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| An In-Depth and Large Scale Analysis of the Treatment of Feeding Disorders Among Children with Autism Spectrum Disorders |
| Monday, May 26, 2014 |
| 2:00 PM–3:50 PM |
| W183b (McCormick Place Convention Center) |
| Area: AUT/CBM; Domain: Applied Research |
| Chair: Valerie M. Volkert (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Discussant: Dorothea C. Lerman (University of Houston-Clear Lake) |
| CE Instructor: Valerie M. Volkert, Ph.D. |
| Abstract: Feeding problems are frequently exhibited by children with autism spectrum disorders (ASD). The current symposium will focus on the evaluation of commonly used and new treatments and provide two large-scale analyses of treatment outcomes for children with feeding problems and ASD. The first presentation compares the effects of sensory integration, specifically the Sequential-Oral-Sensory approach, to an applied behavior analytic approach in the treatment of food selectivity. The second presentation describes outcomes for 43 children with ASD treated in an intensive day-treatment program between 2009 and 2013. The third presentation provides an overview of how intensive treatment can be initiated for children with feeding disorders in the home environment using an interdisciplinary model. Data will be presented for at least 185 patients in the last 10 years. The fourth presentation describes treatment outcomes for a group of six children with ASD treated for food selectivity and obesity. A proposed treatment model for addressing food selectivity and concurrent weight management concerns in ASD will also be presented. Finally, Dr. Dorothea Lerman will serve as the discussant and will provide a synthesis of these studies within the context of current research in the area of feeding problems exhibited by children with ASD. |
| Keyword(s): autism, feeding disorders, food selectivity, treatment outcomes |
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A Comparison of the Sequential-Oral-Sensory Approach to an Applied Behavior Analytic Approach in the Treatment of Food Selectivity in Children with Autism |
| KATHRYN M. PETERSON (University of Nebraska Medical Center), Valerie M. Volkert (Munroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: The prevalence of feeding disorders in children with autism is estimated to be as high as 85% (Ahearn et al., 2001; Laud et al., 2012), with food selectivity (i.e., consumption of a limited variety of foods) reported as the most common problem. Although applied behavior analytic (ABA) treatments have the most empirical support as treatment for feeding problems (Volkert & Piazza, 2012), professionals often recommend and caregivers often use sensory-integration-based treatments. In the current investigation, we compared the effects of sensory integration (the Sequential-Oral-Sensory approach [SOS]; Toomey, 2009) to ABA in the treatment of food selectivity in children with autism. Thus far, we have enrolled six participants, in pairs, who were diagnosed with autism and displayed food selectivity. We assigned two participants to ABA and two to SOS and then evaluated the effects of each treatment in a multiple baseline design. Results thus far, have demonstrated that the SOS intervention did not lead to improvement across any dependent measures (acceptance, mouth clean [swallowing]), while ABA led to marked increases in responding across all measures. |
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| A Retrospective Chart Review of Dietary Diversity and Feeding Behavior of Children with Autism Spectrum Disorder Before and After Admission to a Day-Treatment Program: An Update of Research Findings |
| ROSEANNE S LESACK (Marcus Autism Center), William G. Sharp (The Marcus Autism Center), David L. Jaquess (Marcus Autism Center) |
| Abstract: Children with autism spectrum disorders (ASD) have a fivefold increase in the odds of developing a feeding problem compared with peers, placing this population at risk for vitamin and mineral deficiencies (Sharp et al., 2013). At this time, behavioral intervention is the only treatment for severe feeding disorders with well-documented empirical support (Sharp et al., 2011), and there is growing evidence that this technology can be applied to address feeding problems in ASD. Evidence supporting behavioral intervention targeting feeding disorders in ASD involves a small number of single-case design studies (Ledford & Gast, 2006), as well as retrospective chart reviews (Laud et al., 2009; Sharp et al., 2010) treating samples of 46 and 13 children (respectively) treated at intensive feeding programs. The current study updates the work of Sharp et al. by presenting outcomes for 43 children with ASD treated between 2009 and 2013. Upon admission, participants exhibited severely restricted diets and high rates of disruptive mealtime behavior. Treatment involved escape extinction, reinforcement, and stimulus fading procedures. Outcomes focused on dietary diversity and key mealtime behaviors, including acceptance, swallowing, and disruptive mealtime behaviors. Following treatment, significant improvements (p < .01) regarding food variety, consumption, and appropriate mealtime behavior were demonstrated. |
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| Evaluating the Outcomes of an Interdisciplinary Home-Based Pediatric Feeding Disorders Program for Children with Autism and other Developmental Disabilities |
| STEPHANIE MILLER (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz), Allyne Marcon-Dawson (Clinic 4 Kidz), Christa F. Curtaz (Clinic 4 Kidz), Sherrene B. Fu (Clinic 4 Kidz), Ashlee Matrigali (Clinic 4 Kidz), Aida Miles (Clinic 4 Kidz), Danielle Shahan (Clinic 4 Kidz) |
| Abstract: Feeding disorders are common in children with autism and other disabilities. Some children may be at risk for weight loss and may eventually be placed on gastrostomy feedings while others may not have advanced with regards to variety and textures of food. Nutritional deficiencies may also be noted especially with children with autism who display severe food selectivity. It is ideal that treatment be provided by a team of professionals. Typically these services are provided in a clinic/hospital environment; however, a similar model is also used in the home environment. The purpose of this presentation is to provide an overview of how intensive treatment can be initiated for children with feeding disorders in the home environment using an interdisciplinary model. Data will be presented for at least 185 patients who were admitted to the Clinic 4 Kidz Pediatric Feeding Disorders Program in the last 10 years. Preliminary data suggests that this type of intensive home-based program is effective at decreasing tube dependency, increasing oral intake and variety of foods consumed, and decreasing refusal behaviors in a short period of time. Outcome data and the treatment approach used to treat feeding problems in children with autism will also be presented. |
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| Outcomes for Children with Autism Spectrum Disorder Treated for Food Selectivity and Obesity in an Outpatient Setting: Establishing Foundations for a Treatment Model |
| KATHRYN HOLMAN (Marcus Institute), Kristen K Criado (Marcus Autism Center & Emory University), William G. Sharp (The Marcus Autism Center) |
| Abstract: Children with autism spectrum disorders (ASD) often present with food selectivity involving strong preferences for starches, fats, and snack foods coinciding with a bias against fruits and vegetables. Emerging evidence also indicates children with ASD are at increased risk for obesity compared with peers. In our outpatient feeding clinic, we are increasingly faced with addressing both food selectivity and obesity among children with ASD, yet no treatment models exist to support clinical care. A significant obstacle to weight management in ASD involves restricting high fat/calorie foods and increasing consumption of fruits and vegetables due the intense behavioral responses that accompany the restriction of preferred foods and introduction of healthy foods. Additional barriers to healthy lifestyles in ASD include cognitive deficits (impairing healthy food choices and promoting impulsive eating) and decreased opportunities for physical activity. The current study describes treatment outcomes for a group of six children with ASD treated for food selectivity and obesity in an outpatient setting. Outcomes include dietary variety, BMI percentile, and engagement in physical activity. A proposed treatment model for addressing food selectivity and concurrent weight management concerns in ASD is presented with consideration of the unique behavioral and developmental presentations in this population. |
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