Individualized Mealtime Routines Support Family-Specific Feeding Goals

Up to 84% of autistic children have feeding challenges, significantly impacting mealtime for all family members. However, mealtime is also an ideal opportunity for interventions that are contextually embedded and build on family strengths and unique routines. This study aimed to understand how family participation in a caregiver-mediated feeding intervention, the Engaged Eaters Program, impacted mealtime experiences. A quasi-experimental pre-post-test design was used to evaluate mealtimes for families (n=8) with an autistic child with feeding challenges. Families identified a representative mealtime to be recorded and evaluated using the Mealtime Interaction Coding System (MICS). Mealtime length, structure, and location was unique to each family. The MICS was used as an observational coding system for evaluating naturalistic family mealtime. Post-intervention mealtimes were coded for changes in MICS scores that represented the individualized family intervention goals. All seven MICS variables (Task Accomplishment, Communication, Affect Management, Interpersonal Involvement, Behavior Control, Roles, Family Functioning) improved post-intervention with Behavior Control being the only MICS variable to reach significance (p=.033). Behavior control measures the ways a family maintains standards for the meal including meeting individual member’s needs, maintaining social expectations, and managing physical danger. In addition, five families had observable changes in their final mealtimes that were directly related to the family identified intervention goals. Results of this study suggest that the diversity in mealtime construction represented in this study may not align with the norms established within the MICS and therefore may not have adequately measured change in diverse mealtimes with autistic children. Occupational therapists are uniquely situated to support families in developing individualized mealtime routines that support their family specific feeding goals.

References

Dickstein, S., Hayden, L., Schiller, M., Seifer, R., & San Antonio, W. (1994). Providence Family Study. Family mealtime interaction coding system. Unpublished coding manual.

Leader, G., Tuohy, E., Chen, J. L., Mannion, A., & Gilroy, S. P. (2020). Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(4), 1401–1410. https://doi.org/10.1007/s10803-019-04357-7

St. John, B. M., & Ausderau, K. K. Changes in the daily mealtime experience of families following participation in the Engaged Eaters Program: A qualitative study (Target submission June 2023).

Suarez, M., A., Atchison, B., J., & Lagerwey, M. (2014). Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity. American Journal of Occupational Therapy, 68(1), 102–107. https://doi.org/10.5014/ajot.2014.008748