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Abstract
This article defines food selectivity and food sensitivity and evaluates Sequential Oral Sensory, Sensory Integration, and Differential Reinforcement of Alternative Behavior interventions via a systematic literature review. Articles included were high fidelity, peer-reviewed, and published between 2000-2016. The literature defined food selectivity as behavioral-based and food sensitivity as sensory-based. Sequential Oral Sensory has emerging evidence for treating both. Sensory Integration has growing evidence for food sensitivity. Differential Reinforcement of Alternative Behavior shows consistent outcomes with food selectivity. Currently, no evaluation differentiates between food selectivity and food sensitivity; therefore, the Sequential Oral Sensory approach is recommended, since it addresses both feeding aversions.
Key words
Differential reinforcement of alternative behavior, occupational therapy, pediatric, sensory integration, sequential oral sensory.
Occupational therapists regularly work with children with autism spectrum disorder (ASD) and their families in clinical practice. Common reasons for referral include difficulties participating during mealtime and maintaining a healthy, balanced diet (Lockner, Crowe, & Skipper, 2008; Scott, 2011). For instance, food aversions, which are limiting behaviors with feeding and/or eating, are common in as many as 80% of children with ASD (Ahearn, Castine, Nault, & Green, 2001; American Psychiatric Association, 2013; Ben-Sasson, Carter, & Briggs-Gowan, 2009; Emond, Emmett, Steer, & Golding, 2010; Keen, 2008; Suarez, 2015; Williams, Dalrymple, & Neal, 2000). Food aversions can present as food selectivity and/or food sensitivity (Suarez, 2015). Food selectivity is often the result of past traumatic experiences with feeding and/or eating that result in a behavioral aversion to foods; whereas, food sensitivity is often caused by sensory sensitivities that result in aversions to certain textures, tastes, and/or smells (Bandini et al., 2010; Cermak, Curtin, & Bandini, 2010; Levin & Carr, 2001; Matson & Fodstad, 2009; Nadon, Feldman, Dunn, & Gisel, 2011).
Food aversions in children with ASD are a concern due to the negative impact they may have on nutritional intake and overall development (Bandini et al., 2010; Beighley, Matson, Rieske, & Adams, 2013; Nadon et al., 2011). A common misconception is that feeding and eating are easy and instinctive processes that will naturally occur when a child is hungry; in reality, feeding and eating are multistep processes that are only instinctive in infancy (Toomey & Ross, 2011). Another myth is that food aversion can resolve over time as the...