settings. Participants were 14 multidisciplinary providers who attended one of the three intensive workgroups that included focus groups about the fit of MEAL Plan in their practice setting. Qualitative analysis was used to determine the main themes that came up within the focus groups. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, how providers might adapt their delivery of MEAL Plan, billing and insurance considerations, administrator support for MEAL Plan, and the content and format of ongoing training and consultation. By proactively considering and responding to these factors, it may be possible to enhance MEAL Plan so that it is better able to be delivered and sustained within community practices that support autistic children.
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Affiliation(s)
| | - T Lindsey Burrell
- Atlanta Children's Center, Emory University, USA
- Children's Healthcare of Atlanta, USA
| | | | | | | | - William Sharp
- Emory University, USA
- Children's Healthcare of Atlanta, USA
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Compañ-Gabucio LM, Ojeda-Belokon C, Torres-Collado L, García-de-la-Hera M. A Scoping Review of Tools to Assess Diet in Children and Adolescents with Autism Spectrum Disorder. Nutrients 2023; 15:3748. [PMID: 37686780 PMCID: PMC10489631 DOI: 10.3390/nu15173748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Eating is considered one of the activities of daily living most affected by autism spectrum disorder (ASD) in children and adolescents and, therefore, needs to be thoroughly assessed using specific tools. The aim of this scoping review was to describe the most widely used tool to assess diet in children and adolescents with ASD. A search was conducted on PubMed, Scopus, EMBASE, Web of Science and PsycINFO databases. Two authors screened the articles and included all randomized or non-randomized studies published in English or Spanish in the last five years in which the diet of children and adolescents with ASD was assessed. Fifteen studies were included in this review. Mealtime behaviour was the most assessed variable in the included studies (n = 7). Thirteen different assessment tools were identified to evaluate the diet of children and adolescents with ASD, mainly at ages 2-12 (n = 11). The Brief Assessment scale for Mealtime Behavior in Children (BAMBI) and 24-h recalls were the most commonly used dietary assessment tools in the included studies. Our results can help professionals in the selection of an optimal scale to assess diet in children and adolescents with ASD.
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Affiliation(s)
- Laura María Compañ-Gabucio
- Nutritional Epidemiology Unit (EPINUT), Department of Public Health, History of Science and Gynaecology, University of Miguel Hernández (UMH), 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL, 03010 Alicante, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Carolina Ojeda-Belokon
- Nutritional Epidemiology Unit (EPINUT), Department of Public Health, History of Science and Gynaecology, University of Miguel Hernández (UMH), 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL, 03010 Alicante, Spain
| | - Laura Torres-Collado
- Nutritional Epidemiology Unit (EPINUT), Department of Public Health, History of Science and Gynaecology, University of Miguel Hernández (UMH), 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL, 03010 Alicante, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Manuela García-de-la-Hera
- Nutritional Epidemiology Unit (EPINUT), Department of Public Health, History of Science and Gynaecology, University of Miguel Hernández (UMH), 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL, 03010 Alicante, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
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19
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Conti MV, Breda C, Basilico S, Luzzi A, Voto L, Santero S, De Filippo G, Cena H. Dietary recommendations to customize canteen menus according to the nutritional and sensory needs of individuals with autism spectrum disorder. Eat Weight Disord 2023; 28:66. [PMID: 37526770 PMCID: PMC10393838 DOI: 10.1007/s40519-023-01590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023] Open
Abstract
Individuals with autism spectrum disorders (ASD) are often characterized by food-selectivity, food-neophobia and a marked preference for mild flavor, semi-liquid foods with pale colors. Therefore, they adopt a monotonous dietary pattern, and they prefer ultra-processed food, leading to a high risk of developing malnutrition. In Italy, where 75,072 individuals are diagnosed with ASD, center-based services play a crucial role in their daily management. Despite the centrality of nutrition in maintaining a good state of health, even more for vulnerable subjects, no validated protocol at collective catering level has been developed yet. The manuscript presents customized dietary recommendations aimed at managing the meals for individuals with ASD at collective catering service, derived from a non-systematic literature review exploring food behaviors and nutritional needs in individuals with ASD. Simple practical tips for mealtimes, such as eating together, proper seating, lighting, smell control, presenting food in a simple manner and using the same type of tableware at each meal, to meet the needs of individuals with ASD, were described. The proposal could represent a starting point in developing official guidelines aimed at ASD individuals, in collective catering service.Level of Evidence: Level V.
