A systematic review of interventions for feeding-related behaviors for individuals with autism spectrum disorders

Background Feeding problems are common for individuals with ASD. Researchers have most often used single case designs, a type of design appropriate for evaluating causal relations, to assess feeding interventions. Previous reviews of effectiveness have included only peer-reviewed studies (e.g., did not include gray literature) and have not analyzed outcomes via the presence of functional relations, the primary analysis method for single case research. Method Authors reviewed peer-reviewed and non-peer-reviewed sources including studies designed to improve mealtime behaviors for individuals with autism spectrum disorder (ASD) to determine participant characteristics, common intervention characteristics and components, and success rates (percentage of studies with functional relations). Results Studies often included individuals with ASD who were highly selective; common dependent variables were acceptance of food and problematic mealtime behaviors. Researchers, rather than indigenous adults, most often implemented studies in clinics, rather than typical settings. Interventions designed to improve acceptance had higher success rates (percentage of studies demonstrating a functional relation) than those targeting rumination/vomiting or problematic mealtime behavior. Conclusions Outcomes were more often positive for food acceptance and less often positive for problematic mealtime behavior. More research is needed, particularly in typical contexts with indigenous implementers and including component analyses, feasibility assessment, and social validity measurement. Feeding interventions should be selected based on identified caregiver priorities (e.g., focus on problematic mealtime behavior or food acceptance) and should include consideration of behavioral function and less restrictive interventions.