Food Selectivity in Children with Autism - Using ABA Parent Training to Improve Eating Habits
Picky or selective eating, also known as food selectivity, is a common issue seen in children with autism spectrum disorder. This is a serious issue which could lead to health problems and nutritional deficiencies in these children. Some children may have such severe food selectivity that they may only eat about five different foods. (Cermak, et. al., 2010).
It is not clear what causes food selectivity but sensory issues may be one factor. The aversiveness of the smell, texture, color, or temperature of some foods may contribute to food selectivity, so taking this into consideration with behavioral programming is something to consider. Additionally, consulting with competent professionals and only practicing within your own competence and under training when appropriate is ethical practice which applies to treating food selectivity.
Using behavioral skills training is one way to teach parents to work on food selectivity at home outside of treatment. One study by Cermak, Curtin, and Bandini (2010) utilized behavioral skills training to help parents work on taste exposure, escape extinction, and fading for their children who had difficulties with food selectivity. They found that parents improved their performance after the training session and that the intervention resulted in improvements with the children’s acceptance of taking bites of food. Maladaptive behavior reduction also occurred. Even at follow-up, the children from the study maintained increases in the variety of foods they were consuming.
Mueller et al. (2003) used behavioral skills training (BST) involving instructions, modeling, rehearsal, and feedback, to train parents to work on food selectivity with their child. The parents were taught to use extinction and either differential reinforcement of alternative behavior (DRA) or noncontingent reinforcement (NCR). Results of their study suggest that parents can effectively implement intervention that has been trained by an ABA professional and that positive outcomes can be seen from parent-implemented intervention.
To provide ABA parent training for food selectivity in children with autism it is important that the ABA provider have competency in this area in order to provide guidance to the family on feeding-related issues. Per the BACB Professional and Ethical Compliance Code, BCBAs must only practice in their area of competence and receive proper training for new areas that they would like to become competent in.
Parents can be trained to work on food selectivity by first teaching them to complete a taste session as was completed in a study by Sieverling, et. al. (2012). This could include having the caregiver present a single bite of food to their child. After the child ate the bite presented, they were allowed to leave the area for 3 minutes. In the study, The presented bites started out being about the size of a pea and then after the child took the bite of food within 30 seconds of presentation without maladaptive behaviors for three sessions, the size of the bite was increased to half a spoonful. The caregiver tried to work on providing foods from all food groups.
Extinction was used in the study if the child spit out the food and a new presentation of the food was presented. Ignoring of maladaptive behavior was used to decrease the problematic behaviors displayed. After ten taste sessions, the caregiver presented 10 minute probe meals with new foods to evaluate generalization of trying new food items.
A task analysis to be provided during ABA parent training, particularly for working on food selectivity, can be helpful. When helping a parent learn to utilize a task analysis, using BST is beneficial. The ABA provider can use modeling, rehearsal, and feedback to help a parent learn the steps in the task analysis.
To help treat food selectivity in children with autism, using behavioral skills training in ABA Parent Training including use of modeling, rehearsal, and feedback has been demonstrated to have positive outcomes on child eating habits.
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), 238-46.
Mueller, M. M., Piazza, C. C., Moore, J. W., Kelley, M. E., Bethke, S. A., Pruett, A. E., Oberdorff, A. J., … Layer, S. A. (2003). Training parents to implement pediatric feeding protocols. Journal of applied behavior analysis, 36(4), 545-62.
Seiverling, L., Williams, K., Sturmey, P., & Hart, S. (2012). Effects of behavioral skills training on parental treatment of children's food selectivity. Journal of applied behavior analysis, 45(1), 197-203.