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Affiliation(s)
- Maria Vittoria Conti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
| | - Chiara Breda
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Sara Basilico
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Alessia Luzzi
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100, Pavia, Italy
- Post Graduate Course in Food Science and Human Nutrition, Università Statale di Milano, 20122, Milan, Italy
| | - Luana Voto
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- ImmunoNutritionLab at the CEINGE-Biotecnologie Avanzate s.c.ar.l Research Center, University of Naples Federico II, 80131, Naples, Italy
| | - Sara Santero
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Giorgia De Filippo
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100, Pavia, Italy
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20
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Burrell TL, Sharp WG, Gillespie S, Pickard K, Brasher S, Buckley D, Scahill L. A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06013-7. [PMID: 37256479 DOI: 10.1007/s10803-023-06013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. METHODS Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. RESULTS A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. CONCLUSIONS These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.
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Affiliation(s)
- Teresa Lindsey Burrell
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, USA
- Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, USA
- Children?s Healthcare of Atlanta, Atlanta, GA, USA
| | - William G Sharp
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, USA
- Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, USA
- Children?s Healthcare of Atlanta, Atlanta, GA, USA
| | - Scott Gillespie
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, USA
| | - Katherine Pickard
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, USA
- Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, USA
| | - Susan Brasher
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, Atlanta, GA, USA
| | - Derianne Buckley
- Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, USA
- Children?s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lawrence Scahill
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, USA.
- Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, USA.
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21
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Baker A, Tomchek SD, Little LM, Wallisch A, Dean E. Interventions to Support Participation in Basic and Instrumental Activities of Daily Living for Autistic Children and Adolescents (2013-2021). Am J Occup Ther 2023; 77:7710393140. [PMID: 37562056 DOI: 10.5014/ajot.2023.77s10014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on interventions to support participation in basic and instrumental activities of daily living by autistic1 children and adolescents (birth to 18 yr).
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Affiliation(s)
- Alissa Baker
- Alissa Baker, MS, OTRL, is Instructor, Department of Occupational Therapy, Western Michigan University, Kalamazoo, MI
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, is Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Anna Wallisch
- Anna Wallisch, PhD, OTR/L, is Postdoctoral Research Associate, Juniper Gardens Children's Project, University of Kansas, Lawrence, KS
| | - Evan Dean
- Evan Dean, PhD, OTR/L, is Associate Director, Beach Center on Disability, University of Kansas, Lawrence, KS
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22
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Bresciani G, Da Lozzo P, Lega S, Bramuzzo M, Di Leo G, Dissegna A, Colonna V, Barbi E, Carrozzi M, Devescovi R. Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020253. [PMID: 36832380 PMCID: PMC9955415 DOI: 10.3390/children10020253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023]
Abstract
The aim of this study was to evaluate the interaction between gastrointestinal (GI) disorders, sleep problems, and challenging behaviors in children with a diagnosis of Autism Spectrum Disorder (ASD) and their effect on parental stress. The secondary objective was to assess the frequency and type of GI and feeding disorders in a sample of children with ASD through a multidisciplinary assessment and, finally, to investigate families' perceptions and satisfaction with the proposed multidisciplinary approach. All children underwent a comprehensive gastroenterological and neuropsychiatric evaluation supported by standardized questionnaires. Pediatric gastroenterologists, specifically trained in Applied Behavior Analysis (ABA), provided advice for parent-delivered behavioral intervention for food selectivity. Thirty-six children with an autism diagnosis (29 males, age 4.5 +/-2.2 years, mean +/- SD) were enrolled. A positive correlation between sleep problems and aggressive behavior was found, and this association was stronger in children experiencing more problematic mealtime behaviors (b = 0.788, p = 0.014). Sleep difficulties were associated with stereotyped behaviors and parent-perceived stress. Parents interviewed about the gastroenterology visit perceived this multidisciplinary approach as helpful in addressing food selectivity. This study shows that sleep and mealtime issues can have a synergistic negative impact on ASD symptoms. A multidisciplinary approach and an integrated assessment of GI, feeding problems, and sleep disorders could be helpful in diagnosing comorbidities and to provide targeted advice to parents.
