Brief Report

Evaluation of MealSense©: A Sensory

Integration–Based Feeding Support
Program for Parents

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Audrey Trewin, Zoe Mailloux, Roseann C. Schaaf

Importance: Children with autism spectrum disorder (ASD) often experience feeding challenges related to
difficulties with sensory integration.

Objective: To evaluate the content, acceptability, and usefulness of MealSense©, an online parent education
program for children with ASD who have feeding challenges related to poor sensory integration.

Design: A descriptive study in which experts reviewed and rated MealSense content for consistency with Ayres
Sensory Integration® (ASI) principles and evidence-based practices in feeding.

Participants: A convenience sample of expert reviewers (n 5 5) and parents of children with ASD and feeding
challenges (n 5 5).

Results: Expert ratings (n 5 5) met criteria showing that MealSense is consistent with ASI and evidence-based
practices in feeding. Parent ratings (n 5 5) met criteria showing that MealSense is acceptable and useful.

Conclusions and Relevance: MealSense is acceptable and useful to parents of children with ASD and is
consistent with ASI and evidence-based practices in feeding.

What This Article Adds: This study provides preliminary support for MealSense as an evidence-based tool to
supplement direct intervention for children with ASD and feeding difficulties. Further research is needed to
determine its efficacy in improving the transfer of feeding skills into the home environment.
Trewin, A., Mailloux, Z., & Schaaf, R. C. (2022). Brief Report—Evaluation of MealSense©: A sensory integration–based feeding support program for
parents. American Journal of Occupational Therapy, 76, 7603345020. https://doi.org/10.5014/ajot.2022.046987

eeding is a fundamental occupation, one that is body effectively in the environment” (Ayres, 1989, p.
F needed for optimal health, and it is an area fre-
quently addressed by pediatric occupational therapists.
11). Multiple studies have shown a correlation between
feeding challenges and sensory integration difficulties
Feeding difficulties, such as selective eating, negative for children with ASD (Ausdereau et al., 2019; Cermak
mealtime behaviors, food refusal, and reduced accep- et al., 2010; Nadon et al., 2011; Schreck et al., 2004;
tance of textured foods (Cermak et al., 2010; Kral Suarez et al., 2012). For example, sensory sensitivity—
et al., 2013; Kuschner et al., 2017; Marshall et al., 2014; in particular tactile sensitivity—may be a factor in
Nadon et al., 2011; Provost et al., 2010; Zimmer et al., food selectivity for children with ASD (Cermak et al.,
2012), are prevalent in 48% to 89% of children with 2010; Nadon et al., 2011; Schreck et al., 2004; Suarez
autism spectrum disorder (ASD), limiting successful et al., 2012). Thus, addressing the underlying sensory
participation in the essential daily occupation of eating integration challenges related to feeding may lead to
and affecting the quality of life of many children and improved mealtime behaviors.
their families (Ledford & Gast, 2006). Parents of chil- Parent education, a term that refers to programs
dren with ASD report high stress levels and identify that are designed to teach parents skills or provide
eating as one of the most frustrating occupations for them with information (Schultz et al., 2011), is an evi-
their child (DeMyer, 1979; Hayes & Watson, 2013). dence-based component of feeding intervention for
Sensory integration is defined as “the neurological children with ASD (Adamson et al., 2013; Howe &
process that organizes sensations from one’s body and Wang, 2013). Parent education can provide natural
from the environment and makes it possible to use the learning opportunities in the home that extend
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 1
intervention beyond the clinic environment (Steiner also included in the MealSense program. KTA is a
et al., 2012). Parent-implemented intervention is also complex and dynamic process of knowledge creation
cost-effective and can increase the rate of progress in and application that facilitates knowledge use by guid-
therapy (Steiner et al., 2012). ing the translation of knowledge into sustainable and
Recent interest in online strategies and telehealth evidence-based interventions (Field et al., 2014). KTA
intervention for people with ASD has been successful strategies used in MealSense included adding parent
in meeting parents’ specific educational concerns reflections, tips for completing the modules, and mod-
(Kobak et al., 2011; Vismara et al., 2013.) Web-based ification of parent worksheets to allow monitoring of
parent education programs may address the identified progress.
barriers preventing parents from attending educational The purpose of this project was to answer the fol-
programs outside of the home, such as travel time, lowing three research questions:

