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A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder

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Title: A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder
Language: English
Authors: Teresa Lindsey Burrell, William G. Sharp, Scott Gillespie, Katherine Pickard, Susan Brasher, Derianne Buckley, Lawrence Scahill (ORCID 0000-0001-5073-1707)
Source: Journal of Autism and Developmental Disorders. 2025 55(6):2000-2008.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Eating Disorders, Autism Spectrum Disorders, Children, Patients, Therapy, Community Surveys, Evidence Based Practice, Intervention, Pediatrics
DOI: 10.1007/s10803-023-06013-7
ISSN: 0162-3257
1573-3432
Abstract: Purpose: Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. Methods: Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. Results: A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. Conclusions: These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1470809
Database: ERIC
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  Value: <anid>AN0185099689;aut01jun.25;2025May14.02:48;v2.2.500</anid> <title id="AN0185099689-1">A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder </title> <p>Purpose: Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. Methods: Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. Results: A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. Conclusions: These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.</p> <p>Keywords: Autism Spectrum Disorder; Pediatric Feeding Disorder; ARFID; Community Involvement; Parent Training; Evidence-Based Treatment; Medical and Health Sciences Public Health and Health Services</p> <p>The Original article is revised to update the first author.</p> <p>The estimated prevalence of autism spectrum disorder in school-age children has increased over the past two decades from 2 to 1000 to 18.5 per 1000 (Yeargin-Asllopp et al., [<reflink idref="bib34" id="ref1">34</reflink>]; Maenner et al., [<reflink idref="bib14" id="ref2">14</reflink>]). This trend reflects the broadening of the diagnostic criteria, improved assessment methods and increased awareness. Over this same period, there has also been an increase in evidence-based interventions for treating core features of ASD and commonly occurring behavioral problems in this population (Lord & Charman et al., [<reflink idref="bib12" id="ref3">12</reflink>]). There has also been an increase in demand for these services (Landa, [<reflink idref="bib11" id="ref4">11</reflink>]). The adoption of empirically supported interventions into routine practice, however, has not kept pace with the growing body of evidence and increased demand (Boyd et al., [<reflink idref="bib4" id="ref5">4</reflink>]). Although not unique to ASD, the gap between accumulated research evidence and clinical practice is recognized in many fields of medicine (Morris et al., [<reflink idref="bib17" id="ref6">17</reflink>]; Lyon et al., [<reflink idref="bib13" id="ref7">13</reflink>]). Barriers to the adoption of new evidenced-based treatments by community providers for children with ASD may include questions about the fit of the intervention in community settings, staff turnover, and limited access to training on the intervention in community settings perhaps due to, insufficient administrative support for training (Boyd et al., [<reflink idref="bib4" id="ref8">4</reflink>]).</p> <p>In children with ASD, findings from many studies support the effectiveness of parent-mediated interventions for skill development and reduction of behavioral problems in children with ASD (Bearss et al., [<reflink idref="bib2" id="ref9">2</reflink>]). Parent-mediated interventions that teach parents to implement therapeutic strategies have demonstrated efficacy in improving social communication and joint attention skills (Ingersoll & Wainer, [<reflink idref="bib7" id="ref10">7</reflink>]; Kasari et al., [<reflink idref="bib10" id="ref11">10</reflink>]), disruptive behavior (Postorino et al., [<reflink idref="bib19" id="ref12">19</reflink>]; Tarver et al., [<reflink idref="bib32" id="ref13">32</reflink>]), as well as sleep and feeding problems (Johnson et al., [<reflink idref="bib9" id="ref14">9</reflink>], [<reflink idref="bib8" id="ref15">8</reflink>]; Sharp et al., [<reflink idref="bib26" id="ref16">26</reflink>]). Collectively, this body of work illustrates that parent-mediated interventions for children with ASD provide caregivers information and techniques that specifically target the child's behavioral problem or skill deficit. By contrast, parent education provides caregivers with useful – but more general information about autism (Bearss et al., [<reflink idref="bib2" id="ref17">2</reflink>]). The transfer and integration of parent training into community practice, however, is limited, with only a handful of studies examining the implementation of parent training programs within community systems (Chlebowski et al., [<reflink idref="bib5" id="ref18">5</reflink>]; Rieth et al., [<reflink idref="bib21" id="ref19">21</reflink>]; Stahmer et al., [<reflink idref="bib30" id="ref20">30</reflink>]). However, gathering information from community providers about the service demand for the clinical problem (e.g., feeding problems) and interest in parent-mediated intervention may offer guidance on the translation of evidence-based interventions into community settings.