Behavioral Intervention for Feeding Disorders

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Individualswith autism are often poor eaters which may put them at risk for a variety of health problems including, poor bone density, vitamin deficiencies, obesity, and constipation among other medical problems. Behavioral intervention has been well validated in the literature as evidence-based treatment of pediatric feeding disorders and has been increasingly applied to those individuals with autism and other disabilities who are poor eaters. This paper highlights some of the latest behavioral intervention shown effective in increasing food consumption and may serve as a guide for professional and families.

As many as 90% of children with autism have feeding problems ranging from consuming a small variety of foods (i.e., food selectivity) to rejecting most or all foods (i.e., food refusal). Some families report their child consumed a large variety of foods in toddlerhood and over time consumption of these very same foods diminished significantly. Many of these children eat only starchy foods, specific brands, pureed foods, and/or little to no vegetables. A diet high in snacks and low in vitamins, minerals, and vegetables may lead to long-term health issues including poor bone growth, constipation, and obesity.

Behavioral interventions have increasingly been shown effective in the treatment of feeding disorders for some children with autism and other developmental disabilities. These interventions typically involve structured meal schedules, repeated exposure to non preferred foods, reinforcement in the form of verbal praise or tangible items for food acceptance, and ignoring inappropriate mealtime behaviors, for example. Some of these interventions have been implemented by parents while others were more complex and required a trained professional and/or inpatient hospitalization. Following is a summary highlighting some of the previously published case studies on feeding disorders that have been shown effective in increasing food consumption and in some cases food variety.

Presenting both non preferred and preferred foods together may be a simple option for some children with mild food selectivity. For example, Ahearn increased vegetable consumption in an adolescent with autism and mild food selectivity by placing a preferred condiment (i.e., ketchup, BBQ sauce, or mustard) on top a non preferred vegetable (i.e., carrots, broccoli, or corn). Preferred condiments were determined by a preference assessment and the top three were selected for intervention. Food consumption immediately increased from zero at baseline to 100% during intervention. A choice board was added at the conclusion of the study giving the participant the opportunity to choose a condiment for his vegetables from a selection. The author reported that one year later this participant continued to eat vegetables with condiments and requested them with an augmentative communication system. The author also noted that neither positive reinforcement in the form of verbal praise nor tangible items were used and may not be necessary when using a simultaneous presentation intervention for some children with mild food selectivity.