A School-Based Sensory Intervention for Food Selectivity in Young Autistic Pupils

Background: Feeding difficulties are twice as prevalent in autistic children as in neurotypical children. Food selectivity is the most common feeding difficulty in this population and has a significant association with disruptive mealtime behaviour. There is also strong correlation between mealtime behaviour and parental stress. Furthermore, parents of autistic children identify diet as a priority area for support. A limited diet has a negative impact upon nutritional intake, cognitive development and overall health. The need for food selectivity interventions to address the sensory components of eating is underlined by the increasing evidence supporting the causal relationship between sensory differences and food selectivity.

Objectives: To aim of the study, produced by school-based professionals, was to examine the impact of a sensory based intervention to address food selectivity in autistic pupils that could be integrated into the school day and delivered by existing staff in the school setting.

Methods: 19 children (3 girls and 16 boys) from the same government-funded, special school in inner-city London took part. Participants ranged in age from 4 years 10 months to 10 years 7 months (M=6 years; 5 months; SD=1;7). The intervention focused on encouraging tactile and oral exploration of foods, looking to normalise sensation, as the first of a sequence of steps to address food selectivity. It was delivered daily over 12 weeks by existing school staff following a brief training session. 30% of sessions were observed by the school dietitian to ensure fidelity to the intervention. Baseline and Post intervention measures were taken in terms of: number of foods eaten across 17 categories (based on food group and texture); and scores on the Brief Autism Mealtime Behaviour Inventory (BAMBI).

Results: There was a significant difference between the number of food categories eaten following the intervention (F(1,36)=10.46, p=.003, η²=.23). The average number of categories before the intervention (M=5.53, SD=3.64) was significantly lower than post intervention (M=9.26, SD=3.48). Total BAMBI scores of the participants were significantly lower post-intervention (M=31.00, SD=9.37) than at baseline (M=38.53, SD=12.49), t(18)=4.66, p<.001, d=1.07. Similarly, the Food Selectivity score was significantly lower post-intervention (M=11.37, SD=4.31) than at baseline (M=14.00, SD=4.67), t(18)=5.06, p <.001, d=1.16. Food Refusal scores were also significantly lower on average post-intervention (M=5.53, SD=2.04) than at baseline (M=7.26, SD=2.85), t(18)=3.18, p=.005, d=0.73. Disruptive Mealtime Behaviour scores were also significantly lower post-intervention (Mdn = 7, range: 5-14) than at baseline (Mdn = 10, range: 5-21), Z =-2.46, p<.05, r=-0.4.

Conclusions: The results from the study are promising and indicate that sensory-based intervention can successfully reduce selective eating in primary school aged autistic pupils. Furthermore, it demonstrated that school staff can deliver the programme to fit in with the existing school day, with little disruption and few financial, time or staff resources required. The lesson plans developed for the study could therefore be easily adopted by more schools to support selective eating. Further research is needed to see if the method can be extended to main meals and the results generalised to a home setting.