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cost, and child care, as well as the additional time 1. Do expert reviewers consider MealSense to be
needed to schedule programs in real time and costly consistent with the principles of ASI?
equipment that is required (Heitzman-Powell et al., 2. Do expert reviewers view MealSense as adhering
2013; Vismara et al., 2013). Moreover, parent educa- to best practices in feeding?
tion delivered virtually may be useful for times when 3. Do parents of children with ASD and feeding dif-
in-person intervention is not possible, as has been the ficulties rate MealSense as acceptable and useful?
case during the coronavirus disease 2019 (COVID-19)
pandemic.
To address the need for an online program that Method
educates parents of children with ASD about the In this descriptive study, we distributed electronic sur-
impact of sensory integration challenges on feeding veys (Qualtrics) and a MealSense program link to
and that provides a means to carry over feeding skills expert reviewers and parents of children with ASD
from the therapeutic environment into the home, we and feeding difficulties to obtain feedback about the
developed MealSense©, a web-based parent education program’s content, acceptability, and usefulness.
program.

Participants
MealSense Program Development Expert reviewers (n 5 5), recruited through conve-
MealSense is a self-paced online educational program nience sampling by emails sent to local pediatric
for parents of children with ASD who have feeding clinicians with experience in both sensory integration
difficulties related to challenges in sensory integration. and feeding, were pediatric occupational therapists
We developed the MealSense program using current who met the following four inclusion criteria: (1) a
evidence in Ayres Sensory Integration® (ASI; Schaaf & minimum of 4 yr of clinical experience in occupational
Mailloux, 2015,) and feeding, along with feedback therapy, (2) advanced training and education (certifi-
from experts in sensory integration, feeding, knowl- cation) in sensory integration, (3) a minimum of 3 yr
edge translation, and online instruction. Although of experience working with children who have feeding
MealSense is primarily a sensory-based feeding pro- difficulties, and (4) a minimum of three pediatric feed-
gram, it acknowledges that feeding is a multifaceted ing continuing education courses. Parent participants
occupation that may be influenced by factors related
(n 5 5) were recruited through convenience sampling
to motor, behavior, and social functioning. Designed
from the first author’s (Audrey Trewin’s) place of
as a supplement to direct intervention, MealSense tar-
employment, a large therapy clinic devoted to treat-
gets the transfer of feeding skills from the clinic into
ment of children with neurodevelopmental disorders.
the home environment through incorporation of
Eligibility criteria included being fluent in English and
knowledge translation strategies and an emphasis on
education about sensory integration factors that may having a child between ages 2 and 8 yr with a diagno-
contribute to feeding difficulties. A detailed outline of sis of ASD (no other medical diagnosis) and who had
MealSense content is provided in Table 1. at least one feeding goal related to sensory integration
ASI is an evidence-based practice for children with difficulties on a current treatment plan.
ASD that is frequently requested and used (Schoen Five parents of children with ASD reviewed the
et al., 2019). Given the correlation between feeding program. Mothers made up 80% of the sample, and
challenges and sensory integration difficulties, ASI fathers made up 20%. Most (80%) ranged in age from
principles (Ayres, 1979; Schaaf & Mailloux, 2015) were 35 to 39, and some (20%) were older than age 45; 40%
a key perspective included in the MealSense program. were White or Caucasian, 40% were Hispanic, and
MealSense includes sensory-rich experiences, encour- 20% were Asian. Eighty percent of participants
aging active engagement of the child and offering reported having two dependents in the home (80%),
activities that are the just-right challenge (Parham and 20% had more than five dependents in the home.
et al., 2011). Twenty percent had completed high school, 60% had
The Knowledge to Action (KTA) framework (Field completed college, and 20% had completed graduate
et al., 2014) and knowledge translation strategies were school.
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 2
Table 1. MealSense Content Outline
Module Page Content Parent Activity
Welcome Page and Video 䊏 Discussion of program format NA
䊏 PowerPoint video
䊏 Knowledge checks
䊏
Parent observation or activity
䊏 Guiding principles
Introduction 䊏 ASD and feeding MealSense Initial Reflection
䊏
Common ASD characteristics MealSense Goal List
䊏 Common health problems
What Is Feeding? 䊏 Defining feeding terms MealSense Observation Log

