Effectiveness of a Parent-Mediated in-Home Feeding Intervention for Families with Children with Autism Spectrum Disorders

Background: Up to 89% of children with autism spectrum disorder (ASD) have feeding challenges impacting their development, health, social interactions, and parent–child relationships. Feeding challenges are heterogeneous in presentation and include a range of behavioral, sensory, and health problems that put children at risk for decreased/excessive caloric intake, abnormal growth patterns, atypical social interactions, and difficulty participating in peer and family activities. Current evidence for intervention is limited even though the prevalence and negative effects on the family have been clearly established.

Objectives: The purpose of this pilot study was to examine the feasibility, acceptability and evaluate the preliminary effectiveness of an in-home parent-mediated intervention for children with ASD and feeding challenges.

Methods: A convenience sample of seventeen children diagnosed with ASD ages 2 to 7 years participated in a parent-mediated intervention that occurred in the home. A quasi-experimental pre-test/post-test design was used. Families received approximately 32 visits over six-months that included a combination of parent training, direct intervention, and parent coaching. Intervention was delivered by occupational therapists, a dietitian, and graduate students. Measures of feasibility were collected from parents and interventionists. Goal Attainment Scales (GAS), the primary outcome, were used to assess intervention effectiveness using a paired-sample t-test. GASs were collaboratively set with families at the initiation of the intervention following standardized GAS procedures. Parents did not view the GAS during or upon completion of the study. Parents were interviewed prior and post intervention along with videotaped mealtimes.

Results: The parent-mediated intervention was feasible to implement and acceptable to parents and interventionists. Fifteen children/families (88%) completed the intervention with two families withdrawing due to significant parent schedule changes. 100% of parents completing the intervention reported being satisfied. However, they described different aspects of the intervention (e.g., parent training versus direct intervention) as being most beneficial for their child and family. Results identified significant positive changes in GAS scores (p<.05). GAS for the families fell into three primary categories of mealtime behaviors, self-help skills, and selective diets. The most challenging goal to achieve across families was adding portion-sized vegetables to their diet. However, other common goals such as decreasing mealtime behavior, improving nutritional content of meals, adding food to the child’s food repertoire, and improving self-help skills were more likely to be achieved. Parent report indicated increased self-efficacy and decreased stress. At the close of the intervention, parents also expressed an increased knowledge base and skills to address future mealtime challenges and feeding difficulties with their children.

Conclusions: The parent-mediated intervention to address feeding challenges for children with ASD was feasible and viewed positively by families in the study. Interventionists and families collaborated to achieve goals directly related to the child’s health and nutrition, eating behaviors, and family mealtime. Families met the majority of their goals for their children. Although not all goals were met and families expresses their children still had inconsistent eating patterns at times, they expressed an increased knowledge and confidence of know how to approach their child’s feeding challenges in the future.