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Affiliation(s)
- Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Prisca Da Lozzo
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
| | - Sara Lega
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Grazia Di Leo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 38122 Trieste, Italy
- CIMeC Centre for Mind/Brain Sciences, University of Trento, 38122 Rovereto, Italy
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- Correspondence:
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
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23
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Rodrigues JVS, Poli MCF, Petrilli PH, Dornelles RCM, Turcio KH, Theodoro LH. Food selectivity and neophobia in children with autism spectrum disorder and neurotypical development: a systematic review. Nutr Rev 2023:6986143. [PMID: 36633300 DOI: 10.1093/nutrit/nuac112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
CONTEXT Individuals with autism spectrum disorder (ASD) have common eating problems, including food refusal, dietary restrictions, and behavioral problems during eating. OBJECTIVE The aim of this systematic review was to find more clear evidence on the relationship between food selectivity or food neophobia (FN) and ASD in children up to age 14 years. The PECO-based question was: Are food selectivity and FN behaviors more prevalent in children with ASD than in children with neurotypical development (NTD)?, in which the P is children, E is ASD, C is children with NTD, and O is food selectivity and FN. DATA SOURCES Clinical studies in the databases PubMed, Embase and Web of Science, comparing children with ASD and those with NTD, were reviewed from October 1966 to October 2021. STUDY SELECTION AND DATA EXTRACTION A total of 122 studies were analyzed for summary reading, and only 17 of these were included in the descriptive qualitative analysis. In 9 studies, the analysis of food selectivity was performed via a questionnaire. RESULTS The results showed that children with ASD are more selective than those with NTD. Four studies evaluated FN through scales; however, only 2 found higher levels of FN in the ASD group than in children with NTD. The sensory profile was measured using questionnaires in 9 studies, and we found that altered sensory processing is more common in children with ASD. CONCLUSION Children with ASD present greater food selectivity than children with NTD. However, the occurrence of FN was higher in only 50% in which FN was investigated, which points to a need for studies that compare FN between siblings with ASD and those with NTD in the same family nucleus. In addition, atypical oral sensitivity seems to be a sensory characteristic most related to eating disorders. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021247880.
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Affiliation(s)
- João Victor S Rodrigues
- Department of Diagnostic and Surgery, School of Dentistry of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Maria Clara F Poli
- Department of Diagnostic and Surgery, School of Dentistry of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Pedro H Petrilli
- Department of Diagnostic and Surgery, School of Dentistry of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Rita Cássia M Dornelles
- Department of Basic Sciences, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Karina H Turcio
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Leticia H Theodoro
- Department of Diagnostic and Surgery, School of Dentistry of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil
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24
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Exploration of Treatment Response in Parent Training for Children with Autism Spectrum Disorder and Moderate Food Selectivity. J Autism Dev Disord 2023; 53:229-235. [PMID: 35032300 DOI: 10.1007/s10803-021-05406-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Managing Eating Aversions and Limited Variety (MEAL) Plan is a structured parent-mediated intervention for children with autism spectrum disorder and moderate food selectivity. Our previously reported group-based clinical trial revealed a positive treatment response rate of 47.3%. Although encouraging, this response rate raises questions about factors that may affect treatment outcomes. Here, we examine the impact of child and parent characteristics and feeding behaviors on treatment response. Higher maternal education and higher child communication abilities at baseline were associated with positive treatment response. Improvement in sitting at the table and reductions in disruptive mealtime behavior promoted treatment success. Results also suggest that individually delivered MEAL Plan may offer more flexibility than group-based intervention for some parents.
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25
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Hodges AK, Hathaway KL, McMahon MXH, Volkert VM, Sharp WG. Treatment of Feeding Concerns in Children With Autism Spectrum Disorder: A Systematic Review of Behavioral Interventions With Caregiver Training. Behav Modif 2022:1454455221137328. [DOI: 10.1177/01454455221137328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Successful feeding intervention ultimately requires generalization and adoption of treatment into the home. Treatment models, however, differ regarding how and when caregivers are integrated into care delivery process. Some treatments involve a primary model of parent training with caregivers serving as co-therapist at the onset of intervention, while others involve a complimentary model where a therapist delivers the intervention and caregiver training occurs once the child’s behavior is stable. This review systematically evaluates the evidence-base regarding behavioral feeding intervention for children with autism spectrum disorder (ASD), with a specific focus on interventions involving parent training. Results provide further evidence regarding the potential benefits of behavioral intervention to improve feeding concerns in ASD, while also highlighting growing attention to documenting and/or evaluating parent training within the treatment literature. Important questions remain regarding factors guiding the use of a primary or complimentary model of parent training.
