The Therapeutic Breakfast As a Tool for Improving Eating Behaviors and Communication Skills in Children with ASD

Background:  Children with Autism Spectrum Disorders (ASD), may exhibit, in addition to communication difficulties, behaviors such as insistence on sameness, inflexible tendencies and a need for a strict routine (Myers & Johnson, 2007). Though feeding disorders are not among the diagnostic criteria for autism listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), many of these individuals exhibit different eating habits including sensory based issues (sensitivity to smell, taste, texture etc.) and/or the need for a constant routine (eating only at fixed times or fixed foods). In many cases, in order to avoid struggles with their child during meals, parents of children with autism tend to offer their child a fixed menu, thus maintaining food selectivity and a limited diet.

Objectives:  The purpose of the "Therapeutic Breakfast" is to encourage improvement in eating behaviors and communication skills among children with autism.

Methods: This study included 13 children, ages 4-6, diagnosed with PDD-NOS or Autism who participated in a therapeutic breakfast program on a weekly basis for 20 weeks. The "Therapeutic Breakfast", carried out in groups of up to 8 children, includes a multidisciplinary team (Dietician, OT, SLP, Psychologist and Developmental Pediatrician) providing individual intervention for each child. Parent involvement is an integral part of the program to ensure carryover at the home. Participants are gradually exposed to a variety of foods throughout the program in order to encourage healthy eating habits. In addition to the eating experience, the group provides an opportunity for communication around the table. Fifteen observations on each child were collected and consisted of the following variables: independent eating, use of utensils, variability of food intake, initiation of communication, adaptive response to others, sitting near the table and body posture while sitting. A five-level Likert scale was used for rating where the highest performance was scored as 5 and the lowest performance was scored as 1. The first and last observations for each variable were compared using a t-test.

Results:  Results suggest that initiation of communication and body posture while sitting were found to have improved significantly following our intervention. For the other 5 variables there was a trend for improvement, although not statistically significant.

Conclusions:  The Therapeutic Breakfast improves eating behaviors and communication skills in children with ASD. It is necessary to evaluate and address the eating behaviors of these children as part of their care. A larger randomized controlled study is needed in order to establish the efficacy of the "Therapeutic Breakfast" as a therapeutic tool for children with ASD. The "Therapeutic Breakfast" model will be presented as well as ideas for food exposure used by the professional team.