</p> <p>Over the past decade, there has been increased interest in the clinical management of feeding problems in children with ASD (Sharp et al., [<reflink idref="bib22" id="ref21">22</reflink>], [<reflink idref="bib23" id="ref22">23</reflink>], [<reflink idref="bib27" id="ref23">27</reflink>]; Johnson et al., [<reflink idref="bib8" id="ref24">8</reflink>]). Feeding problems ranging from mild to severe are common in autistic children. Severe feeding problems often require intensive treatment in specialty clinics (Sharp et al., [<reflink idref="bib27" id="ref25">27</reflink>]). Children with mild feeding problems may not need treatment beyond parent education. Moderate feeding problems, often characterized by food selectivity and disruptive mealtime behavior may adversely affect the child's health (Mayes & Zickgraf, [<reflink idref="bib16" id="ref26">16</reflink>]; Sharp et al., [<reflink idref="bib25" id="ref27">25</reflink>]; Sharp & Postorino, [<reflink idref="bib28" id="ref28">28</reflink>]) and the quality of family life (Postorino et al., [<reflink idref="bib20" id="ref29">20</reflink>]; Suarez et al., [<reflink idref="bib31" id="ref30">31</reflink>]). Therefore, treatment for or autistic children with moderate feeding problems is warranted.</p> <p>Recently, our group conducted a randomized clinical trial of a structured parent-mediated intervention: Managing Eating Aversions and Limited Variety (MEAL) Plan compared to a structured Parent Education program. In that study of children with ASD and moderate food selectivity, MEAL Plan was found acceptable to caregivers. Moreover, it was superior to Parent Education in decreasing disruptive mealtime behavior and increasing dietary variety (Sharp et al., [<reflink idref="bib26" id="ref31">26</reflink>]). These results on the efficacy of parent-mediated intervention for children with ASD and food selectivity are consistent with other reports (Johnson et al., [<reflink idref="bib8" id="ref32">8</reflink>]). Current treatment demand for feeding problems in autistic children in community settings and approaches to treatment, however, are uncertain. In addition, the level of interest in a structured parent-mediated intervention for food selectivity in community providers is unknown.</p> <p>In the community, feeding problems in children with ASD may be treated by Speech-language pathologists (SLPs), occupational therapists (OTs), registered dietitians (RDs), or Board-Certified Behavior Analysts (BCBAs) (Marshall et al., [<reflink idref="bib15" id="ref33">15</reflink>]; Taylor & Taylor, [<reflink idref="bib33" id="ref34">33</reflink>]; Sharp et al., [<reflink idref="bib25" id="ref35">25</reflink>]). Intervention strategies may vary by provider discipline. We surveyed SLPs, OTs, BCBAs and RDs in community practice to collect information on demand for treating feeding problems in children with ASD, on the current treatment approaches used in community practice and on the level of interest in parent-mediated intervention for this clinical population. The report presents the key findings of the survey.</p> <hd id="AN0185099689-2">Methods</hd> <p></p> <hd id="AN0185099689-3">Survey Design and Distribution</hd> <p>To gather information on the demand and community treatments of feeding problems in autistic children, we developed a 15-item online survey (available from corresponding author upon request). The initial draft was revised following review and feedback from experts in the multidisciplinary feeding program at Marcus Autism Center at Emory University School of Medicine. The final version included questions about professional discipline, practice setting, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in structured, parent-mediated interventions. Five items required "yes" or "no" responses; four multiple-choice items requested a single selection; four items invited respondents to check all that apply. Two additional items, adapted from the Ottawa Acceptability Survey, inquired about provider openness to new treatment approaches and attitudes on using a manual-driven treatment (O'Connor & Cranney, [<reflink idref="bib18" id="ref36">18</reflink>]). These two items were scored on a 5-point Likert scale ranging from strongly disagree to strongly agree.</p> <p>Between November 2019 and November 2020, we invited BCBAs, SLPs, OTs, RDs and other interested providers to complete the survey. We used various methods to recruit local (greater Atlanta metropolitan area), regional (Southeast United States), and national (United States) participants. These efforts included announcements on e-mail listservs, professional conferences, continuing education programs, social media webpages of professional organization and electronic newsletters (see Table 1). Survey respondents who answered "no" to the question: "Do you see children with ASD and feeding problems?" were excluded from analysis. Individuals who checked "other" on the professional discipline item were reclassified into an aligned group if possible (e.g., registered behavior technicians were classified with BCBAs, SLP assistants were classified with SLPs). Respondents who checked "other" but could not be reclassified due to incomplete information were dropped from the analyses.