SIGNIFICANCE: Children with autism spectrum disorder (ASD) often have selective eating behaviors that may potentially lead to nutritional deficit, disruption of family mealtime, parental stress, and long-term behavioral issues (Johnson et al., 2014). We developed the Engagement–Communication–Exploration (ECE) snack time intervention to promote food exploration and eating and social engagement in young children with ASD. A team of occupational therapists (OTs), graduate students, and preschool teachers implemented this interdisciplinary, play-based, child-centered intervention during the preschool snack time.

Between 50% and 90% of children with ASD experience eating difficulties, such as food selectivity, which is more than children with intellectual disability and children with typical development (Sharp et al., 2013). Children with ASD also tend to have limited social skills and difficulty with social interactions. Snack time offers the potential to promote positive social skill development and opportunities to improve food selectivity (i.e., increase the variety of healthy foods eaten) within a natural, social setting. Therefore, in this study, we attempted to answer the following research question: Does the ECE snack time intervention improve social engagement and eating behaviors in young children with ASD?

METHOD: This multiple-baseline design included 6 children, aged 3 to 4 yr, diagnosed with ASD. Children were recruited from two Midwestern institutions to participate in the ECE snack time intervention. OTs, graduate students, and the classroom teachers provided the ECE to small groups of 6 to 7 children for 5 wk, targeting 1 to 2 children biweekly during snack. In this study intervention, we combined environmental arrangement (i.e., arranging adult/peer supports), child-centered play, responsiveness, scaffolding, modeling, and encouraging peer interaction. Combinations of three to four familiar and novel healthy foods were offered at each session. Data from the Food Frequency Questionnaire (FFQ) and Brief Assessment of Mealtime Behavior in Children (BAMBIC) were collected from parents before and after intervention. Videos were analyzed by two independent raters using 30-s interval scoring for social engagement and food-related behaviors. Data for the 5 wk were graphed and visually analyzed to determine differences in eating and social behavior at baseline and during implementation of the intervention.

RESULTS AND CONCLUSION: In this pilot study in which we used a multiple-baseline, single-subject design, children improved their rates of social initiations (3/6), social responses (2/6), and food exploration (4/6). Significant changes in the FFQ or BAMBIC from baseline to postintervention were not observed. Therefore, half of the children benefited, particularly in social competence.

Eaves, L. C.,& Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 739–747. http://dx.doi.org/10.1007/s10803-007-0441-x

Johnson, C. R., Turner, K., Stewart, P. A., Schmidt, B., Shui, A., Macklin, E., … Hyman, S. L. (2014). Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. Journal of Autism and Developmental Disorders, 44, 2175–2184. http://dx.doi.org/10.1007/s10803-014-2095-9

Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., ... Jaquess, D. L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders, 43, 2159–2173. http://dx.doi.org/10.1007/s10803-013-1771-5