The Sequential Oral Sensory Approach Intervention in Treating Children with Autism Spectrum Disorder and Limited Food Repertoire. a Pilot Study

Background:  

Food selectivity is one of the most common feeding challenges noted within Autism Spectrum Disorder (ASD). This phenomenon is inclusive of food refusal, limited food repertoire (LFR) and high frequency single food intake.  Its etiology is thought to be multifactorial, involving sensory, motor and mealtime behavioural idiosyncrasies. Excessive weight gain and nutritional deficiencies have been linked to poor feeding behaviours in ASD.  Currently there is a lack of evidence based treatments to address these feeding challenges. Most hospital based interventions used to address this issue are limited to a multidisciplinary team approach which may have economic and human resource limitations. There are a myriad of behavioural interventions targeting feeding challenges; among them, the Sequential Oral Sensory Approach (SOS) is a commonly used approach used within the community. However, SOS is most commonly administered in a dyad (individual and clinician) construct which could be costly to the family. Its application in a group setting to mitigate cost and maximize human resources has not been studied.

Objectives:  

This pilot study’s aim is to evaluate the feasibility and effectiveness of the SOS approach intervention in increasing the food repertoire in children with ASD and LFR.

Methods:  

Children 4 to 8 years with ASD were recruited. LFR was defined as eating less than 20 foods identified in a 3 day food diary. Participants were randomized to receive the 12 SOS intervention sessions (inclusive of a parent education sessions) or to a control group where parents were provided with educational material and three feeding education sessions over a 12 week period. 

Results:  

Fifteen children completed the study (n=8 in the SOS group and n=7 in the control group). A study participant and a parent attended eighty one percent (81%) of sessions in the SOS group.  There is a trend towards an increase in the number of foods eaten over a 12 week period in the SOS group and a decrease in the Brief Autism Mealtime Behaviour Inventory score and reduction of parental stress. All parents met individual goals established at the start of the intervention.

Conclusions:  

This study supports the overall feasibility of the SOS intervention in a group based setting to address feeding challenges in ASD based on only 1 participant (12.5%) being unable to complete the 12 week intervention program.  This study suggests that participation in the SOS intervention program may help to increase the number of foods eaten by a child with ASD and LFR over time.  A larger randomized control trial is needed to further evaluate the effectiveness of the SOS intervention in children with ASD.