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Affiliation(s)
- Abby K. Hodges
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Kristin L. Hathaway
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Meara X. H. McMahon
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - Valerie M. Volkert
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
| | - William G. Sharp
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta’s Multidisciplinary Feeding Program, Atlanta, GA, USA
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26
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Evaluating Outcome Measure Data for an Intensive Interdisciplinary Home-Based Pediatric Feeding Disorders Program. Nutrients 2022; 14:nu14214602. [DOI: 10.3390/nu14214602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness of an interdisciplinary home-based feeding program, which is a unique service delivery model. Methods: Data were provided on oral intake, tube feeding elimination, and weight for patients who were dependent on tube feedings (n = 78). Weight data were collected for patients who showed failure to thrive (n = 49). Number of foods consumed and percentage of solids were collected for patients who were liquid-dependent (n = 23), and number of foods consumed were collected for patients who were food-selective (n = 61). Results: Data were analyzed using paired sample t-test with 95% confidence interval. For patients dependent on tube feedings, 81% achieved tube feeding elimination. Tube elimination was achieved after 8 months of treatment on average. All failure-to-thrive patients showed weight gain from baseline to discharge. For liquid-dependent patients, there was an increase in foods consumed from 2 foods at admission to 32 foods at discharge. For food selective patients, there was an increase from 4 foods at admission to 35 foods at discharge. For all dependent variables, results showed statistical significance and a large-sized effect. Conclusions: These data show that an intensive interdisciplinary home-based program can be successful in treating complex feeding problems in children.
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27
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Ibañez VF, Peters KP, Bacotti JK, Lloveras LA, Van Arsdale A, Vollmer TR. Teaching behavior analysts in an early intensive behavioral intervention setting to conduct a structured mealtime protocol. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vivian F. Ibañez
- Deparment of Psychology University of Florida Gainesville Florida USA
| | - Kerri P. Peters
- Deparment of Psychology University of Florida Gainesville Florida USA
- Department of Psychiatry University of Florida Gainesville Florida USA
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28
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Thorsteinsdottir S, Njardvik U, Bjarnason R, Olafsdottir AS. Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial. Nutrients 2022; 14:4000. [PMID: 36235654 PMCID: PMC9571701 DOI: 10.3390/nu14194000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
| | - Urdur Njardvik
- Faculty of Psychology, School of Health Sciences, University of Iceland, Saemundargata 12, 102 Reykjavik, Iceland
| | - Ragnar Bjarnason
- Faculty of Medicine, School of Health Sciences, University of Iceland, Laeknagardur 4th Floor, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland
- Department of Pediatrics, National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
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29
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Ahumada D, Guzmán B, Rebolledo S, Opazo K, Marileo L, Parra-Soto S, Viscardi S. Eating Patterns in Children with Autism Spectrum Disorder. Healthcare (Basel) 2022; 10:healthcare10101829. [PMID: 36292276 PMCID: PMC9601475 DOI: 10.3390/healthcare10101829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this research was to analyze the eating patterns of preschool- and school-aged children with ASD, as provided by their families, in the La Araucanía Region of Chile. It involved a cross-sectional study with 72 families with children diagnosed with ASD aged between 2 and 12 years old. Food selectivity, appetite, body mass index (BMI) and frequency of food consumption were studied. The research determined that 97.67% present food selectivity, corresponding to alterations in the frequency of consumption of specific food groups. Moreover, 93.06%, 90.28%, 80.56% and 62.50% of children in the study do not meet the daily recommendations for fruit, fish, water and vegetable consumption, respectively. Therefore, it is important for these findings to be considered when designing and carrying out educational interventions regarding food in families with children with ASD for greater assertiveness and effectiveness in improving health.