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䊏
Complexity of feeding
䊏 Primary priorities of feeding
Sensory Systems and Feeding 䊏 What is ASI? MealSense Sensory Systems Log
䊏
Sensory systems and impact on
feeding
䊏 Tactile system
䊏 Proprioceptive system
䊏 Vestibular system
䊏 Visual system
䊏 Auditory system
䊏 Gustatory system
䊏 Olfactory system
䊏 Interoception
The Mealtime Environment 䊏 General mealtime strategies MealSense Environment Action Plan
䊏 Developing mealtime routines
䊏 Optimal mealtime seating
䊏
Creating a calm environment and
supporting attention
Parent and Child Mealtime Interaction 䊏 Setting realistic mealtime MealSense Communication Checklist
expectations
䊏 Building on your child’s strengths
and interests
䊏 Reading your child’s cues
䊏 Making mealtime positive
Play and the Just-Right Challenge 䊏 What is play? Play Exploration and the Just-Right
With Food Exploration 䊏 Elements of play Challenge Log
䊏 Play language
䊏 Play and feeding
䊏 The Just-Right Challenge
䊏 Exploring foods

Note. ASD 5 autism spectrum disorder; ASI 5 Ayres Sensory Integration; NA 5 not applicable.

Data Collection program acceptability, defined as adherence, reasonable

This study was determined by the Thomas Jefferson time to complete, usability, clarity, and satisfaction, and
Institutional Review Board to be exempt from review. program usefulness, defined as applicability and trans-
ferability (Burchett et al., 2013; Cooper et al., 2007;
Kuschner et al., 2017). We also emailed a program link
Instruments to parents for access to MealSense content and an
Program-specific surveys were developed and reviewed anonymous survey link (13 questions) to evaluate
by a survey expert for purposes of clarity and to ensure acceptability and usefulness of MealSense. A table of
that the items were clear and relevant to the research revisions was developed to summarize expert and par-
area. Survey questions were rated on a Likert scale that ent feedback and identify modifications.
ranged from 1 (strongly disagree) to 4 (strongly agree)
and were distributed via Qualtrics. The expert survey
was designed to evaluate program consistency with ASI Data Analysis
(12 questions) and best practices in feeding (7 ques- Data were analyzed by determining the mean score for
tions). The parent survey was designed to evaluate each question. Because ratings of 3.0 and 4.0 indicated

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 3
agreement, a mean score of 3.0 or higher was consid- 4.0), and environmental barriers to mealtime participa-
ered acceptable. tion are considered (M 5 3.8). Survey items with the
lowest mean score but that still met criteria included
those that addressed how MealSense incorporates
Results behavioral strategies as appropriate (M 5 3.4),
Expert Reviews of Content for Consistency With addresses acquisition of feeding in a sequential way
Ayres Sensory Integration (M 5 3.4), and directs parents to consider environ-
The results from expert reviewers (n 5 5) revealed a mental strengths (M 5 3.4).
mean rating of ≤3.0 on each of the 12 questions related
to adherence to ASI principles, indicating that Meal-
Sense content was consistent with the principles of ASI. Parent Reviews of Acceptability and Usefulness
The results from parent participants (n 5 5) indicated

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As shown in Figure 1, experts indicated that MealSense
a mean rating ≤3.0 on each question. As shown in
content addresses sensory exploration during mealtime
Figure 3, the highest survey responses indicated that
(M 5 4.0), provides mealtime tasks at the just-right level
for the child (M 5 4.0), factors the child’s interests into the modules could be completed in a reasonable
amount of time (M 5 4.0), that information is pre-
mealtime-related experiences (M 5 4.0), addresses meal-
sented in a logical way (M 5 4.0), and that modules
time factors related to posture (M 5 3.8), encourages
were easy to understand (M 5 4.0). High survey rat-
parent–child collaboration during mealtime (M 5 3.8),
ings were also obtained on the following questions:
and provides strategies that support the child’s ability to
each module was easy to navigate (M 5 3.8), entire
be successful during mealtime (M 5 3.8). Survey items
website was easy to navigate (M 5 3.8), am satisfied
with the lowest mean score (3.0) but that still met crite-
ria were related to MealSense modules that address with the information (M 5 3.8), would recommend
the program (M 5 3.8), and information applies to
ocular skills and bilateral motor control.
feeding needs (M 5 3.8). The survey item with the
lowest mean score (M 5 3.0) but that still met criteria
Expert Reviews of Content for Inclusion of Best included those addressing whether MealSense parent
Practices in Feeding activities were perceived to be completed in a reason-
The results from expert reviewers indicated a mean able amount of time.
rating ≤3.0 on each of the seven questions related to
best practices in feeding. As shown in Figure 2, the
highest ratings were as follows: the modules teach Discussion
feeding as a multifaceted occupation (M 5 4.0), parent The findings from this study suggest that MealSense
education is used to support the child’s feeding (M 5 demonstrates consistency with ASI and best practices

Figure 1. Expert data related to consistency with ASI.

