OCCUPTIONAL THERAPY PROGRAM, DEPARTMENT OF KINESIOLOGY - UNIVERSITY OF WISCONSIN-MADISON

Mealtime Behaviors, Sensory Responsiveness, and Feeding Services for Children with ASD

Molly Smith, OTS and Karla Ausderau, PhD, OTR/L

A gracious thank you to the participating families who dedicated their time and energy to contribute to the ASD Feeding Project, and to the Feeding Disorders in Autism and Impact on Family Mealtime, Wisconsin Alumni Research Foundation. A special thank you to Dr. Karla Ausderau and Dr. Martha McCurdy for their guidance and mentorship.

Many thanks to my resilient team members for their thoughtful feedback and reassurance throughout the research process. Finally, thank you to my amazing family for their support, assistance, and encouragement. Another special thank you to my brother, Nolan, who is the primary inspiration for this research project.

INTRODUCTION RESULTS

RESEARCH DESIGN AND METHODS

ACKNOWLEDGEMENTS

1Schreck, K. A., & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities, 27(4), 353– 363.2Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified. Journal of Autism and Developmental Disorders, 31(5), 505-511.3Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21(3), 153.4Lukens, C. T., & Linscheid, T. R. (2008). Development and validation of an inventory to assess mealtime behavior problems in children with autism. Journal of Autism and Developmental Disorders, 38(2), 342-352.5Brock, M. M., Freuler, A. A., Baranek, G. G., Watson, L. L., Poe, M. M., & Sabatino, A. A. (2012). Temperament and Sensory Features of Children with Autism. Journal Of Autism & Developmental Disorders, 42(11), 2271-2284. doi:10.1007/s10803-012-1472-56Leekam, S., Nieto, C., Libby, S., Wing, L., & Gould, J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5), 894-910.

REFERENCES

Limited Feeding Services Received

Participant ID Current Feeding Intervention (Minutes/Week)

Daycare/School Addressing Feeding

Parent in Workshop in Past

1 0 Yes Yes2 0 Yes No3 1-25% time, 1x/week

(8min/week) Speech TherapyYes Yes

4 0 Yes No5 1-25% time, 1x/week

(8min/week) Occupational Therapy

Yes Yes

Occupational Therapists (OT) are uniquely equipped to work with children with ASD due to their focus on adjusting tasks and the environment to match a child’s needs and abilities. OTs also are skilled at developing strategies that help a child respond to and process sensory information to promote engagement in mealtime.

OTs should advocate for families who have children with ASD to influence the provision of services to remediate feeding challenges.

OTs should collaborate with other health professionals to promote the use of standardized tools to evaluate feeding challenges and their origin.

The participants were currently receiving limited direct services to address their feeding and mealtime behaviors despite parent-identified mealtime challenges.

Results from preliminary analyses suggest that a trend exists between parents reports of mealtime difficulties and sensory features present in their children.

The participants exhibited a variety of responses to stimulation, with individualized responses across sensory patterns (Hyper, Hypo, Seek, and EP). Seek and Hyper had the strongest relationship with the frequency of mealtime behaviors.

Certain sensory patterns seem to contribute to mealtime challenges, however, further research is needed to investigate the relationship between mealtime behaviors and sensory responsiveness in children with ASD.

Participants Five male children with ASD who have parent

identified feeding difficulties between the ages of two and six (M = 4.6, SD = 1.52).

Procedure A cross-sectional case series design was used to

examine mealtime behaviors, sensory patterns, and the feeding services currently provided to address mealtime challenges.

Measures Background Information questionnaire (BIQ)–

parents indicated the percent of feeding intervention services that their child is currently received per week. Parents also indicated if feeding was addressed during school time.

Brief Autism Mealtime Behavior Inventory (BAMBI), an 18-item caregiver questionnaire designed to evaluate food repertoire, food refusal tendencies, and behavioral features of autism on a 5-point Likert scale was administered.

Sensory Experiences Questionnaire (SEQ), a 105-item questionnaire designed to evaluate a child’s responses to sensory stimuli, using four subscales: hyper and hypo-responsiveness, sensory seeking, and enhanced processing (Hyper, Hypo, Seek, EP) on a 5-point Likert scale was administered.

Background Atypical eating behaviors and feeding challenges have become a growing concern among parents of children with autism spectrum disorders1 (ASD), with estimated prevalence reported to be between 30 and 89 percent2,3,4 .

Despite the documented prevalence of mealtime challenges, research examining the relationship between aberrant mealtime behaviors and features typical of ASD such as sensory responsiveness5,6, is preliminary.

Further evaluation of mealtimes is needed to uniformly characterize and understand mealtime behaviors in children with ASD.

AimsDetermine the relationship between mealtime behaviors and sensory patterns in children with ASD.

Determine the relationship between mealtime behaviors and sensory patterns to feeding intervention services received that address difficulties.

Varied Mealtime Behavior Severity and and Sensory Responsiveness

Across Participants

1 2 3 4 50

0.51

1.52

2.53

3.54

4.55

Comparison of Mealtime Behaviors and Sensory Pattern Scores

BAMBIHyper-ResponsivenessSensory SeekingHypo-ResponsivenessEnhanced Perception

Participants

Scor

e

Note: Mean scores are reported

Sum scores of BAMBI closely correspond to SEQ sum scores in most participants (1,3,4,5). Sum scores for Participant 2 diverged.

Atypical eating coexists with higher hyper-responsiveness (1,3,5) and sensory seeking (1,5) but spectrum of subscale scores is highly individualized.

Participant ID BAMBI Sum Score

SEQ Sum Score

BAMBI Mean Score(SD)

SEQ Mean Score (SD)

1 51 231 3(2) 2.34(1.45)

2 32 193 2(1) 2.05(1.21)

3 52 185 3(2) 1.59(0.97)

4 31 158 2(1) 1.87(1.22)

5 55 277 3(2) 2.84(1.34)

1 2 3 4 50

50

100

150

200

250

300

350

400

450

18

28

38

48

58

68

78

88

Comparison of Mealtime Behaviors and Sensory Responsiveness

SEQ Sum Scores

BAMBI Sum Scores

Participants

SEQ

Sco

re

BAM

BI S

core

s

IMPLICATIONS FOR PRACTICE

CONCLUSION