News and Notes about Scientific Research on Autism and other Developmental and Behavioral Disorders

Editor: Gina Green, PhD, BCBA
Director of Research, New England Center for Children

Feeding Problems in Children with Autism Spectrum Disorder: What Does Research Tell Us?

Anecdotal reports of feeding problems in children on the autism spectrum are common. Some of those problems include eating only a very small number of foods, eating only foods with certain textures, lack of feeding skills (such as chewing, sipping, swallowing, taking manageable bites, using utensils), refusing liquids, engaging in disruptive behavior at mealtimes, and even refusing all foods. Obviously, these kinds of problems can seriously jeopardize a child’s health, which can further impair her ability to learn. For those and other reasons, effective assessment and treatment of feeding problems are essential. But because there has been relatively little scientific research on these topics, we do not yet have much reliable information with which to answer several important questions: How often do feeding problems occur in children on the autism spectrum? Are they more common in that population than in typically developing young children? children with other developmental disabilities? Are the feeding problems observed in children with autism fundamentally different from those observed in other populations of children? Can feeding problems in children with autism be treated effectively?

Led by Dr. Bill Ahearn (one of our Program Directors and Board Certified Behavior Analysts), several New England Center staff have been conducting research that addresses some of those questions. For example, they used behavioral assessment methods to determine just how many of a group of children with autism spectrum disorder were overly selective about the foods they consumed, and the nature of any selective eating observed. A report of that study will appear in an upcoming issue of the Journal of Autism and Developmental Disorders; the abstract appears on the following page. Dr. Ahearn and other New England Center staff have also used behavior analytic methods to teach children with autism spectrum disorder to increase the variety and quantity of foods they eat, as well as fundamental eating skills like how to chew and how to feed themselves. A description of one such successful case appears later in this newsletter, starting on the next page.

A cautionary note: Difficult feeding problems in children with autism or other developmental disabilities should be treated by professionals with the appropriate training and experience. For more information on this topic and a review of research in this area, see “Help! My son eats only macaroni and cheese: Dealing with feeding problems in children with autism” by William H. Ahearn in Making a Difference: Behavioral Intervention for Autism, edited by Catherine Maurice, Gina Green, and Richard M. Foxx (2001; PRO-ED, Austin, TX). – Ed.

An Assessment of Food Acceptance in Children with Autism
or Pervasive Developmental Disorder - Not Otherwise Specified
(in press, Journal of Autism and Developmental Disorders)

William H. Ahearn, Todd Castine, Karen Nault, The New England Center for Children and Northeastern University

Gina Green, The New England Center for Children and University of Massachusetts Medical School, E. K. Shriver Center

Abstract
Some children with autism and pervasive developmental disorder-not otherwise specified (PDD-NOS) have been reported to have atypical feeding behavior, such as sensitivity to food texture and selective preferences for particular foods. No systematic studies of feeding behavior in this population have been published, however. Munk and Repp (1994) developed methods for assessing feeding problems in individuals with cognitive and physical disabilities that allow categorization of individual feeding patterns based on responses to repeated presentations of food. In this study, we systematically replicated the Munk and Repp procedures with children with autism and PDD-NOS. Thirty children ranging in age from 3 to 14 years were exposed to 12 food items across six sessions. Food acceptance, food expulsion, and disruptive behavior were recorded on a trial-by-trial basis. Approximately half of the participants exhibited patterns of food acceptance indicating selectivity by food category or food texture. Others consistently accepted or rejected items across food categories. Whether these patterns of food acceptance are atypical remains to be determined by comparison with the feeding patterns of typically developing children and other children with developmental delays.

Treating Selective Eating: A Case Study
Bill Ahearn, Ph.D., BCBA

When Geoff entered the New England Center in 1999 at the age of four, he ate only snack foods and baby food. His parents were concerned about his refusal to eat age-appropriate foods and his lack of self-feeding skills. Today he eagerly anticipates meal times and feeds himself a wide variety of foods. Geoff ’s parents, teachers, and friends are very proud of the progress he has made, but it did not occur overnight, and required careful application of research-based assessment and treatment methods.