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Affiliation(s)
- Danay Ahumada
- Carrera de Nutrición y Dietética, Departamento de Procesos Diagnóstico y Evaluación, Facultad de Ciencias de la Salud, Campus San Francisco, Universidad Católica de Temuco, Temuco 4813302, Chile
- Programa de Magister en Epidemiología Clínica, Facultad de Medicina, Universidad de la Frontera, Temuco 4813115, Chile
| | - Barbara Guzmán
- Carrera de Nutrición y Dietética, Departamento de Procesos Diagnóstico y Evaluación, Facultad de Ciencias de la Salud, Campus San Francisco, Universidad Católica de Temuco, Temuco 4813302, Chile
| | - Soledad Rebolledo
- Carrera de Nutrición y Dietética, Departamento de Procesos Diagnóstico y Evaluación, Facultad de Ciencias de la Salud, Campus San Francisco, Universidad Católica de Temuco, Temuco 4813302, Chile
| | - Karol Opazo
- Carrera de Nutrición y Dietética, Departamento de Procesos Diagnóstico y Evaluación, Facultad de Ciencias de la Salud, Campus San Francisco, Universidad Católica de Temuco, Temuco 4813302, Chile
| | - Luis Marileo
- Programa de Doctorado en Ciencias Agropecuarias, Facultad de Recursos Naturales, Universidad Católica de Temuco, Temuco 4813302, Chile
- Biotechnology of Functional Foods Laboratory, Camino Sanquilco, Padre Las Casas 4850827, Chile
| | - Solange Parra-Soto
- School of Health & Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
- Departamento de Nutrición y Salud Publica, Universidad del Bio-Bio, Chillan 3780000, Chile
| | - Sharon Viscardi
- Biotechnology of Functional Foods Laboratory, Camino Sanquilco, Padre Las Casas 4850827, Chile
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnóstico y Evaluación, Facultad de Ciencias de la Salud, Campus San Francisco, Universidad Católica de Temuco, Temuco 4813302, Chile
- Núcleo de Investigación en Producción Alimentaria, Universidad Católica de Temuco, Temuco 4813302, Chile
- Correspondence:
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30
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Gray HL, Pang T, Agazzi H, Shaffer-Hudkins E, Kim E, Miltenberger RG, Waters KA, Jimenez C, Harris M, Stern M. A nutrition education intervention to improve eating behaviors of children with autism spectrum disorder: Study protocol for a pilot randomized controlled trial. Contemp Clin Trials 2022; 119:106814. [PMID: 35671902 PMCID: PMC10822341 DOI: 10.1016/j.cct.2022.106814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder that affects communication and social behaviors. Children with ASD often experience mealtime behavior challenges and selective eating behaviors. They also tend to consume fewer fruits and vegetables and more high-energy dense foods, compared to neurotypical peers. A nutrition intervention was designed to prevent the development of feeding disorders and the long-term negative health impacts associated with poor dietary intake. This randomized controlled trial will evaluate the feasibility and preliminary efficacy of the nutrition education intervention for children with ASD and their parents through the Early Intervention (EI) services. We will recruit EI providers and parent-child dyads (n = 48) from EI programs, and randomly assign them into Autism Eats intervention (n = 24) or enhance usual care (EUC) comparison group (n = 24). The Autism Eats is 10 weekly sessions delivered individually as part of EI, while the EUC group will receive only 1 nutrition education session and then weekly parent handouts. The Autism Eats integrates ASD-specific feeding strategies and behaviorally-focused intervention strategies such as goal setting. Feasibility indicators include reach/participation, attrition, completion, fidelity, compatibility, and qualitative participant feedback. Outcome measures include dietary intakes and mealtime behaviors of children with ASD using 3-day food records and a validated questionnaire, the Brief Autism Mealtime Behavior Inventory (BAMBI). We will examine whether there are differences in children's food intakes, variety, diet quality, and mealtime behaviors between Autism Eats and EUC groups at post-intervention and 5-month follow-up assessment. This study will provide critical data to inform a full-scale randomized controlled trial.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, United States of America.
| | - Tiantian Pang
- College of Public Health, University of South Florida, Tampa, FL, United States of America.
| | - Heather Agazzi
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America.
| | - Emily Shaffer-Hudkins
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America.
| | - Eunsook Kim
- Department of Educational Measurement and Research, College of Education, University of South Florida, Tampa, FL, United States of America.
| | - Raymond G Miltenberger
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
| | - Karah A Waters
- College of Public Health, University of South Florida, Tampa, FL, United States of America.
| | - Claudia Jimenez
- College of Public Health, University of South Florida, Tampa, FL, United States of America.
| | - Monise Harris
- College of Public Health, University of South Florida, Tampa, FL, United States of America.
| | - Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
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31
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Short SS, Reeder RW, Lewis KE, Dickie B, Grabowski J, Sepuha T, Durham MM, Frischer J, Badillo A, Calkins CM, Rentea RM, Ralls M, Wood RJ, Fuller MK, van Leeuwen K, Avansino JR, Austin K, Rollins MD. The presence of a neurodiverse disorder is associated with increased use of antegrade enema therapy in children with severe constipation: A study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). J Pediatr Surg 2022; 57:1676-1680. [PMID: 35597676 DOI: 10.1016/j.jpedsurg.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with laxative or enema therapy remain limited and are often complicated by patient/caregiver compliance. We hypothesized that children with neurodiverse disorders and severe constipation would benefit from a bowel management program (BMP) that includes early use of antegrade enemas. MATERIALS AND METHODS Children requiring BMP in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry with diagnosis of constipation and/or constipation with pseudo-incontinence were reviewed. Those with Hirschsprung disease and/or Anorectal Malformation were excluded. BMP needs in patients with a neurodiverse diagnosis were compared to those without to evaluate differences in BMP's. RESULTS 372 patients requiring a BMP were identified. 95 patients (58 autism spectrum, 54 developmental delay) were neurodiverse, and 277 patients were not. Neurodiverse patients had a higher prevalence of enema therapy 62.1% (59/95) vs. 54.9% (152/273) and use of antegrade enema therapy 33.7% (32/95) vs. 21.2% (58/273), p = 0.126. Neurodiverse patients were older 37.9% (36/95) > 12 years vs. 23.1% (63/273), p = 0.001 and 47.6% (10/21) were changed from laxative to enema therapy over time. 80% (8/10) of those changed from laxatives to enemas used antegrade therapy. 67.3% (35/52) of neurodiverse patients followed over time were on enema therapy at the most recent visit with 80% (28/35) requiring antegrade therapy. CONCLUSION A large portion of patients with a neurodiverse disorder who fail laxative therapy use antegrade enemas to achieve effective bowel management. Early consideration of an antegrade conduit may simplify treatment in this group of children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Scott S Short
- Primary Children's Hospital, 100 N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, USA.
| | | | | | | | | | | | | | | | | | | | | | - Matt Ralls
- C.S. Mott Children's Hospital/Univ. of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | - Michael D Rollins
- Primary Children's Hospital, 100 N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, USA
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Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders. Nutrients 2022; 14:nu14132660. [PMID: 35807840 PMCID: PMC9268444 DOI: 10.3390/nu14132660] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022] Open
Abstract
Food selectivity (FS) in children with autism spectrum disorders (ASD) is common, and its impact on a nutritional level is known. However, the etiology of gastrointestinal disorders (GID) related to alterations in the intestinal microbiota in children with ASD remains unclear. This article provides a narrative review of the literature on FS from the last 15 years, and its relationship with GID in children with ASD. Sensory aversion in ASD leads to food elimination, based on consistencies, preferences, and other sensory issues. The restriction of food groups that modulate the gut microbiota, such as fruits and vegetables, as well as the fibers of some cereals, triggers an intestinal dysbiosis with increased abundance in Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa, which, together with an aberrant immune response and a leaky gut, may trigger GID. It is observed that FS can be the product of previous GID. GID could provide information to generate a hypothesis of the bidirectional relationship between FS and GID. Emphasis is placed on the need for more studies with methodological rigor in selecting children with ASD, the need for homogeneous criteria in the evaluation of GID, and the adequate classification of FS in children with ASD.
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A Preliminary Evaluation of a Brief Behavioral Parent Training for Challenging Behavior in Autism Spectrum Disorder. J Autism Dev Disord 2022:10.1007/s10803-022-05493-3. [PMID: 35488976 PMCID: PMC9055015 DOI: 10.1007/s10803-022-05493-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/03/2022]
Abstract
Children with autism spectrum disorder (ASD) often exhibit challenging behaviors. Existing behavioral parent trainings (BPT) address ASD symptomology, but are lengthy and associated with significant attrition. In the current pilot study, a longitudinal randomized controlled trial was used to evaluate a novel brief BPT targeting caregivers of children with ASD ages 5–9. The 6-session BPT, delivered in a group format, focused on high-frequency challenging behaviors (e.g., problem behaviors, feeding and sleep issues). Caregivers who received BPT (n = 29), relative to an active control (psychoeducation/supportive therapy; n = 9), reported higher treatment satisfaction and acceptability. Challenging behaviors were reduced in the BPT and active control groups. The novel BPT was a feasible and acceptable intervention to target challenging behaviors in youth with ASD.
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Carter Leno V, Micali N, Bryant-Waugh R, Herle M. Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating. EUROPEAN EATING DISORDERS REVIEW 2022; 30:604-615. [PMID: 35388530 PMCID: PMC9542277 DOI: 10.1002/erv.2902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Objective Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours. Method Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent‐rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self‐reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education. Results Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002–0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours. Conclusion Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development.
There is evidence that high levels of autistic traits are associated with an increased likelihood of experiencing an eating disorder. The current study sought to test whether the link between autism and eating disorders could in part be explained by variation in fussy eating. In a large prospective cohort study, we found a significant indirect effect of fussy eating, such that higher childhood autistic traits were associated with a shallower decline in fussy eating between childhood and adolescence, which in turn was associated with higher levels of eating disorder behaviours in adolescence.
