Interventions for Atypical Feeding Behaviour Interventions In Children with Autistic Spectrum Disorders (ASD): a Systematic Review of the Evidence

Background: Many children with ASD have feeding, eating and mealtime challenges . These feeding difficulties may be one of the earliest symptoms of ASD and  these problems may be lifelong without appropriate treatment.

Objectives: This study systematically reviews the literature on the safety and effectiveness of interventions for atypical feeding behaviours. .

 

Methods: Articles were identified by electronic database and manual searches and critically reviewed using established criteria. Interventions needed to focus on eating or feeding problems as a discreet outcome measures.   Effectiveness in Atypical Feeding Behaviour was defined as reduced symptoms in children with Atypical Feeding Behaviour and ASD or reduced parental stress; improving clinical parameters or symptom scales for these children with additional data on safety of any interventions if appropriate. Outcome parameters were Atypical Feeding Behaviour in a child or impact on the child’s family such as stress.

Results:

Two systematic reviews (1 of them specific to ASD) and 23 case studies were identified. 6 of the case studies focussed on pica type behaviour. The 2 systematic reviews of behavioural interventions found only case studies and low grade evidence for effectiveness with a wide variety of outcome data (few directly observed) and  little follow-up data. The articles covered a wide range of different interventions but most involved behavioural therapy including functional analysis. All case studies reported that their intervention had been effective, but no studies had a control group. Behavioural treatments seemed better accepted if they involved parent training, were based within a child’s home or school or if children were offered simple programs such as pager prompting or fading. Children were reported to show individual responses to different interventions (particular in pica type behaviour) and programmes were often  tailor-made for a particular child. Where children presented with very severe feeding difficulties multi-disciplinary programs seemed helpful and in some extreme cases intervention required hospitalisation. No evidence for effectiveness of interventions by Speech & Language therapy, Occupational therapy or Dietietics were found. Anectodal evidence for the effectiveness of medication was presented with little data on safety. It was not possible to do a meta-analysis because of  the heterogeneity of patients, interventions and outcomes  in the studies. .

Conclusions:

There is low level –(i.e. case study) evidence that some types of behavioural therapy may work on atypical feeding behaviour in children with ASD . The characteristics of children who may benefit are unclear. It seems after many case studies it is time now to design intervention studies with control groups and agreed meaningful out comes with follow up. This will help to see whether interventions work consistently, can be generalised, are safe and work long-term. The research into functional analysis seems best placed to enlarge this body of knowledge.