</p> <p>Table 1 Recruitment Strategy by Discipline</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Discipline Type</p></th><th align="left"><p>Recruitment Strategy</p></th><th align="left"><p>Location</p></th></tr></thead><tbody><tr><td align="left" rowspan="3"><p>BCBA</p></td><td align="left"><p>51 ABA practices</p></td><td align="left"><p>Regional</p></td></tr><tr><td align="left"><p>Georgia Applied Behavior Analysis Facebook Page</p></td><td align="left"><p>Regional</p></td></tr><tr><td align="left"><p>Behavior Analyst Certification Board (BACB) Listserv</p></td><td align="left"><p>National</p></td></tr><tr><td align="left" rowspan="5"><p>SLP/OT</p></td><td align="left"><p>Affiliated pediatric hospital OTs and SLPs</p></td><td align="left"><p>Local</p></td></tr><tr><td align="left"><p>34 Rehabilitative practices</p></td><td align="left"><p>Regional</p></td></tr><tr><td align="left"><p>Presentation at Georgia Association for Speech and Hearing Sciences (GSHA) Conference</p></td><td align="left"><p>Regional</p></td></tr><tr><td align="left"><p>Presentation at the Association for Speech and Hearing Sciences (ASHA) Conference</p></td><td align="left"><p>National</p></td></tr><tr><td align="left"><p>Pediatric feeding newsletter</p></td><td align="left"><p>National</p></td></tr><tr><td align="left" rowspan="2"><p>Dietitians</p></td><td align="left"><p>Presentation at Georgia Atlanta Dietetic Association (GADA) Conference</p></td><td align="left"><p>Regional</p></td></tr><tr><td align="left"><p>Pediatric Nutrition Practice Group Listserv</p></td><td align="left"><p>National</p></td></tr></tbody></table> </ephtml> </p> <p>The survey was approved by the Emory University School of Medicine Institutional Review Board. The electronic consent document indicated that participation was voluntary and that survey responses were anonymous. However, respondents were invited to provide contact information if interested in "learning more about assessment and treatment of feeding problems in children with ASD." Survey data were collected and managed using Research Electronic Data Capture (REDCap) hosted by Emory University.</p> <hd id="AN0185099689-4">Analytic Plan</hd> <p>Data analyses were performed in SAS v.9.4 (Cary, NC); statistical significance was set at the 0.05 threshold. Survey responses were summarized overall and by professional categories using means and standard deviations for continuous variables and frequencies and percentages for categorical data. Differences in responses between professional categories were assessed using unequal variances one-way analysis of variance (ANOVA) tests for continuous data. Post hoc pairwise tests were calculated when omnibus tests were significant. For categorical comparisons, we used Chi-square tests of independence or Fisher's exact tests. Statistically significant differences are labeled in Tables by superscripts. In this exploratory and descriptive study, we did not adjust the p-value for multiple comparisons.</p> <hd id="AN0185099689-5">Results</hd> <p>A total of 541 survey respondents began the survey; 446 participants completed all survey questions. Of those, 6 participants "did not see children" and 21 selected "other" profession and could not be re-classified. The characteristics of the final sample N = 419 are shown by professional category in Fig. 1.</p> <p>Graph: Fig. 1 Flow Chart of Survey Respondents</p> <p>Provider demographic and practice characteristics are presented in Table 2. There were significant differences by profession on years in practice, number of children seen per week, and number of children with ASD (all p <.001). On "years in professional experience" OTs had the highest percentage of late-career providers (> 15 years); BCBAs had the highest percentage of early career providers (0 to 5 years) and lowest percentage of late-career providers. As shown in Table 2, SLPs and OTs reported higher weekly volumes for patients with and without ASD. As a percentage, SLPs and OTs reported that > 10 children with ASD per week equaled 30% of their caseloads. This was slightly higher than BCBAs and considerably higher than RDs.