Multidisciplinary Intervention for Childhood Feeding Difficulties: A Randomized Clinical Trial.

OBJECTIVE:: To determine whether operant conditioning (OC) or systematic desensitization (SysD) intervention resulted in more improvements in dietary variety/ intake, and more reductions in difficult mealtime behaviors. METHODS:: Children 2-6 years with autism spectrum disorder (ASD) or with a non-medically complex history (NMC) were recruited. Feeding difficulties were confirmed via clinical assessment. Participants were randomized to receive ten OC or SysD sessions (parents could opt for intervention once/week, or intensively within a week). Immersive parent education was delivered across both arms. A 3-month review was provided to measure outcomes post-intervention. RESULTS:: In total, 78 children were enrolled, and 68 participants (87%) completed the study. There were no significant differences in outcome measures between the OC and SysD intervention groups from baseline to 3-month review. However, when the data were combined across both groups, significant improvements in primary outcome measures were observed (p < 0.05). Although not statistically significant, it was considered clinically significant that participants in the OC arm demonstrated more increases in dietary variety (mean difference 3.3 foods, 95% CI: -0.1 to 6.8, p = 0.06) compared to the SysD arm. There were limited differences in response observed between the ASD and NMC groups, and the intensive and weekly arms. CONCLUSIONS:: Favorable results were observed regardless of intervention, intensity or etiological group. Results suggest that, when delivered to a protocol by experienced therapists and coupled with parent education, these two intervention approaches are effective. Further research is required in exploring these interventions across other sub-groups, and examining outcomes over longer periods of time.