Facilitator of the Month| Tasneem Rangwala, Mumbai, India
The following article is an open access article published in Hong Kong Journal of Occupational Therapy in 2017. The link for the article is provided at the end of the post.
Aims and issues addressed by the article:
The article intends to find out the effectiveness of the program that was designed to provide information to the parents of children with ASD about factors of food preferences and approaches for coping with problems of selective eating. The said article not only discusses the eating behaviors of the children but also addresses the self-efficacy of the parents, degree of difficulty experienced by parents to feed their child and parental recommendations.
Firstly, the article shortlists the factors that lead to selective eating behaviors in children with ASD. Next, the article describes about approaches undertaken to tackle selective eating in children with ASD.
Why does it matter? How does it fit to what it already known?
The awareness for ASD has increased in the past few years. Selective eating is often reported by parents and discussed with the Occupational therapist but it is not given much priority as providing with primary intervention. The authors of this study claim that it is the first ever study done to address selective eating behaviors in children diagnosed with ASD that involves parental discussions and training. Moreover, the study provides with a comprehensive view of the factors that lead to selective eating and approaches that can be undertaken to combat specific food preferences of children diagnosed with ASD.
Study design:
Single group, self-controlled trial that compared variables at baseline and before and after the intervention.
Study methods and Intervention design:
The participants were 23 Japanese speaking parents of children diagnosed with ASD, recruited from 2 out-patient development support centers in Osaka. The eligibility criteria were that the parent had attended all program conducted in the study (2 sessions and 2 discussions), their respective child is diagnosed with ASD/scored more than 15 on social communication questionnaire and lastly had difficulty with their child’s selective eating behaviors.
Outcomes:
a) The changes in parental attitudes b) Changes in eating patterns of children with ASD.
Main Findings:
The most common approaches used by parents were to change the disliked texture, gradually mix the preferred texture and change to favored flavors and tastes.
Results:
The results included significant decrease in the level of difficulty perceived by the parents in feeding their child with ASD, a significant increase in the degree of self-efficacy of the parents and in number of recommendations carried out by the parents which were provided/taught to them. There was also an increase in the number of food items that were acceptable to the children with ASD who demonstrated selective eating.
Implications:
1) The authors mention that in their next trial, they would increase the number of approaches that can improve the degree of self-efficacy and decrease the difficulty perceived by the parents to feed their children with ASD who report selective eating.
2) Further development of this program can aid Occupational Therapists in implementing better intervention strategies in order to increase the amounts/varieties of food for children who demonstrate selective eating.
Limitations:
1) No significant change was found in the degree of dietary imbalance or the number of foods acceptable to the children
2) Some parents found it difficult to follow/implement the recommendations to improve selective eating in their children with ASD which led to decrease in number of parents who participated in each session.
3) It was taxing to address selective eating in children that demonstrate strong preferences for only one to two food items.
Conclusion:
The results of this study showed that the proposed intervention can be used as an introductory program for parents who experience difficulty with regard to selective eating behaviors in their children and resulted in short term improvements in quality of life both of parents and their children.
Facilitator's Comments:
The process of eating is a part of basic activity of daily living that help us humans remain functional. Having a limited a food repertoire, a child with ASD may be deprived of essential nutrients necessary for growth and development of body and brain. The said article based on selective eating behaviors which are common in children with ASD is a detailed interventional study that not only focused on the limited food preferences but also addressed parental views, perceptions, difficulties and their efficacy. The interesting part in this study was that the parents shared their own experiences during the discussions that helped the author and the other participants (parents) to either relate to the issues or provide a better approach to tackle the same. Though a level 4 study, the intervention program proved to be effective to deal with the concerned issue of selective eating. However, the article could not give significant evidence as to the dietary imbalances and for the required approaches to adopt for children who demonstrate a strong liking to 1 or 2 food items.
Link for the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092012/
PMID: 30186077 PMCID: PMC6092012
The article is available at www.sciencedirect.com
Please share your comments, knowledge and ideas below!!!
Happy Autism Awareness Month!
Method thoughts: a number of tools were used to assess change in a quantitative way, appropriate measurement that explores both parental difficulties and change in selective eating patterns. Relevant method used with SPSS, a credible management system to improve reliability in recording change. Nevertheless, a questionnaire to measure parental chemist have its flaw, as parents are unable office their own words. Though this would not be practical to quantify. Responses would need to be discussed between several researchers to ensure accurate interpretation, improving reliability. The study could have repeated outcome measures at a later date to ensure continued improvements in selective eating. Findings only indicate short-term improvements in the quality of life of both the parents and children but what about a year later?
Overall the intervention appears really appropriate to develop parental understanding, it is great to hear of an OT focus when working with those with sensory needs. This help we cement my understanding of the significance of changing sensory input in daily activity, which can be applied to other meaningful activity to better meeting the child 's need.
Psychological impact
Some children may learn at a slower rate, requiring some time to get used to changes from parents cooking. There may also a concern with food association, if someone already dislikes the texture of a good then the smell of such food could trigger an assumption of not liking the taste. It can take time to break such habits, as well as confidence for the child to try new things. This may related to theories regarding learned behaviour. Authors have failed to consider the behavioural needs of children, food selectivity may be related to other needs. Perhaps food selectivity is a way for the child to communicate their distress and make their attentional needs known? While these other factors cannot be known and assessed, there could be some recognition of other factors that may impact changing eating patterns. There may also be a placebo effect due to changes in perceived knowledge and acceptance of selective eating patterns?
We had some really great engagement and discussion in our first Journal Club, from @shonafmiles, @ktbergson, @Charmi Shah, @Aimee Dyamond, @Jo Harding and @Abi Matthews. Perhaps one of these Members might like to get the conversation going in this one?
Thank you very much for offering to host April's Journal Club [@Tasneem M. Rangwala]! We'll get this shared and the conversation started tomorrow!