</p> <p>Table 2 Demographic and clinical characteristics by provider type</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Survey Questions</p></th><th align="left"><p>N</p></th><th align="left"><p>All Participants</p><p>N = 419</p></th><th align="left"><p>SLP</p><p>N = 109 (26%)</p></th><th align="left"><p>OT</p><p>N = 63 (15.1%)</p></th><th align="left"><p>BCBA</p><p>N = 195 (46.5%)</p></th><th align="left"><p>RD</p><p>N = 52 (12.4%)</p></th><th align="left"><p>P-Value</p></th></tr></thead><tbody><tr><td align="left"><p>Practice years</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> 0–5</p></td><td char="." align="char"><p>419</p></td><td char="." align="char"><p>141 (33.6%)</p></td><td align="left"><p>29 (26.6%)<sup>a</sup></p></td><td align="left"><p>13 (20.6%)<sup>b</sup></p></td><td align="left"><p>82 (42%)<sup>c</sup></p></td><td align="left"><p>17 (32.7%)<sup>a,b</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> 6–15</p></td><td align="left" /><td char="." align="char"><p>147 (35.1%)</p></td><td align="left"><p>37 (33.9%)</p></td><td align="left"><p>13 (20.6%)</p></td><td align="left"><p>85 (43.6%)</p></td><td align="left"><p>12 (23.1%)</p></td><td align="left" /></tr><tr><td align="left"><p> >15</p></td><td align="left" /><td char="." align="char"><p>131 (31.3%)</p></td><td align="left"><p>43 (39.5%)</p></td><td align="left"><p>37 (58.7%)</p></td><td align="left"><p>28 (14.4%)</p></td><td align="left"><p>23 (44.2%)</p></td><td align="left" /></tr><tr><td align="left"><p>Child cases per week</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> 0–5</p></td><td char="." align="char"><p>419</p></td><td char="." align="char"><p>75 (17.9%)</p></td><td align="left"><p>4 (3.7%)<sup>a</sup></p></td><td align="left"><p>3 (4.8%)<sup>a</sup></p></td><td align="left"><p>58 (29.7%)<sup>b</sup></p></td><td align="left"><p>10 (19.2%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> 6–10</p></td><td align="left" /><td char="." align="char"><p>112 (26.7%)</p></td><td align="left"><p>11 (10.1%)</p></td><td align="left"><p>8 (12.7%)</p></td><td align="left"><p>78 (40%)</p></td><td align="left"><p>15 (28.9%)</p></td><td align="left" /></tr><tr><td align="left"><p> >10</p></td><td align="left" /><td char="." align="char"><p>232 (55.4%)</p></td><td align="left"><p>94 (86.2%)</p></td><td align="left"><p>52 (82.5%)</p></td><td align="left"><p>59 (30.3%)</p></td><td align="left"><p>27 (51.9%)</p></td><td align="left" /></tr><tr><td align="left"><p>ASD cases per week</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> 0–5</p></td><td char="." align="char"><p>419</p></td><td char="." align="char"><p>178 (42.5%)</p></td><td align="left"><p>42 (38.5%)<sup>a</sup></p></td><td align="left"><p>28 (44.4%)<sup>a</sup></p></td><td align="left"><p>62 (31.8%)<sup>a</sup></p></td><td align="left"><p>46 (88.4%)<sup>b</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> 6–10</p></td><td align="left" /><td char="." align="char"><p>135 (32.2%)</p></td><td align="left"><p>34 (31.2%)</p></td><td align="left"><p>16 (25.4%)</p></td><td align="left"><p>82 (42.1%)</p></td><td align="left"><p>3 (5.8%)</p></td><td align="left" /></tr><tr><td align="left"><p> >10</p></td><td align="left" /><td char="." align="char"><p>106 (25.3%)</p></td><td align="left"><p>33 (30.3%)</p></td><td align="left"><p>19 (30.2%)</p></td><td align="left"><p>51 (26.1%)</p></td><td align="left"><p>3 (5.8%)</p></td><td align="left" /></tr><tr><td align="left"><p>Ages of children served</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Only young children (≤ 10 years)</p></td><td char="." align="char"><p>419</p></td><td char="." align="char"><p>175 (41.8%)</p></td><td align="left"><p>53 (48.6%)<sup>a</sup></p></td><td align="left"><p>22 (34.9%)<sup>a,b</sup></p></td><td align="left"><p>86 (44.1%)<sup>a</sup></p></td><td align="left"><p>14 (26.9%)<sup>b</sup></p></td><td char="." align="char"><p><bold>0.038</bold></p></td></tr><tr><td align="left"><p> Young and children > 10 years)</p></td><td align="left" /><td char="." align="char"><p>244 (58.2%)</p></td><td align="left"><p>56 (51.4%)</p></td><td align="left"><p>41 (65.1%)</p></td><td align="left"><p>109 (55.9%)</p></td><td align="left"><p>38 (73.1%)</p></td><td align="left" /></tr><tr><td align="left"><p>See children with ASD + feeding problems?</p></td><td char="." align="char"><p>419</p></td><td char="." align="char"><p>406 (96.9%)</p></td><td align="left"><p>105 (96.3%)</p></td><td align="left"><p>63 (100%)</p></td><td align="left"><p>188 (96.4%)</p></td><td align="left"><p>50 (96.2%)</p></td><td char="." align="char"><p>0.537</p></td></tr><tr><td align="left"><p>Treat children with ASD + feeding problems?<sup>1</sup></p></td><td char="." align="char"><p>406</p></td><td char="." align="char"><p>367 (90.4%)</p></td><td align="left"><p>102 (97.1%)<sup>a</sup></p></td><td align="left"><p>59 (93.6%)<sup>a,b</sup></p></td><td align="left"><p>165 (87.8%)<sup>b</sup></p></td><td align="left"><p>41 (82%)<sup>b</sup></p></td><td char="." align="char"><p><bold>0.009</bold></p></td></tr><tr><td align="left"><p>Treatment for feeding problems involve parents?