Date Presented 04/02/2022
Children with autism spectrum disorder (ASD) have significant feeding challenges that create barriers to successful mealtimes. A qualitative study consisted of thematic analysis of 12 semistructured interviews of mothers who participated in 24 home-based feeding sessions and parent education to examine the perceived impact of parent-mediated feeding therapy. Data validated the complexity of maternal roles and supported positive child-specific goals as well as parenting efficacy and family participation.
Primary Author and Speaker: Libby Hladik
Additional Authors and Speakers: Karla Ausderau, Brittany St John
PURPOSE: Children with autism spectrum disorders (ASD) have significant feeding challenges creating barriers to successful mealtimes. Feeding challenges are heterogeneous and may include a range of sensory, behavior, oral motor, and underlying health challenges, increasing parent stress (Thullen & Bonsall, 2017). Family mealtime promotes cohesion and positive eating experiences, but stress surrounding feeding is often high. Mothers are often the caregiver responsible for orchestrating mealtimes and integrating their child with ASD and feeding challenges (McAuliffe et al., 2019). Parent-mediated interventions embed the caregiver in the intervention process by providing training, coaching, and direct child intervention to facilitate child goals and improved mealtime participation. Insight into the experiences and perspectives of mothers of children with ASD participating in a novel parent-mediated feeding intervention, in the home context, provides an understanding of real-life therapy participation and caregiver implications. The purpose of this study was to examine the perceived impact of participating in a parent-mediated in-home feeding intervention for children with ASD.
DESIGN: A qualitative interview study design was used.
METHOD: Interviews were conducted with mothers of mother-child dyads who participated in 24 home-based feeding sessions and accompanying parent education modules delivered by an occupational therapist. Semi-structured post-intervention interviews (n = 12) were completed with mothers and were transcribed verbatim. A thematic analysis was completed to examine mothers’ experiences and perspectives (Braun and Clarke, 2006). Transcripts were independently coded in NVivo by at least two researchers, then through a collaborative and iterative process, codes were refined, and themes were identified. Themes and sub-themes were defined and compared across the entirety of the data set.
RESULTS: Four primary themes emerged from the data: Parent Skill and Knowledge Development, Impact of Intervention Location, Responsibilities and Challenges, and Increased Family Social Participation. Sub-themes in the data further define similarities and differences within the participants. Mothers indicated that practical tools provided from sessions increased their confidence and aided in perspective shifts to meet the needs of their child. The in-home context and therapeutic relationship supported therapeutic progress and carry-over into daily life as well as other social and educational environments. In addition to benefits, mothers also reported increased stress and responsibility of participating in parent-mediated therapy.
CONCLUSION: Data gathered in this study validated the complexity of maternal roles, supported positive child-specific goals, as well as parenting efficacy and family participation for in-home, parent-medicated feeding therapy for children with ASD. Positive experiences appear to relate to an increase intangible skills and tools to increase confidence in feeding. The congruence between the demands of daily life and how the in-home parent-mediated nature of intervention allowed for families to meet their feeding goals. Potential drawbacks were related to balance, especially for mothers with increased daily demands and complex life circumstances. Study findings support the ecological validity of in-home parent-mediated feeding intervention for children with ASD and feeding challenges.
IMPACT STATEMENT: Parent–mediated interventions may align well with occupational therapy intervention to support client and family-centered interventions in an ecologically valid context. However, the impact of the intervention on the caregiver requires attention to support their learning and needs.
Althoff, C. E., Dammann, C. P., Hope, S. J., & Ausderau, K. K. (2019). Parent-mediated interventions for children with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 73(3), 7303205010. https://doi.org/10.5014/ajot.2019.030015
Mcauliffe, T., Thomas, Y., Vaz, S., Falkmer, T., & Cordier, R. (2019). The experiences of mothers of children with autism spectrum disorder: Managing family routines and mothers’ health and wellbeing. Australian Occupational Therapy Journal, 66(1), 68-76. https://doi.org/10.1111/1440-1630.12524
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Thullen, M., & Bonsall, A. (2017). Co-parenting quality, parenting stress, and feeding challenges in families with a child diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(3), 878-886. http://dx.doi.org/10.1007/s10803-016-2988-x