Parent-Mediated Intervention for Families With Children With Autism and Feeding Challenges

Study Overview
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Brief Summary
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The goal is to pilot a parent-mediated intervention for feeding challenges in children with autism building on recent research and current successful models already being used. A parent-mediated intervention would primarily occur in the home environment, working with the parent to establish goals and implement the intervention based on their child's specific needs.

Detailed Description
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Recruitment of participants: Families will be recruited through local autism and therapy organizations, the Waisman Center Research Registry and existing studies of Autism Spectrum Disorder (ASD) and feeding. In addition, a targeted effort will be made to recruit a sample representative of the larger Madison community. A total of 50 families who have a child with a diagnosis of ASD (ages 2-7 years) and parent reported feeding problems will be recruited. Each child will be screened for eligibility based on the BAMBIC, STEP-CHILD, and a 10-item screening questionnaire developed for the study. The age range was selected to reliably confirm the ASD diagnosis, high parental involvement in feeding, and capture a small developmental range with a high prevalence of disordered feeding patterns. The diagnosis of ASD will be confirmed based on gold-standard assessment procedures: the ADOS and clinical impression under the supervision of a licensed clinical psychologist. The parent who assumes the primary role of feeding the child will be asked to participate with the child in the study. All individuals will be informed that they may withdraw participation at any time. Procedures: Fifty families with a child with ASD will be asked to participate in 24 parent-mediated feeding intervention visits over approximately six-months. In addition, parents will be asked to participate in 6 to 8 parent training sessions in their home or by phone. Enrollment with two groups of families will be staggered to allow for any further adaptation and refinement of the protocol based on feedback from enrolled families. All families will be asked to participate in an initial intake session that will include an overview of the intervention program, assessment of the intervention targets, parent interview, observation/videotape of a family mealtime, and complete standardized questionnaires on specific variables (e.g., developmental level, autism severity and sensory processing) that can influence feeding behaviors to further describe the population and explore potential confounding variables. The assessments and mealtime observation will assist in determining the child's current feeding challenges and targeted goals. Both parent and child will be asked to participate in a video-taped mealtime and free play time during a laboratory session at pre and post-intervention time points. During the laboratory session, both parent and child will be asked to wear a heart rate activity monitor that attached to their chest via a harness and an electrodermal skin conductance wrist band to allow for wireless physiological data collection. In addition, parents and children will also be requested to wear the heart rate activity monitor two times in their home environment during family mealtime. Hair samples will be taken from both the parent and the child to assess recent stress levels. Parents will collaborate in Goal Attainment Scaling to allow for a pre- and post-test comparison of child specific goals. In addition, feeding assessments as well as a parent stress measure, heart rate variability, and hair cortisol measurement will be used for a pre- and post-test comparison. Parents will participate in brief structured interviews before, one time during, and immediately following completion of the program to provide feedback on the intervention. Intervention: Parents will attend 8 group sessions that will be clustered in the first three quarters of the program focused on topics related to feeding challenges (e.g. goal setting, feeding development, parent-child interactions, sensory processing, behavior management, nutrition, the gastrointestinal system, and family mealtimes). Education sessions will be facilitated by the principal investigator and research team members. Parents will receive 6-10 individual sessions with a feeding interventionist that will support targeted goal setting, problem solving and individual coaching and feedback through video review of parent-led intervention. Parent-child dyads will receive 24 weekly sessions in the home that demonstrate modeling of intervention strategies and provide direct feedback of parent-led intervention. Parent satisfaction and burden will be assessed after each weekly session using a brief Likert scale questionnaire. Parents will be asked to commit 10-15 hours per week in the home setting to directly support targeted feeding goals and related challenges such as sensory processing that may be a barrier to successful eating. Two trained individuals with experience working with children with ASD will be hired to support facilitation of the parent-mediated intervention. Several steps will be taken to train and supervise the interventionists. In addition, a minimum of 20% of their interactions will be video-taped reviewed by the principal investigator to monitor treatment fidelity. Analysis: Descriptive statistics will be used to describe the family and child characteristics as well as family satisfaction. Interview data from the parents will be audio recorded, transcribed verbatim and imported into Nvivo for data management and analysis support to inform future adaptations of the intervention program as well as beginning to unravel who the program may be most effective for and why. An analysis of variance (ANOVA) will be used to assess the pre- and post-intervention differences of the key variables of interest.

Official Title
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Parent-Mediated Intervention for Families With Children With Autism and Feeding Challenges

Conditions
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Parent-Child Relations, Meals, Autism Spectrum Disorder

Intervention / Treatment
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* Behavioral: Parent-Mediated Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Child with a confirmed diagnosis of ASD (ages 2-7 years) Parent reported feeding problems English Speaking Exclusion Criteria: Any conditions co-morbid with ASD (e.g., fragile X) Significant visual, hearing or physical impairments Children who receive any non-oral nutritional supplementation (e.g. gastrostomy tubes)

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: One group, pre, post-test
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Parent-Mediated Intervention with ASD<br>In-home intervention (1-2x/week) will occur with families with children with ASD, including direct intervention, parent coaching, and parent training. | Behavioral: Parent-Mediated Intervention<br>* Children with ASD will participate in a 6-month parent-mediated intervention that will include direct intervention and parent education.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Brief Autism Mealtime Behavior Inventory (BAMBIC) | Parent report 18 item inventory that uses a Likert scale (1 = never to 5 = always) to report frequency of mealtime problem behaviors in children. Total possible range of scores is 18-90 where higher scores indicate increased frequency of mealtime problems. | Pre/post measure through study completion, an average of 6 months | 
| Change in Sensory Experiences Questionnaire (SEQ 3.0) | Caregiver report instrument designed to characterize sensory features in children ages 2-12 years with ASD. This is a 105-item questionnaire, the scoring is based on the first 97: scored on a 5 point scale from 1 (almost never) to 5 (almost always). The remaining items are qualitative and provide context. Total possible range of scores is 97-485, higher scores indicate greater intensity of sensory behaviors. | Pre/post measure through study completion, an average of 6 months | 
| Change in Behavioral Pediatric Feeding Assessment Scale (BPFAS) | Parent report measure designed to identify mealtime behaviors | Pre/post measure through study completion, an average of 6 months | 
| Change in Goal Attainment Scaling (GAS). | Assesses the effectiveness of psycho-social interventions in the community setting in ASD. | Pre/Post measure through study completion, an average of 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Beck Depression Inventory-II (BDI) | Used to assess parent depression and stress. | Pre/post measure through study completion, an average of 6 months | 
| Parenting Stress Index-Short Form (PSI-SF) | Used to assess parent depression and stress. | Pre/post measure through study completion, an average of 6 months | 
| Change in the Caregiver Involvement Scale Score | The Caregiver Involvement Scale is a 6-item instrument scored on a 5-point likert scale for a total possible range of scores from 6-30, where higher scores indicate increased caregiver comfort and involvement with the intervention. | Pre/Post intervention session measure through study completion, an average of 1 time per month (for up to 6 months) |