<sup>2</sup></p></td><td char="." align="char"><p>367</p></td><td char="." align="char"><p>360 (98.1%)</p></td><td align="left"><p>102 (100%)</p></td><td align="left"><p>59 (100%)</p></td><td align="left"><p>159 (96.4%)</p></td><td align="left"><p>40 (97.6%)</p></td><td char="." align="char"><p>0.115</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>1</sups>Denominator is providers that see patients with ASD + feeding problems (N = 406); <sups>2</sups>Denominator is providers that see autistic patients and feeding problems, <uline>and do</uline> provide treatment (N = 367); <sups>*</sups>Omnibus tests are unequal variances one-way ANOVA for continuous variables, summarized by Mean (SD), and Chi-square or Fisher's Exact tests for discrete variables, summarized by N (%); <sups>†</sups>Pairwise p-values were calculated when omnibus tests were significant–non-overlap of superscripts indicates significant pairwise comparisons (e.g., a vs. b is significant; a vs. a is insignificant)</p> <hd id="AN0185099689-6">Patient Characteristics and Treatment Approaches</hd> <p>Of the 419 respondents included in the analyses, 406 (96.7%) reported seeing autistic children; 367 (87.5%) endorsed providing treatment for feeding problems. The 39 of 406 (9.6%) providers who did not treat children with feeding problems cited "insufficient training" (23/39; 59%) and "outside scope of practice" (21/39; 53.9%) as the most common reasons. All 39 providers who did not offer treatment for feeding problems for autistic children, however, reported current demand and professional interest in treating this population.</p> <p>Figure 2 presents the survey responses for the 367 providers (87.6% of the sample) who indicated that they treat feeding problems in autistic children. Across all disciplines, the most reported treatment targets were limited variety, texture sensitivity and disruptive mealtime behavior. Differences across providers are shown in Table 3. BCBAs reported the highest percentage of treating disruptive mealtime behavior. By contrast, OTs and SLPs reported higher percentages of treating texture sensitivity.</p> <p>Graph: Fig. 2 Types of presenting problems treated by all respondents</p> <p>Table 3 Respondents who report treating autistic children with feeding problems</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Survey Questions</p></th><th align="left"><p>All Respondents N = 367</p></th><th align="left"><p>SLP</p><p>N = 102</p></th><th align="left"><p>OT</p><p>N = 59</p></th><th align="left"><p>BCBA</p><p>N = 165</p></th><th align="left"><p>RD</p><p>N = 41</p></th><th align="left"><p>P-Value</p></th></tr></thead><tbody><tr><td align="left"><p>Types of feeding problems treated<sup>1</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Number of types, Mean (SD)</p></td><td align="left"><p>6.0 (2.2)</p></td><td align="left"><p>6.7 (2.0)<sup>a</sup></p></td><td align="left"><p>7.8 (1.8)<sup>b</sup></p></td><td align="left"><p>5.1 (1.8)<sup>c</sup></p></td><td align="left"><p>5.4 (2.1)<sup>c,d</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Limited variety</p></td><td align="left"><p>356 (97%)</p></td><td align="left"><p>100 (98%)<sup>a,b</sup></p></td><td align="left"><p>59 (100%)<sup>a</sup></p></td><td align="left"><p>160 (97%)<sup>a,b</sup></p></td><td align="left"><p>37 (90.2%)<sup>b</sup></p></td><td char="." align="char"><p><bold>0.030</bold></p></td></tr><tr><td align="left"><p> Texture sensitivity</p></td><td align="left"><p>322 (87.7%)</p></td><td align="left"><p>96 (94.1%)<sup>a</sup></p></td><td align="left"><p>58 (98.3%)<sup>a</sup></p></td><td align="left"><p>135 (81.8%)<sup>b,c</sup></p></td><td align="left"><p>33 (80.5%)<sup>c</sup></p></td><td char="." align="char"><p><bold>0.001</bold></p></td></tr><tr><td align="left"><p> Disruptive mealtime behavior</p></td><td align="left"><p>302 (82.3%)</p></td><td align="left"><p>81 (79.4%)<sup>a,b</sup></p></td><td align="left"><p>48 (81.4%)<sup>a,b</sup></p></td><td align="left"><p>146 (88.5%)<sup>a</sup></p></td><td align="left"><p>27 (65.8%)<sup>b</sup></p></td><td char="." align="char"><p><bold>0.006</bold></p></td></tr><tr><td align="left"><p> Self-feeding</p></td><td align="left"><p>265 (72.2%)</p></td><td align="left"><p>60 (58.8%)<sup>a</sup></p></td><td align="left"><p>56 (94.9%)<sup>b</sup></p></td><td align="left"><p>130 (78.8%)<sup>c</sup></p></td><td align="left"><p>19 (46.3%)<sup>a</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Chewing difficulty</p></td><td align="left"><p>210 (57.2%)</p></td><td align="left"><p>90 (88.2%)<sup>a</sup></p></td><td align="left"><p>53 (89.8%)<sup>a</sup></p></td><td align="left"><p>47 (28.5%)<sup>b</sup></p></td><td align="left"><p>20 (48.8%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Pocketing</p></td><td align="left"><p>198 (53.9%)</p></td><td align="left"><p>78 (76.5%)<sup>a</sup></p></td><td align="left"><p>50 (84.8%)<sup>a</sup></p></td><td align="left"><p>60 (36.4%)<sup>b,c</sup></p></td><td align="left"><p>10 (24.4%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Messy eating</p></td><td align="left"><p>192 (52.3%)</p></td><td align="left"><p>46 (45.1%)<sup>a</sup></p></td><td align="left"><p>46 (78%)<sup>b</sup></p></td><td align="left"><p>93 (56.4%)<sup>a</sup></p></td><td align="left"><p>7 (17.1%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Feeding tube/formula dependence</p></td><td align="left"><p>178 (48.5%)</p></td><td align="left"><p>66 (64.7%)<sup>a</sup></p></td><td align="left"><p>43 (72.9%)<sup>a</sup></p></td><td align="left"><p>42 (25.5%)<sup>b</sup></p></td><td align="left"><p>27 (65.8%)<sup>a</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Weight loss</p></td><td align="left"><p>161 (43.9%)</p></td><td align="left"><p>57 (55.9%)<sup>a</sup></p></td><td