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Affiliation(s)
- Virginia Carter Leno
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nadia Micali
- Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Moritz Herle
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Fujino H, Ikeda Y. Dealing with food selectivity and mealtime behaviour in school-children with autism: a qualitative study of special education teachers in Japan. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 69:860-868. [PMID: 37885840 PMCID: PMC10599203 DOI: 10.1080/20473869.2022.2028419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/10/2022] [Indexed: 10/28/2023]
Abstract
Food selectivity in children with autism spectrum disorder (ASD) is a serious issue in special needs schools, and special education teachers face various difficulties in their management of the problem. The aim of this study is to investigate the difficulties that special education teachers face in managing food selectivity in children with ASD. Data were obtained from 12 special education teachers in 2018 via semi-structured in-depth interviews. Thematic analysis was used to identify key conceptions of the participants' experiences, while qualitative analysis of the interview data revealed three major themes. Their personal and professional thoughts and hopes regarding eating habits in children, feelings of uncertainty about their practice, and their interactions with the children and their parents were the key factors behind the difficulties they experience as special education teachers. The findings improve our understanding of the challenges experienced by teachers managing food selectivity in children with ASD. A different conceptualisation of the problem may lead to difficulties in collaboration among the people who are tasked with solving the problem.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, United Graduate School of Child Development, Osaka University, Suita, Japan
- Department of Special Needs Education, Oita University, Oita, Japan
| | - Yukiko Ikeda
- Department of Special Needs Education, Oita University, Oita, Japan
- Nagasaki Prefectural Kakunan Special Needs School, Nagasaki, Japan
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Harris HA, Mou Y, Dieleman GC, Voortman T, Jansen PW. Child Autistic Traits, Food Selectivity, and Diet Quality: A Population-Based Study. J Nutr 2021; 152:856-862. [PMID: 34871440 PMCID: PMC8891181 DOI: 10.1093/jn/nxab413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/28/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with Autism Spectrum Disorders (ASDs) tend to be selective in their food intake, which may compromise their diet quality. While ASD diagnoses capture severe levels of impairment, autistic traits vary on a continuum throughout the population. Yet, little is known about how autistic traits relate to diet quality at the population level. OBJECTIVES This study examines the association between autistic traits in early childhood and diet quality in mid-childhood and explores the mediating role of food selectivity. METHODS Participants were children (n = 4092) from the population-based Generation R Study. Parents reported their child's autistic traits at 1.5, 3, and 6 years; food selectivity at 4 years; and food intake at 8 years, from which a diet quality score was derived. Associations of autistic traits and the autistic trait trajectory (identified using Latent Class Growth Modelling) with diet quality were examined using multiple linear regression models. The indirect effect of food selectivity in the association between autistic traits at 1.5 years and diet quality was examined using mediation analysis. RESULTS Autistic traits were associated with diet quality (e.g., 1.5 years: β = -0.09; 95% CI: -0.13 to -0.06). Two classes captured the autistic trait trajectories from 1.5 to 6 years: children with "low and stable" (95%) and "high and increasing" (5%) mean scores. Children in the high and increasing group had poorer diet quality than those in the low and stable group (β = -0.28; 95% CI: -0.44 to -0.11). Food selectivity mediated the association between autistic traits at 1.5 years and diet quality at 8 years (βindirect = -0.03; 95% CI: -0.03 to -0.02). CONCLUSIONS Autistic traits in early childhood are associated with poorer diet quality in mid-childhood, and food selectivity appears to mediate this association. Interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents' responding to their child's food selectivity.
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Affiliation(s)
| | - Yuchan Mou
- Generation R Study, Erasmus MC, University Medical Center, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gwen C Dieleman
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Pauline W Jansen
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Manzanarez B, Garcia S, Iverson E, Lipton-Inga MR, Blaine K. Lessons in Adapting a Family-Based Nutrition Program for Children With Autism. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1038-1047. [PMID: 34895557 DOI: 10.1016/j.jneb.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents. METHODS Children aged 7-12 years with autism and their parent participated in 6 weekly sessions. Recruitment, intervention, and data collection took place in a community health center in an urban area. RESULTS Of the 50 referred participants, 38% attended the first classes, and 26% completed the program. Families and staff expressed satisfaction; parents reported increased physical activity, fruit, and vegetable intake in their children. Parents also desired continued learning and individualized recommendations. CONCLUSIONS AND IMPLICATIONS Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism. As many children with autism battle with obesity, the findings from this pilot provide important insight into supporting these families and can further inform the development of evidence-based practices currently lacking for children with autism and their families.