Note. Items are rated on a scale that ranges from 1 (strongly disagree) to 4 (strongly agree). ASI 5 Ayres Sensory Integration.
a
n 5 3.

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 4
Figure 2. Expert data related to best practices in feeding.

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Note. Items are rated on a scale that ranges from 1 (strongly disagree) to 4 (strongly agree).

Figure 3. Parent data related to acceptability and usefulness.

Note. Items are rated on a scale that ranges from 1 (strongly disagree) to 4 (strongly agree).

in feeding and that parents perceive it as acceptable Occupational Therapy Association, 2017), and successful
and useful. To our knowledge, this is the first evi- mealtime participation can enhance a family’s quality of
dence-based, online parent feeding support program life (Ausderau et al., 2019; Henton, 2018; Meral &
for children with ASD that emphasizes education Fidan, 2015). Family-centered feeding interventions that
about the sensory integration factors that can contrib- address feeding and mealtime behaviors for children
ute to feeding difficulties. with ASD, such as for the MealSense program presented
Feeding is an important occupation that contributes here, are needed (Henton, 2018), and the findings from
to a child’s growth and development (American this study lend support to the MealSense program.

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 5
 As a parent education program, MealSense is not 䊏 MealSense provides an example of an online
intended to provide direct intervention that adheres to educational tool for parents of children with
principles of ASI as designated by the ASI Fidelity ASD and may be especially useful for times
Measure (Parham et al., 2007). However, our findings when in-person visits are not possible.
suggest that ASI principles were readily operational-
ized into the MealSense program, showing that these
principles may be used outside of the traditional direct Conclusion
intervention, in an online parent education program. A need exists for parent education feeding programs
One important aspect of the MealSense program is for children with ASD that address the sensory inte-
that it is an online parent education tool that supports gration factors that can affect feeding behaviors and
the occupation of feeding in the home environment. facilitate the transfer of skills into the home. This

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Implementation of virtual interventions can become study provides preliminary support for MealSense, a
unexpectedly important, as has been the case during web-based program designed to educate parents about
the COVID-19 pandemic. Because families often have their child’s sensory integration related to addressing
not been able to participate in face-to-face interventions the feeding needs of children with ASD and for sup-
during this time, the need for innovative program porting the carryover of skills into home.
delivery models in a virtual environment was even
more salient (Jang et al., 2012; Steiner et al., 2012).
Potential benefits of implementing a program such as Acknowledgments
MealSense in this format include its cost-effectiveness We thank Isabelle Beaudry Bellefeuille for reviewing
and accessibility. Challenges may include the lack of abil- the first iteration of MealSense and providing feed-
ity to answer questions for parents in real time and back related to feeding content. We also thank Amy
parent completion of modules in a timely manner. Using Carroll for contributions in knowledge translation
MealSense as a supplement to direct intervention may and Mary Cohen for feedback related to online
help address these potential downsides of the program. instruction.
Descriptive feedback and quantitative data from
expert reviewers identified principles of ASI that may
benefit from further development, including address- References
ing oral–motor skills and bilateral motor control. Adamson, M., Morawska, A., & Sanders, M. R. (2013). Childhood
Similarly, best practices in feeding that may benefit feeding difficulties: A randomized controlled trial of a group-based
parenting intervention. Journal of Developmental and Behavioral
from further emphasis include addressing behavioral
Pediatrics, 34, 293–302. https://doi.org/10.1097/
strategies, sequential development of feeding skills,
DBP.0b013e3182961a38
and considering environmental strengths. Future itera-
American Occupational Therapy Association. (2017). The practice of
tions of MealSense may benefit from more emphasis
occupational therapy in feeding, eating, and swallowing. American
on these specific areas. Journal of Occupational Therapy, 71(Suppl. 2), 7112410015. https://
doi.org/10.5014/ajot.2017.716S04
Ausderau, K. K., St John, B., Kwaterski, K. N., Nieuwenhuis, B., &
Limitations
Bradley, E. (2019). Parents’ strategies to support mealtime
Although the MealSense program showed strong participation of their children with autism spectrum disorder.
adherence to ASI and best practices in feeding, more American Journal of Occupational Therapy, 73, 7301205070. https://
research is needed to evaluate its efficacy. Next steps doi.org/10.5014/ajot.2019.024612
will include pilot testing with parents to provide initial Ayres, A. J. (1979). Sensory integration and the child. Western
data about the efficacy of MealSense related to chang- Psychological Services.
ing feeding behaviors and participation in mealtime in Ayres, A. J. (1989). Sensory Integration and Praxis Tests. Western
the home setting. Psychological Services.
Limitations of this study include that both partici- Burchett, H. E. D., Dobrow, M. J., Lavis, J. N., & Mayhew, S. H. (2013).
pant groups were convenience samples, which may The applicability and transferability of public health research from
limit our ability to generalize the findings to other one setting to another: A survey of maternal health researchers.
populations. In addition, the sample size was small Global Health Promotion, 20, 16–24. https://doi.org/10.1177/
(n 5 5) for both experts and parents, and response 1757975913476904
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and
bias may have influenced reviewer feedback.
sensory sensitivity in children with autism spectrum disorders.
Journal of the American Dietetic Association, 110, 238–246. https://
Implications for Occupational doi.org/10.1016/j.jada.2009.10.032
Cooper, M., Colwell, C., & Jelfs, A. (2007). Embedding accessibility and
Therapy Practice usability: Considerations for e-learning research and development
The results of this study have the following implica- projects. Research in Learning Technology, 15, 231–245. https://doi.
tions for occupational therapy practice: org/10.3402/rlt.v15i3.10933
䊏
Knowledge translation strategies may facilitate DeMyer, M. K. (1979). Parents and children in autism. V. H. Winston.
the usefulness of parent education programs Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the Knowledge
related to sensory integration and feeding. to Action Framework in practice: A citation analysis and systematic