align="left"><p>39 (66.1%)<sup>a</sup></p></td><td align="left"><p>29 (17.6%)<sup>b</sup></p></td><td align="left"><p>36 (87.8%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>27 (7.4%)</p></td><td align="left"><p>8 (7.8%)</p></td><td align="left"><p>8 (13.6%)</p></td><td align="left"><p>7 (4.2%)</p></td><td align="left"><p>4 (9.8%)</p></td><td char="." align="char"><p>0.110</p></td></tr><tr><td align="left"><p>Types of approaches used for feeding problems<sup>1</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Number of types, Mean (SD)</p></td><td align="left"><p>2.1 (1.1)</p></td><td align="left"><p>2.9 (1.0)<sup>a</sup></p></td><td align="left"><p>3.0 (1.1)<sup>a</sup></p></td><td align="left"><p>1.4 (0.8)<sup>b</sup></p></td><td align="left"><p>1.9 (0.7)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Behavioral</p></td><td align="left"><p>324 (88.3%)</p></td><td align="left"><p>90 (88.2%)<sup>a</sup></p></td><td align="left"><p>46 (78%)<sup>a</sup></p></td><td align="left"><p>164 (99.4%)<sup>b</sup></p></td><td align="left"><p>24 (58.5%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Sequential Oral Sensory (SOS)</p></td><td align="left"><p>164 (44.7%)</p></td><td align="left"><p>84 (82.3%)<sup>a</sup></p></td><td align="left"><p>49 (83.1%)<sup>a</sup></p></td><td align="left"><p>22 (13.3%)<sup>b,c</sup></p></td><td align="left"><p>9 (21.9%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Nutritional intervention</p></td><td align="left"><p>128 (34.9%)</p></td><td align="left"><p>43 (42.2%)<sup>a</sup></p></td><td align="left"><p>25 (42.4%)<sup>a</sup></p></td><td align="left"><p>23 (13.9%)<sup>b</sup></p></td><td align="left"><p>37 (90.2%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Oral motor</p></td><td align="left"><p>110 (30%)</p></td><td align="left"><p>53 (52%)<sup>a</sup></p></td><td align="left"><p>40 (67.8%)<sup>a</sup></p></td><td align="left"><p>16 (9.7%)<sup>b,c</sup></p></td><td align="left"><p>1 (2.4%)<sup>c</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>52 (14.2%)</p></td><td align="left"><p>21 (20.6%)<sup>a</sup></p></td><td align="left"><p>18 (30.5%)<sup>a</sup></p></td><td align="left"><p>6 (3.6%)<sup>b</sup></p></td><td align="left"><p>7 (17.1%)<sup>a</sup></p></td><td char="." align="char"><p><bold>< 0.001</bold></p></td></tr></tbody></table> </ephtml> </p> <p> <sups>1</sups>Denominator is providers that see autistic patients and feeding problems, <uline>and do</uline> provide treatment (N = 367); <sups>*</sups>Omnibus tests are unequal variances one-way ANOVA for continuous variables, summarized by Mean (SD), and Chi-square or Fisher's Exact tests for discrete variables, summarized by N (%); <sups>†</sups>Pairwise p-values were calculated when omnibus tests were significant–non-overlap of superscripts indicates significant pairwise comparisons (e.g., a vs. b is significant; a vs. a is insignificant)</p> <p>Practice differences emerged in treatment approach by provider type (Fig. 3; Table 3). Details on these differences are presented in Table 3. OTs and SLPs reported using the highest number treatment of approaches compared to BCBAs or RDs. There was a significant difference in the use of sensory and oral-motor approaches. OTs and SLPs reported significantly higher rates of these approaches. By contrast, BCBAs or RDs did not often report using sensory and oral-motor approaches. BCBAs used behavioral approaches in nearly all cases compared to just over half of cases for RDs. RDs reported a significantly higher percentage of applying nutritional intervention compared to BCBAs.</p> <p>Graph: Fig. 3 Survey responses by discipline on treatment approach and treatment strategy at p <.001</p> <hd id="AN0185099689-7">Provider Acceptance of Structured Parent-Mediated Treatment</hd> <p>The survey did not include queries on the details of parental involvement; however, over 90% of respondents across all disciplines reported including parents in treatment. Most providers indicated openness to "an approach that differs from current practice" and willingness to use a treatment manual (90% and 89.3% respectively).</p> <hd id="AN0185099689-8">Discussion</hd> <p>This study surveyed SLPs, OTs, BCBAs and RDs to obtain information on service demand and practice patterns for children with ASD and feeding problems. Survey responses provide new information on the landscape of community-based practice for this clinical population. Across all four disciplines, over 90% of providers reported seeing autistic children with feeding problems, suggesting high demand for feeding services in this clinical population. There were differences in volume across disciplines. SLPs and OTs reported the highest volume of assessing and treating patients with ASD and feeding problems. RDs reported the lowest volume. Despite demand, approximately 10% of respondents indicated that they do not treat children with ASD and feeding problems. Insufficient training was given as the most common reason for this decision.