Autism Spectrum Disorder Clinical Trial
Official title:
The Sequential Oral Sensory (SOS) Intervention in Treating Children With Autism Spectrum Disorder and Limited Food Repertoire
There is a paucity of research evaluating the effectiveness of a multidisciplinary approach in an outpatient clinic setting in the management of feeding problems in children diagnosed with ASD. Current behavioural interventions geared to address this problem can be labour intensive and costly. The SOS approach for managing feeding problems in children has been adopted internationally. Thus establishing its effectiveness will be useful in providing evidenced based interventions for feeding difficulties in ASD.
Feeding problems in children diagnosed with autism spectrum disorder (ASD) has been found to
vary from 46-89%, with significant variability in feeding patterns. Feeding problems can
lead to failure to thrive, nutritional deficiencies, growth retardation, social deficits and
poor academic achievements. Common feeding problems are typified by limited food repertoire,
food refusal and high frequency single food intake. The etiology of feeding problems in
children with ASD is multifactorial and includes sensory issues, perseveration, avoidance of
novel stimuli and food intolerance. No single aetiology has been assigned to limited food
repertoire in children diagnosed with ASD. A recent meta-analysis of feeding problems and
nutritional intake in children diagnosed with ASD reveals that children with ASD had more
feeding problems when compared to peers (odds ratio 5.11, 95% Confidence interval (CI)
3.74-6.97). There was significantly lower intake of calcium and protein. Children diagnosed
with ASD have limited food repertoire compared to typically developing children (19.0 (5.0)
foods eaten vs. 22.5 (4.6) foods eaten, p value 0.0003) and they have evidence of
nutritional inadequacies and poor bone growth. The impact of feeding problems extends to the
home environment and may contribute to parental stress and affect bonding/ attachment of
child to caregiver during mealtimes. This phenomena has not been explored in depth in
current research.
Behavioural intervention using an interdisciplinary team model is the hallmark intervention
for the treatment of feeding problems in children diagnosed with ASD. However there is
limited research data available in this field. Behavioural intervention approaches described
in the literature include stimulus control, positive reinforcement, negative reinforcement,
discrimination training, extinction, punishment and desensitization. Positive
reinforcement-based intervention, physical guidance, and non-removal of the spoon are
techniques which have found to be useful based on case reports. These interventions require
highly structured environments, are costly and at times parents are not involved in the
management plan, thus limiting generalizability. There is no consensus regarding which
technique is superior and more effective.
There are three published interventional studies which directly address feeding problems in
ASD. These span from intensive inpatient management to behavioural patient based curriculum.
A retrospective chart review of 37 children over a 2 year period seen in group intervention
sessions using the Sequential Oral Sensory (SOS) approach showed some promise in increasing
food variability and intake. The Sequential Oral Sensory (SOS) approach is a
multidisciplinary program for assessing and treating children with feeding and weight
problems. This program uses a systematic desensitization hierarchy of skills necessary for
children to progress with eating various food textures. The technique is patient controlled,
where the patient is "allowed to move away" from the exposure. The goal of the therapy is to
maintain a competing response in the face of increasing incremental exposures. The SOS
approach if effective presents a more affordable treatment option, in a natural outpatient
setting and utilizes parental participation under supervision which may translate to
generalizability to the home environment. Given the prevalence of feeding challenges in ASD
exploring this option should be undertaken given its suggested implications.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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