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Affiliation(s)
- Brenda Manzanarez
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Samantha Garcia
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ellen Iverson
- The Diabetes and Obesity Program and Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Megan R Lipton-Inga
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kevin Blaine
- California-based Nurse-led Discharge Learning (CANDLE) Collaborative, Institute for Nursing and Interprofessional Research, Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA
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Suarez M. Just Right Challenge Feeding Protocol: Case-Report for Guiding Clinical Reasoning and Future Research in Food Selectivity Treatment. Occup Ther Health Care 2021; 36:391-407. [PMID: 34792437 DOI: 10.1080/07380577.2021.2003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Food selectivity impacts health and quality of life for children with developmental disabilities. Best practice protocols are still in development and use of escape extinction, systematic desensitization and parent education are elements that may be part of effective multi-component treatment. The Just Right Challenge Feeding Protocol (JRCFP) includes each of these elements to drive changes in food acceptance for children with developmental disabilities. This case-report provides detailed information about how a group of children progress through treatment. Children in this case-report had 15 or less foods in their food inventory and profiles indicating the presence of sensory over-responsivity. Every 5-10 weeks, each child moved up one step in the Food Interaction Hierarchy (e.g. touch, taste, eat). Significant increases in vegetable and fruit acceptance and mealtime quality are noted and parent compliance on home program assignments is described. This information is valuable for guiding clinical reasoning and future research of treatment for food selectivity.
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Affiliation(s)
- Michelle Suarez
- Occupational Therapy Department, Western Michigan University, Kalamazoo, Michigan, USA
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Abstract
OBJECTIVE To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy. METHOD We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high. RESULTS The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement. CONCLUSIONS Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.
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Markowitz G, Buzby M. Weighing in on Children with Autism: Rethinkingee e Strategies for Weight Management. J Pediatr Nurs 2021; 59:209-210. [PMID: 33934938 DOI: 10.1016/j.pedn.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Goldie Markowitz
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
| | - Marianne Buzby
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
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Narzisi A, Masi G, Grossi E. Nutrition and Autism Spectrum Disorder: Between False Myths and Real Research-Based Opportunities. Nutrients 2021; 13:nu13062068. [PMID: 34204187 PMCID: PMC8234602 DOI: 10.3390/nu13062068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a multicomplex disorder characterized by an umbrella of specific issues in the areas of social communication, restricted interests, and repetitive behaviors [...].
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Affiliation(s)
- Antonio Narzisi
- Department of Child Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56018 Pisa, Italy;
- Correspondence:
| | - Gabriele Masi
- Department of Child Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56018 Pisa, Italy;
| | - Enzo Grossi
- Villa Santa Maria Foundation, Tavernerio, 22038 Como, Italy;
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Clark RJ, Wilder DA, Kelley ME, Ryan V. Evaluation of Instructions and Video Modeling to Train Parents to Implement a Structured Meal Procedure for Food Selectivity Among Children With Autism. Behav Anal Pract 2020; 13:674-678. [PMID: 32953395 DOI: 10.1007/s40617-020-00419-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We evaluated written instructions plus video modeling-and when necessary, in vivo prompting and feedback-to teach 3 parents to implement a structured meal procedure to decrease food selectivity among their children with autism. In addition to data on correct parent implementation, we also collected data on child bite acceptance. Results showed that instructions and video modeling were effective to achieve the mastery criteria for 1 parent; the other 2 parents required in vivo prompts and feedback. Two of the children exhibited an increase in bite acceptance during the structured meal procedure.
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Affiliation(s)
- Ronald J Clark
- Florida Institute of Technology and the Scott Center for Autism Treatment, Melbourne, FL USA
- Florida Institute of Technology, School of Behavior Analysis, 150 West University Blvd., Melbourne, FL 32901 USA
| | - David A Wilder
- Florida Institute of Technology and the Scott Center for Autism Treatment, Melbourne, FL USA
- Florida Institute of Technology, School of Behavior Analysis, 150 West University Blvd., Melbourne, FL 32901 USA
| | - Michael E Kelley
- The University of Scranton, 800 Linden St., Scranton, PA 18510 USA
| | - Victoria Ryan
- Florida Institute of Technology and the Scott Center for Autism Treatment, Melbourne, FL USA
- Florida Institute of Technology, School of Behavior Analysis, 150 West University Blvd., Melbourne, FL 32901 USA
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