</p> <p>Survey respondents reported limited dietary variety, texture sensitivity, and disruptive mealtime behavior as the most common feeding problems in autistic children. The high rate of food selectivity is consistent with studies based on parent reports in this population (Beighley et al., [<reflink idref="bib3" id="ref37">3</reflink>]; Postorino et al., [<reflink idref="bib20" id="ref38">20</reflink>]). Our findings are also consistent with an online survey of BCBAs who treat children with ASD and feeding problems (Clark, Wilder & Lesser, [<reflink idref="bib6" id="ref39">6</reflink>]). The common co-occurrence of limited dietary variety, texture sensitivity, and disruptive mealtime behavior suggests that sensory sensitivities and behavioral elements may be linked. Studies in neophobia (reluctance to try new foods) and disgust (rejection of food considered unsafe) support this association and may play a role in the underlying mechanism of feeding problems in autistic children (Al-Shawaf et al., [<reflink idref="bib1" id="ref40">1</reflink>]).</p> <p>Survey respondents reported using a variety of treatment approaches including behavioral, sensory, oral motor, and nutritional interventions for feeding problems in children with ASD. However, practice differences did emerge. SLPs and OTs reported using the widest range of treatment approaches but relied primarily on behavioral interventions and the Sequential Oral Sensory (SOS) approach. BCBAs reported the use of behavioral interventions and rarely used other approaches. By contrast, dietitians reported nearly exclusive use of nutritional guidance as their intervention of choice. These practice differences presumably reflect differences in professional background and training across disciplines resulting in separate referral pathways. For example, children with feeding problems and moderate or greater disruptive behavior may be more likely to be referred to a BCBA rather than a RD. By contrast, a multidisciplinary approach is recommended for children with severe feeding problems due to the individualized roles and expertise of these unique disciplines. The assessment and treatment of children with ASD and moderate feeding problems such as food selectivity, however, may also benefit from a multidisciplinary approach.</p> <p>Survey results indicate that a large majority of respondents would consider an intervention that differs from their current approach including willingness to use parent-mediated intervention. These findings are consistent with survey results of community providers in Australia (Marshall et al., [<reflink idref="bib15" id="ref41">15</reflink>]).</p> <p>Nearly all respondents in our survey reported involving parents in treating children with ASD and feeding problems. The survey did not inquire about the nature or extent of parental involvement. Available evidence supports the efficacy of structured, parent-mediated interventions for children with ASD and moderate food selectivity (Sharp et al., [<reflink idref="bib26" id="ref42">26</reflink>]; Johnson et al., [<reflink idref="bib8" id="ref43">8</reflink>]). As noted above, children with severe feeding disorders require intensive treatment in day or inpatient treatment programs. The findings from the studies by Sharp et al. and Johnson et al. suggest that parent-mediated intervention is fitting for children with ASD and moderate food selectivity.</p> <p>These interventions provide parents with practical tools to manage disruptive mealtime behavior and expand dietary variety. These tools may reduce the stress reported by parents of children with ASD and food selectivity (Postorino et al., [<reflink idref="bib20" id="ref44">20</reflink>]; Silverman et al., [<reflink idref="bib29" id="ref45">29</reflink>]). Integration of parents as change agents may also reduce commonly reported parental discouragement due to unsuccessful efforts to expand the child's diet (Suarez et al., [<reflink idref="bib31" id="ref46">31</reflink>]).</p> <hd id="AN0185099689-9">Limitations</hd> <p>Because survey participation was anonymous, we do not have information on respondents' geographic location to evaluate regional differences. The study sample may reflect providers with high interest in autistic children with feeding problems. Although we did not exclude psychologists, the survey did not gather responses from psychologists. Therefore, our results may not be representative of all community providers. The brief survey did not include details on the nature of parental involvement in treatment, questions about severity of feeding problems or items about nutritional assessment. The inclusion of broad, undefined terms (e.g., behavioral, nutritional, oral motor) that were used to describe interventions and items that allowed respondents to "check all that apply" reduced the precision analyses and interpretation of the findings.