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2022, VOLUME 76, NUMBER 3 6
 review. Implementation Science, 9, 172. https://doi.org/10.1186/ Parham, L. D., Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green,
s13012-014-0172-2 B., Burke, J. P., . . . Schaaf, R. C. (2011). Development of a fidelity
Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A measure for research on the effectiveness of the Ayres Sensory
meta-analysis of studies comparing the experience of parenting stress Integration® intervention. American Journal of Occupational
in parents of children with and without autism spectrum disorder. Therapy, 65, 133–142. https://doi.org/10.5014/ajot.2011.000745
Journal of Autism and Developmental Disorders, 43, 629–642. https:// Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J.
doi.org/10.1007/s10803-012-1604-y (2010). Mealtime behaviors of preschool children: Comparison of
Heitzman-Powell, L. S., Buzhardt, J., Rusinko, L. C., & Miller, T. M. children with autism spectrum disorder and children with typical
(2013). Formative evaluation of an ABA outreach training program development. Physical and Occupational Therapy in Pediatrics, 30,
for parents of children with autism in remote areas. Focus on Autism 220–233. https://doi.org/10.3109/01942631003757669
and Other Developmental Disabilities, 29, 23–38. https://doi.org/ Schaaf, R. C., & Mailloux, Z. (2015). Clinician’s guide for implementing
10.1177/1088357613504992 Ayres Sensory Integration®: Promoting participation for children with

