Prevention and Intervention

Dietary Intake Outcomes of Feeding Interventions for Children With Autism

Spectrum Disorder (ASD)—A Systematic Review
Amanda Malzacher, Sophia Slocum, Karla Ausderau, PhD
University of Wisconsin–Madison, Madison, WI, USA

Downloaded from http://research.aota.org/ajot/article-pdf/74/4_Supplement_1/7411515342p1/30636/po1115.pdf by Integracion Sensorial Acis, Adriana Ramirez on 12 November 2022
DOI: 10.5014/ajot.2020.74S1-PO1115
Date presented: March 26, 2020
Primary Author and Speaker: Amanda Malzacher, amalzacher@wisc.edu

PURPOSE: As many as 46-89% of children with autism spectrum disorder (ASD) have difficulty with feeding, leading to increased
risk of inadequate nutrition and associated developmental and medical issues. This can lead to increased risks for diseases, bone
health problems, obesity, and more. The purpose of this systematic review was to assess the effectiveness of interventions to improve
dietary intake in children with ASD.
DESIGN: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to conduct this systematic
review.
METHOD: Following the PRISMA guidelines, a systematic review was conducted using a systematic search of relevant academic
databases and relevant reference lists using terms such as autism, feeding, diet, food, eat, nutrition, intervention, program, and
treatment. Academic databases searched included PubMed, CINAHL Plus, PsychINFO and Web of Science. Inclusion criteria
included child diagnosis of ASD and between birth to 25 years old. Studies that considered behavior outcomes only rather than
dietary outcomes were excluded. The search resulted in 1,409 articles. After screening titles and abstracts, 82 articles were
selected for full-text review. Eleven studies were included in the final analysis.
RESULTS: Levels and strength of evidence were identified based on the AOTA guidelines and U.S. Preventive Services Task Force
levels of certainty. The 11 studies included seven with Level I and four with Level III evidence. Studies were categorized into types
of interventions: behavioral and desensitization, school based, vitamins, and minerals. Limited to moderate evidence supported
behavior modification and desensitization practices when delivered by an interdisciplinary team to increase food consumption in
children with ASD to improve a child’s overall dietary status. Strong evidence supported supplements to increase levels of specific
vitamins and minerals, although not necessarily targeted at an identified deficiency in a child.
CONCLUSION: Behavior and sensory focused interventions increased quantity, texture, and variety of food consumption, including
fruits, vegetables, and proteins for children with ASD. Although nutrition supplements were effective at increasing targeted vitamins
and minerals, they were often implemented to target behavioral changes versus nutrient deficiencies. While this systematic review
suggest moderate to strong evidence to support intervention for children with ASD to improve their ADL skills, interventions were
heterogenous and included a range of outcomes. Future research should examine if specific types of interventions may be more
effective for certain outcomes or possibly different approaches (family-centered or individual) may be more effective for different age
ranges. In addition, few studies provided long-term follow-up to determine if ADL skills were maintained overtime or supported
increased independence in occupational performance.
IMPACT STATEMENT: As participation in mealtime is an essential occupation which impacts many areas of a child’s occupational
performance, OTs are well situated to address feeding challenges in children with ASD as well as overall dietary status. Results
from this systematic support that OTs, working in conjunction with a multidisciplinary team, can have significant impact on nutrition
intake through a variety of feeding interventions.

References
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Taylor, T., Kozlowski, A. M., & Girolami, P. A. (2017). Comparing behavioral treatment of feeding difficulties and tube dependence in children with cerebral
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The American Journal of Occupational Therapy, August 2020, Vol. 74, Supplement 1