</p> <hd id="AN0185099689-10">Conclusions</hd> <p>This study provides information about current community practice for children with ASD and feeding problems. The survey results indicate a high demand for treatment of children with ASD and feeding problems such as limited variety, texture sensitivity, and disruptive mealtime behaviors. Although most respondents reported treating children with ASD and feeding problems, treatment approaches varied across disciplines. Most respondents indicated willingness to use parent-mediated intervention to address feeding problems in this population. This study presents opportunities to disseminate empirically supported parent-mediated approaches across disciplines. To be successful, a structured, parent-mediated intervention will face the challenge of integrating differences and contributions of providers across disciplines. Noting that nearly all respondents indicated parental involvement in treatment suggests that parent-mediated intervention may be a good fit for community practitioners. Further study on how to translate empirically supported, structured, parent-mediated intervention into community settings is warranted.</p> <hd id="AN0185099689-11">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0185099689-12"> <title> References </title> <blist> <bibl id="bib1" idref="ref40" type="bt">1</bibl> <bibtext> Al-Shawaf L, Lewis DMG, Alley TR, Buss DM. Mating strategy, disgust, and food neophobia. Appetite. 2015; 85: 30-35. 10.1016/j.appet.2014.10.029. 25450899</bibtext> </blist> <blist> <bibl id="bib2" idref="ref9" type="bt">2</bibl> <bibtext> Bearss K, Burrell TL, Stewart L, Scahill L. Parent training in autism spectrum disorder: What's in a name?. 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Sharp; Scott Gillespie; Katherine Pickard; Susan Brasher; Derianne Buckley and Lawrence Scahill</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib34" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib14" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib11" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib13" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib10" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib19" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib32" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib26" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref19"></nolink> <nolink nlid="nl12" bibid="bib30" firstref="ref20"></nolink> <nolink nlid="nl13" bibid="bib22" firstref="ref21"></nolink> <nolink nlid="nl14" bibid="bib23" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib16" firstref="ref26"></nolink> <nolink nlid="nl17" bibid="bib25" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib20" firstref="ref29"></nolink> <nolink nlid="nl20" bibid="bib31" firstref="ref30"></nolink> <nolink nlid="nl21" bibid="bib15" firstref="ref33"></nolink> <nolink nlid="nl22" bibid="bib33" firstref="ref34"></nolink> <nolink nlid="nl23" bibid="bib18" firstref="ref36"></nolink> <nolink nlid="nl24" bibid="bib29" firstref="ref45"></nolink>
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  Label: Title
  Group: Ti
  Data: A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Teresa+Lindsey+Burrell%22">Teresa Lindsey Burrell</searchLink><br /><searchLink fieldCode="AR" term="%22William+G%2E+Sharp%22">William G. Sharp</searchLink><br /><searchLink fieldCode="AR" term="%22Scott+Gillespie%22">Scott Gillespie</searchLink><br /><searchLink fieldCode="AR" term="%22Katherine+Pickard%22">Katherine Pickard</searchLink><br /><searchLink fieldCode="AR" term="%22Susan+Brasher%22">Susan Brasher</searchLink><br /><searchLink fieldCode="AR" term="%22Derianne+Buckley%22">Derianne Buckley</searchLink><br /><searchLink fieldCode="AR" term="%22Lawrence+Scahill%22">Lawrence Scahill</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-5073-1707">0000-0001-5073-1707</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(6):2000-2008.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Eating+Disorders%22">Eating Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Patients%22">Patients</searchLink><br /><searchLink fieldCode="DE" term="%22Therapy%22">Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Surveys%22">Community Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Pediatrics%22">Pediatrics</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-023-06013-7
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. Methods: Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. Results: A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. Conclusions: These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.
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  Label: Entry Date
  Group: Date
  Data: 2025
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  Label: Accession Number
  Group: ID
  Data: EJ1470809
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1470809
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        Value: 10.1007/s10803-023-06013-7
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 2000
    Subjects:
      – SubjectFull: Eating Disorders
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Children
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      – SubjectFull: Pediatrics
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      – TitleFull: A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder
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              Type: published
              Y: 2025
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