Downloaded from http://research.aota.org/ajot/article-pdf/76/3/7603345020/74248/7603345020.pdf by Integracion Sensorial Acis, Adriana Ramirez on 12 November 2022
Henton, P. A. (2018). A call to reexamine quality of life through autism. AOTA Press.
relationship-based feeding. American Journal of Occupational Schoen, S. A., Lane, S. J., Mailloux, Z., May-Benson, T., Parham, L. D.,
Therapy, 72, 7203347010. https://doi.org/10.5014/ajot.2018.025650 Smith Roley, S., & Schaaf, R. C. (2019). A systematic review of Ayres
Howe, T.-H., & Wang, T.-N. (2013). Systematic review of interventions
Sensory Integration intervention for children with autism. Autism
used in or relevant to occupational therapy for children with feeding
Research, 12, 6–19. https://doi.org/10.1002/aur.2046
difficulties ages birth–5 years. American Journal of Occupational
Schultz, T. R., Schmidt, C. T., & Stichter, J. P. (2011). A review of parent
Therapy, 67, 405–412. https://doi.org/10.5014/ajot.2013.004564
education programs for parents of children with autism spectrum
Jang, J., Dixon, D. R., Tarbox, J., Granpeesheh, D., Kornack, J., & de
disorders. Focus on Autism and Other Developmental Disabilities, 26,
Nocker, Y. (2012). Randomized trial of an eLearning program for
96–104. https://doi.org/10.1177/1088357610397346
training family members of children with autism in the principles
Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of
and procedures of applied behavior analysis. Research in Autism
eating behaviors between children with and without autism. Journal
Spectrum Disorders, 6, 852–856. https://doi.org/10.1016/j.
of Autism and Developmental Disorders, 34, 433–438. https://doi.org/
rasd.2011.11.004
10.1023/B:JADD.0000037419.78531.86
Kobak, K. A., Stone, W. L., Wallace, E., Warren, Z., Swanson, A., &
Steiner, A. M., Koegel, L. K., Koegel, R. L., & Ence, W. A. (2012).
Robson, K. (2011). A web-based tutorial for parents of young
Issues and theoretical constructs regarding parent education for
children with autism: Results from a pilot study. Telemedicine Journal
autism spectrum disorders. Journal of Autism and
and E-Health, 17, 804–808. https://doi.org/10.1089/tmj.2011.0060
Developmental Disorders, 42, 1218–1227. https://doi.org/
Kral, T. V. E., Eriksen, W. T., Souders, M. C., & Pinto-Martin, J. A.
(2013). Eating behaviors, diet quality, and gastrointestinal symptoms 10.1007/s10803-011-1194-0
in children with autism spectrum disorders: A brief review. Journal of Suarez, M. A., Nelson, N. W., & Curtis, A. B. (2012). Associations of
Pediatric Nursing, 28, 548–556. https://doi.org/10.1016/j. physiological factors, age, and sensory over-responsivity with food
pedn.2013.01.008 selectivity in children with autism spectrum disorder. Open Journal of
Kuschner, E. S., Morton, H. E., Maddox, B. B., de Marchena, A., Occupational Therapy, 1. https://doi.org/10.15453/2168-6408.1004
Anthony, L. G., & Reaven, J. (2017). The BUFFET Program: Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., &
Development of a cognitive behavioral treatment for selective eating Monlux, K. (2013). Preliminary findings of a telehealth
in youth with autism spectrum disorder. Clinical Child and Family approach to parent training in autism. Journal of Autism and
Psychology Review, 20, 403–421. https://doi.org/10.1007/ Developmental Disorders, 43, 2953–2969. https://doi.org/
s10567-017-0236-3 10.1007/s10803-013-1841-8
Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing,
autism spectrum disorders: A review. Focus on Autism and Other N. M., & Summer, S. (2012). Food variety as a predictor of
Developmental Disabilities, 21, 153–166. https://doi.org/10.1177/ nutritional status among children with autism. Journal of Autism and
10883576060210030401 Developmental Disorders, 42, 549–556. https://doi.org/10.1007/
Marshall, J., Hill, R. J., Ziviani, J., & Dodrill, P. (2014). Features of feeding s10803-011-1268-z
difficulty in children with autism spectrum disorder. International
Journal of Speech-Language Pathology, 16, 151–158. https://doi.org/
10.3109/17549507.2013.808700
Meral, B. F., & Fidan, A. (2015). Measuring the impact of feeding
covariates on health-related quality of life in children with autism Audrey Trewin, OTD, OTR/L, is Clinician, PlaySense, Redondo Beach, CA.
spectrum disorder. Research in Autism Spectrum Disorders, 10, At the time this project was developed, Trewin was Student, Thomas
124–130. https://doi.org/10.1016/j.rasd.2014.11.009 Jefferson University, Philadelphia, PA; [email protected]
Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011). Mealtime
Zoe Mailloux, OTD, OTR/L, FAOTA, is Adjunct Associate Professor,
problems in children with autism spectrum disorder and their
Department of Occupational Therapy, College of Rehabilitation Sciences,
typically developing siblings: A comparison study. Autism, 15,
Thomas Jefferson University, Philadelphia, PA.
98–113. https://doi.org/10.1177/1362361309348943
Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, Roseann C. Schaaf, PhD, OTR/L, FAOTA, is Director, Jefferson Autism
J. P., . . . Summers, C. A. (2007). Fidelity in sensory integration Center of Excellence; Professor, Department of Occupational Therapy; and
intervention research. American Journal of Occupational Therapy, 61, Faculty Member, Farber Institute for Neurosciences, Thomas Jefferson
216–227. https://doi.org/10.5014/ajot.61.2.216 University, Philadelphia, PA.

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