Example1 - Association of University Centers on Disabilities

1
Snack Time Intervention for Preschoolers with
ASD Fun and Function Karen Harpster, PhD OTR/L,
Pon Trairatvorakul, MD, Katie Felts, BA, Hollyn
Zammit, BSN, RN, Evelyn Koski BS, Michelle Long
BS, S/OT, Katie Walton PhD, Karen Burkett, PhD,
RN, PPCNP, Jane Case-Smith, EdD, OTR/L, FAOTA

• Background
• Children with autism spectrum disorder (ASD)
  experience eating difficulties more than children
  with intellectual disability and neurotypical
  children.1
• Up to 90 of children with ASD have feeding
  difficulties2
• Children with ASD are often reported to have
  unusual eating habits such as
• Rigid mealtime behaviors
• Limited food repertoire
• Food sensitivities and refusal related to food
  texture, color, smell and temperature.3-4
• Eating enjoyment, positive mealtime environment
  and enthusiastic modeling in both adults and
  peers have been shown to increase food acceptance
  and social interaction in children.5-6

• Discussion
• Foods were offered 4-5 times throughout the
  intervention which may not have been enough
  exposure to novel foods.  
• There was high variability in both food related
  behaviors and social communication behaviors
  which were greatly related to the food presented
  at each session.
• There was no parental involvement in the
  intervention. Involving the parent may have
  increased the transfer of the intervention into
  the home environment.  
• Snack time provides an opportunity to build on
  food variety and social communication behaviors.
• The implementation of a snack time group
  treatment is feasible within a preschool
  curriculum.

• Results
• No substantial changes in the FFQ or BAMBIC from
  baseline to the end of the intervention
• Although there is variability in exploration and
  oral intake of food, there is a positive trend
  towards improvements in food related behaviors.
• Although there is variability in communication
  attempts between individuals, there is a positive
  trend towards improvement in communication
  attempts.
• Picky eaters continue to have selective eating
  behaviors at the end of the intervention.

• Method
• CCHMC Cohort design
• OSU Concurrent, multiple baseline design
• Participants
• five boys and one girl with ASD, aged 3 to 4
  years, recruited from CCHMC and OSU
• Procedure
• Pilot study conducted to assess fidelity and
  feasibility
• Play-based and child-centered snack time
  intervention provided in a group for 8 weeks,
  bi-weekly, at 10-30 minutes per session
• Setting at CCHMC small groups of 2-3 children
• Setting at OSU within classroom snack time
• 3-4 foods offered at each session a combination
  of familiar and novel foods
• Food selection determined by results from Food
  Frequency Questionnaire (FFQ), food allergies and
  parental preferences
• Sessions videotaped for scoring using time
  sampling methods (30 second intervals)
• Instrumentation
• Demographic and Food Familiarity Questionnaires
• Food Frequency Questionnaire (FFQ)
• Brief Assessment of Mealtime Behavior in Children
  (BAMBIC)
• Environment
• Peer modeling within classroom setting at OSU

• Limitations
• Food variety limited by allergies and parental
  preferences
• Small sample size and short intervention duration
• Inconsistencies environments and methods between
  institutions
• Lost/missing data from illness, behavior,
  procedural error and weather
• Lessons Learned
• Need for increased coordination between 2
  collaborating programs
• Need to standardize the environments
• Families should be more involved in intervention
  to increase the amount of new food exposure in
  the home environment and to improve
  generalization.

• Conclusion
• Although these results were variable, snack time
  intervention showed a positive trend at
  increasing the variety of foods eaten and
  improving social communication behaviors for some
  children.
• Future Research Directions
• Collaborate with Nationwide Childrens Hospital,
  Columbus, OH for aggregate data analysis
• This pilot study informed future study of the
  importance of parental involvement and parental
  education to generalize food exposure and social
  communication behaviours to the home setting.
• Need for increased sample size

Specific Aims Aim 1 To determine if
child-centered snack time intervention will
increase the frequency of food-related behaviors,
including touching, smelling, playing with food
and eating food during snack time.   Aim 1a To
examine the effect of a child-centered snack time
intervention on the variety of foods eaten at
home.   Aim 2 To examine the effect of a
child-centered intervention on social
communication including vocalizations, using eye
contact, pointing, and/or smiling. Aim 2a To
examine the effect of a child-centered
intervention on appropriate mealtime behaviors as
measured at home. Aim 3 To examine the
feasibility and fidelity of the snack time
intervention.
Acknowledgements These projects were funded by
The Maternal and Child Health Bureau Grant
T73MC00049 and T73MC00032. We would also like to
thank the parents, children, and staff at CCHMC
and OSU for their participation in this study.

CCHMC Data
OSU Data
References (1) Al-Khuffash, S. (2013). A
Comparison of Eating Problems among Children with
Autism, Mental Retardation and Children with
Normal Development. Higher Education of Social
Science, 4(3), 40-45. (2) Kodak, T., Piazza, C.
C. (2008). Assessment and behavioral treatment of
feeding and sleeping disorders in children with
autism spectrum disorders. Child and Adolescent
Psychiatric Clinics of North America, 17(4),
887-905.(3) Bandini, L.G., Anderson, S.E.,
Curtin, C., Cermak, S., Evans, E.W., Scampini,
R., Maslin, M., Must, A. (2010) Food selectivity
in children with autism spectrum disorders and
typically developing children. The Journal of
Pediatrics, 157, 259-264. (4) Cermak, S. A.,
Curtin, C., Bandini, L. G. (2010). Food
selectivity and sensory sensitivity in children
with autism spectrum disorders. Journal of the
American Dietetic Association, 110(2), 238-246
(5) Hendy, H. M., Raudenbush, B. (2000).
Effectiveness of teacher modeling to encourage
food acceptance in preschool children. Appetite,
34, 1, 61-7 (6) van der Horst, K. (2012).
Overcoming picky eating. Eating enjoyment as a
central aspect of children's eating behaviors.
Appetite, 58(2), 567-574..