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The Autism Meal Plan: A Parent-Training Curriculum to Manage Eating Aversions and Low Intake Among Children with ASD
Children with autism spectrum disorder (ASD) are approximately five times more likely to develop feeding problems than are their typically developing peers, and these problems can lead to medical conditions, including vitamin and mineral deficiencies, poor bone growth, and obesity. Hence, there is a need to identify and disseminate evidence-based treatment of feeding problems associated with ASD. Behavioral intervention can be effective when delivered by trained therapists in highly structured settings. Parent Training (PT) may make it possible to disseminate behavioral intervention more broadly, and group-based interventions offer a novel, time-limited and cost effective approach to PT. Although group-based PT has been successfully applied to other prevalent childhood concerns, few studies have evaluated the use of parents as the principal agent of change to address feeding concerns in the ASD population.
Objectives:
Because past research has focused solely on individual treatment protocols for feeding problems in ASD, it is unknown whether standardized, group-based PT is efficacious. The current pilot study sought to fill this gap by developing and evaluating a group-based PT, the Autism MEAL Plan.
Methods:
In the first randomized clinical trial (RCT) ever conducted on a feeding intervention in ASD, we examined the feasibility and acceptability of the intervention and study protocol (e.g., recruitment and retention of participants, assessment procedures). In addition, we explored efficacy in changing feeding behaviors. Participants were 19 parents of children with ASD, age 3-8 years (n = 10 in the treatment group, n = 9 in the waitlist control).
Results:
Eighty three percent of sessions were attended by at least one caregiver with both the mother and father attending at least 3 sessions for four of the families in the treatment group. A post-treatment questionnaire on social validity indicated high program satisfaction, with parents perceiving the program as effective. Additionally, caregivers reported less stress following the intervention (d = 1.1).
Conclusions:
A manualized, behaviorally-based parent training program that can be easily adopted by therapists and caregivers of children with ASD is needed to promote rapid dissemination into the community. In our pilot RCT of the Autism Meal Plan, we obtained evidence of high social validity and reductions in parenting stress following intervention. These findings suggest that the intervention may provide an economical, feasible, and acceptable service delivery model for feeding problems in ASD. In addition, the findings provide important guidance for larger-scale efficacy trials.