Behavioral Intervention for Feeding Disorders

Review Article

Austin J Autism & Relat Disabil. 2017; 3(1): 1036.

Behavioral Intervention for Feeding Disorders

Scattone D*

Department of Pediatrics, University of Mississippi Medical Center, USA

*Corresponding author:Dorothy Scattone, Department of Pediatrics at the University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39211, USA

Received: December 06, 2016; Accepted: February 06, 2017; Published: February 09, 2017


Individuals with 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.

Keywords: Autism; Food selectivity; Pediatric feeding disorders


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) [1,2]. 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 [3]. 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 [2].

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 [4]. Some of these interventions have been implemented by parents [5] while others were more complex and required a trained professional and/or inpatient hospitalization [6]. 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.

Simultaneous presentation of non preferred and preferred foods

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) [7]. 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.

In another study, a sequential presentation method requiring the child to eat a small bite of a non preferred food before being giving the opportunity to eat a larger bite of a preferred food was compared with a simultaneous presentation method in an effort to increase food consumption for three selective eaters with autism [6]. During the simultaneous presentation condition non preferred food was embedded in a preferred food. For example, broccoli was embedded into an apple slice and salad dressing was placed on top of a non preferred food. For sequential presentations, preferred food was presented within 1 or 2 seconds after each accepted bite of non preferred food.

Simultaneous presentations were immediately effective for two of the participants. Additional modifications were made for the remaining child by having the therapist physically guide his mouth open so that food could be placed directly inside. High rates of expulsions occurred with this procedure making it necessary to add yet another component consisting of re-presenting the expelled bites by scooping them up with a spoon and placing them back into his mouth. Although increased food consumption was gradual for the simultaneous condition with these modifications, no food was consumed at all with the sequential condition for this participant.

The authors suggested that foods consumed by the first two participants were somewhat blended (i.e., salad dressing soaked in food) potentially lessening the aversiveness of their non preferred foods as compared with the last participant whose food which was placed right on top (i.e., a pea placed on a chip) [8]. Perhaps blending preferred food with non preferred food may have lessened the aversiveness leading to a higher volume of consumed foods making physical guidance unnecessary [8].

Fun and games

Making eating game-like may be another alternative for some children with mild food selectivity. Gentry and Luiselli [9] evaluated the effectiveness of a “mystery motivator” for a 4-year old with autism. Sam (fictitious name) was presented with a game spinner consisting of seven numbers and one question mark. He was required to eat the number of bites indicated by the game spinner starting with 1-2 bites and gradually increased over the course of the intervention. If he ate all the bites, he was given verbal praise and access to an activity. If he did not eat all the bites, he was told to leave the table and praise and activities were withheld. If the spinner pointed to the question mark, Sam was given a surprise toy and allowed to eat whatever he wanted. Number of bites increased steadily with the use of the mystery motivator from one to two bites per meal at the beginning of the intervention to five and six bites per meal towards the end (Table 1).

Citation: Scattone D. Behavioral Intervention for Feeding Disorders. Austin J Autism & Relat Disabil. 2017; 3(1): 1036.