The first step was to systematically assess Geoff’s eating patterns and skills. We found that he only occasionally accepted foods that were offered to him, and frequently cried when he was asked to eat. Geoff soon became more comfortable during meal times at school, but was still not eating a healthy variety of foods consistently. We started treatment by giving Geoff brief opportunities to read a favorite “Blue’s Clues” book after he took bites of pureed foods. Next, we gradually made Geoff’s foods thicker and taught him how to chew using standard behavior analytic methods (modeling, verbal prompting, and positive reinforcement). Initially his meals often lasted more than 40 minutes, but as Geoff practiced chewing he got better at it, and his meal times became much shorter. Then we taught Geoff how to feed himself. Initially we used gentle physical guidance as a prompt to help him learn to use a spoon. He developed that skill quickly, requiring very few prompts after just a few meals. Within a few days he was independently feeding himself.

There were certainly a number of bumps in the road toward getting Geoff to eat a variety of foods on his own, but Geoff’s teacher, Cathleen O’Donaghue, and Program Specialist, Amy Geckeler, were always there to help him get over them. Geoff is still working toward some goals in this area, but his mom is pleased with the progress he has made so far. She particularly enjoys taking Geoff out to eat without having to pack a special meal for him.

New England Center Research Presentations at the Upcoming Annual Conference of the Berkshire Association for Behavior Analysis and Therapy (BABAT)


October 11-12, 2001
University of Massachusetts at Amherst – Murray D. Lincoln Campus Center
Registration: www.aux.umass.edu/forms/conferenceservices/ucs_reg.htm or
Conference Services, 918 Campus Center CS 02-83, Umass,
Amherst, MA 01003 -- (413)545-2591

Symposium: Recent research on preference/reinforcer assessments
Chair: Richard B. Graff, M.S., BCBA (The New England Center for Children)
Discussant: Brian Iwata, Ph.D., BCBA (University of Florida)

Paper 1: Using brief assessments to track changes in stimulus preference and reinforcer effectiveness over time. Dan Smith, B.A., Myrna E. Libby, Ph.D., BCBA, and Richard B. Graff, M.S., BCBA

Paper 2: Using pictures to assess reinforcers in individuals with developmental disabilities. Lenwood Gibson, B.A., and Richard B. Graff, M.S., BCBA

Paper 3: Evaluating the efficacy of brief multiple-stimulus preference assessments. Frank Ciccone, M.S., and Richard B. Graff, M.S., BCBA

Paper Presentation: Assessing and treating stereotypy in children with autism spectrum disorder. William H. Ahearn, Ph. D., BCBA

A number of other New England Center staff will present 17 data-based posters at the BABAT conference, and outgoing New England Center Director of Research Gina Green is slated to give a closing address on “Science, Pseudoscience, and Antiscience in Autism Treatment.”

Web Resources

For information about autism, visit the National Library of Medicine’s autism site www.nlm.nih.gov/medlineplus/autism.html.


For information about the national certification program for applied behavior analysts, go to the website of the Behavior Analyst Certification Board at www.BACB.com.

For information about applied behavior analysis in the treatment for autism visit www.behavior.org.

For science-based information on biomedical treatments and theories in autism visit www.autism-biomed.org.

For professionally screened information on health care (including some treatments for autism and other developmental disabilities), visit www.quackwatch.com.

Drkoop.com, the website of the former U.S. Surgeon General and the American Council on Science and Health, provides information about scientific research on health care for the general public. NECC Director of Research, Dr. Gina Green, recently published an invited editorial there entitled “Autism and ‘Voodoo Science’ Treatments.” Read it at www.drkoop.com/news/focus/2001/jan/06_autism.html



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