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

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Mealtime Strategies of Caregivers of Children with Autism Spectrum Disorder

Sarah Katz, OTS & Karla Ausderau, Ph.D., OTR/L

Acknowledgments

Results

Research Design & Methods

Introduction Discussion

Implications for OT Practice

References

•  An estimated 46-89% of children with ASD demonstrate feeding difficulties1, compared with 25% in typically-developing children.2

•  Family mealtimes increase language development, physical health, academic achievement, and socialization.3

•  Mealtime can be challenging in children with ASD due to inflexibility, adherence to routine, and sensory issues.1

•  Due to the stressful and challenging nature of mealtime, caregivers must use any strategy available to support their child’s participation in family mealtimes.4

•  Parents use many techniques, routines, and rituals in an attempt to improve their child’s challenging mealtime behavior, but with limited success.5

•  Few studies assess parents’ actual use of mealtime strategies in a natural setting, providing a better understanding of the nature of the problem in realistic settings.

Study Purpose To further understand what strategies caregivers of children with ASD report using to support their child’s participation in mealtime.

1.  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(2), 259-264.

2.  Kodiak, 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.  Larson, R.W., Branscomb, K.R., & Wiley, A.R. (2006). Forms and functions of family mealtimes: Multidisciplinary perspectives. New Directions for Child & Adolescent Development, 2006(111), 1-15.

4.  Cermak S.A., Curtin, C., & Bandini, L. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238-246.

5.  Suarez, M.A., Atchison, B.J., & Lagerwey, M. (2014). Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity. American Journal of Occupational Therapy, 68(1), 102-107.

I would like to thank my mentor Dr. Karla Ausderau and professor Dr. Brittany Travers for their constant guidance and support throughout this process. I would also like to thank the Feeding Disorders in Autism and Impact on Family Mealtime, Wisconsin Alumni Research Foundation/MSN154607 and my fellow ASD research team members Erin Milbach and Malissa Roberts.

Design

•  Qualitative design using caregiver interviews •  Interview data used to identify caregiver-reported

strategies used during mealtime

Data Collection & Analysis

•  Families participated in 2-3 semi-structured and narrative interviews in families’ homes

•  Interviews were recorded and transcribed verbatim •  Thematic analysis of mealtime strategies within and

across caregiver interviews using qualitative data analysis software

Participants  

•  Provides occupational therapists (OTs) with a realistic picture of mealtime in the homes of children with ASD in order to modify and integrate into clinical practice.

•  Health practitioners should rely on caregiver-

reported information as well as mealtime observations to inform clinical decision-making.

•  OTs and practitioners should measure success of

strategies based on family expectations and desires. •  May guide the development of future interventions to

target feeding challenges in mealtime contexts to support the child and other family members.

Themes of Mealtime Strategies Provide Choices Don’t Force Change; At Least They Will Eat

Caregivers discussed refraining from branching out or forcing their child to try different foods and making the child’s desired foods as often as the child wants, even when it means making an entirely different meal. Distraction

Make it Fun

Playing with food or connecting food consumption with an enjoyable activity like a preferred TV show or game.

Successive Approximation

Slowly introducing a new food item to increase child’s willingness to eat that food, including: hiding in or pairing with preferred food, modifying size or texture, and familiarizing with food through touching, pictures, and talking about the food.

“I just wanted to keep him there and engaged, and we were right there by the window so he could look at the cars go by..he also had my iPhone. He did great with those distractions” -- Amy

“Sometimes I feel like a short order cook. I have to make special things for everybody. I hadn’t really stopped to think about it and I was like yeah, this is kind of ridiculous” -- Diane

“It is just a fine line because if I put something on his plate that he just doesn’t want or is not going to eat, then al bets are off. No dinner. He won’t eat it or anything on the plate so it’s like, do I really want to do this?” -- Amy

Caregivers described providing a tool to distract the child from eating (i.e. table in front of the TV, games on iPhone, book), so the child can “eat mindlessly”.

“I kind of hold back, and I just want him to eat.” -- Carol

“Just a week ago, I wrote up things he would like for breakfast and so I gave him this little sheet of paper and he reads it over…those are all things he likes.” -- Amy

“I ask them sometimes what they want for lunch…and give them two options.” -- Brenda

“They’re always eating celery at the end of every mission so it’s like ‘Well, let’s see if she’ll do celery!’…one day we tried it and she’s like, ‘Oh! I’m a Wonderpet!’…She ate the whole thing! It was great!” -- Diane

“We had to do a lotta games with it. Like, she likes to count how many trees she’s done and so we’ll do like different languages. But she likes numbers a lot so it’s good incentive.” -- Diane

“I used to put them in pancakes to make her eat vegetables. I would chop ‘em up real fine and just cook ‘em in pancakes.” -- Diane

“So, a lot it was the back word beforehand. Looking at food, talking about food, eating food next to him…trying to expose him as much as possible…I think that helped a lot.” -- Carol

Caregivers provided child with a list of previously identified “preferred foods” and let the child choose.

Child Gender/Age

Income Mother’s Occupation

Father’s Occupation

Siblings

Amy Male/ 3.5

$100,000+ Homemaker Psychiatrist 1

Brenda Male/ 5

<$20,000 Dietician Student 2

Carol Male/ 4

$80,000-$99,000

University Teacher

Business Manager

1

Diane Female/ 6

$80,000-$99,000

Homemaker Engineer 1

Alpha. (Photographer). (2015, February 26). Liam eating vegemite toast soldiers [digital image]. Retrieved from http://flickr.com/photos/avlxyz/16621755196

•  Five themes emerged from this study: Distraction, Don’t Force Change; At Least They Will Eat, Provide Choices, Make it Fun, and Successive Approximation.

•  Each theme is distinct, but caregivers may implement more than one type of strategy.

•  Although these themes portray strategies caregivers are using, they may be unsuccessful.

•  Caregivers choose strategies based on shifting personal expectations for mealtime.

•  Caregivers expressed a strong desire for more effective strategies.