SIGNIFICANCE: Autism spectrum disorder (ASD) is a growing area of practice for occupational therapy practitioners. It is increasingly recognized that mealtimes present intense challenges for children with ASD and their families. The current study evaluated the efficacy of family-centered, naturalistic interventions on the occupational performance of children with ASD during mealtimes.

INNOVATION: This research shifts the emphasis of intervention for children with ASD from a client-centered, practitioner-delivered model to a family-centered, parent-delivered model. Prior research in this area has been focused on single behaviors and interventions, leading to an oversimplification of the problem and solution. Rather than relying on a single strategy, this research combines evidence-based practices (EBPs) and other clinical interventions to support the complex system of mealtimes.

APPROACH: This study attempted to answer the following research question: Does a family-centered, multicomponent intervention package developed in conjunction with parents improve the food acceptance of children with ASD?

The research in EBPs for mealtime behaviors of children with ASD has focused on isolated techniques, such as the use of simultaneous presentation of familiar and novel foods. Although mealtimes are complex, few studies have simultaneously addressed multiple strategies, and none have simultaneously explored four key areas known to be important for children with ASD: sensory factors (including food characteristics), social environment (e.g., behavioral strategies), communication (expressive and receptive), and physical environment. Additionally, other than case reports, there are no known studies that individualized the intervention for the child and used natural environments/supports. This study addresses these gaps in current knowledge.

METHOD: This study used a single-subject, multiple-baselines-across-participants design that was designed following recommended practices from leading single-subject researchers. Data were gathered via direct in-home observations of the mealtimes by the researchers and systematically analyzed following best practice guidelines.

Data were collected exclusively in the family home for three families. The fourth family began sessions in a clinic setting and then transitioned to the home.

Participants were 4 parent–child dyads. Children were aged 5 to 8 yr, with a multidisciplinary diagnosis of ASD and a history of food selectivity/challenging behaviors. Data were collected per bite opportunity on the occurrence of challenging behaviors and the level that the child reached on a preidentified food acceptance hierarchy scale. Data were analyzed within and between conditions, consistent with best practice guidelines for single-subject research. Interpretation of the data relied on analysis of the data regarding data level, data trend, and percentage of nonoverlapping data between conditions.

RESULTS: All 4 children demonstrated significantly decreased challenging behaviors and increased acceptance of less preferred foods over the course of the study.

CONCLUSION: This study indicates that the intervention package developed with the parents was effective in improving the mealtime behaviors of the 4 children with ASD. Additional research is required to replicate these findings and to examine the efficacy of training a wider range of community professionals to coach parents.