Dealing with food selectivity in child with autis m [623385]

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Dealing with food selectivity in child with autis m

Dealing wit h food selectivity in child with autism

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Dealing with food selectivity in child with autis m

Abstract

A 8 -year-old boy diagnosed with autism spectrum disorder who present feeding disorders ,food

selectivity (i.e., the child consumed only a few fo ods and refused all others) was taught not expelled

the food.The goal of treatment was to increase the quantity and/or variety of foods consumed and

descrease disruptions during meal by using the ante cedent-based procedures :simultaneous

presentation of two foods (one preferred, the other nonpreferred) .Resulted showed that adding

preffered food simultaneous with nonpreffered food produced increased food consumption and

descrease expulsion of item targhet food for the ch ild.Is interesant in future to evaluate percentage

of consumption in generalization probe conducted in the homes with parents,at school ,also with

peer to see if would consume item food or novel it em food in a different environment.

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Dealing with food selectivity in child with autis m

Dealing with food selectivity in child with autism

Food selectivity, defined as consumpti on of a narrow range of foods, is a common feeding

problem in children with autism spectrum disorders (ASD; Williams & Seiverling, 2010).

There are multiply reasons for food refusal behavio r but escape or avoidance of the feeding

situation is often a maintaining variable (Riordan, Iwata, Finney, Wohl, & Stanley, 1984). The

characteristics of food (e.g., type or texture) may influence its acceptance or rejection (Munk &

Repp, 1994). Piazza et al. (2003), for example,con ducted functional analyses of the inappropriate

mealtime behavior of 12 children. Results suggested that negative reinforcement (escape from bites

of food) served as the most frequently identified m aintaining variable, with 90% of the children

who displayed differential responding showing sensi tivity to negative reinforcement and results

suggest that negative reinforcement may play a prim ary role in the maintenance of feeding

problems, but the behavior of many children with fe eding disorders also may be sensitive to

positive reinforcement (i.e., access to adult atten tion, preferred foods, or toys).

Behavioral interventions have been d emonstrated to be effective for treating feeding

problems in children. A numbers of studies shown th at positive reinforcement ,involves providing

the child with access to preferred stimuli (e.g., f ood, toys, praise, tokens for desired eating behavi or)

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Dealing with food selectivity in child with autis m

and escape extinction is the most commonly used int ervention for treat feeding problem .When a

child’s feeding problem is supposed to be maintaine d by negative reinforcement escape extinction

is implemented; a procedure in which escape from or avoidance of the demand of eating is no

longer permitted. Expulsion of food is another pro blematic behavior present at children with

feeding disorders.Frequent expulsions during meals are often associated with decreased food

consumption and longer meal durations ( Peter,Bosco e & Roscoe, 2007). Several studies has

suggested that escape extinction (i.e., presenting and re-presenting food on a spoon until the food

was consumed) is an effective intervention for decr easing expulsions (e.g., Coe et al., 1997; Sevin,

Gulotta, Sierp, Rosica, & Miller, 2002 ). But , esc ape extinction is demonstreted in some studies

that has been associated with a number of undesirab le side effects.For example , Lerman, Iwata and

Wallace,( 1999) indicated that undesirable side eff ects of escape extinction may include response

bursts (i.e., initial increases in problem behavior ), extinction-induced aggression, and emotional

responding (e.g., crying). Bart et al ( 2002) prese nted that treatment with escape extinction ,by

procedure nonremoval of the spoon, produced an incr ease in food acceptance and a decrease in

disruption, but expulsion of food increased; expuls ion was treated, packing of food increased;

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Dealing with food selectivity in child with autis m

finally, when packing was treated,all refusal behav iors remained low, and acceptance continued to

occur at high and stable levels.

Several studies have shown that some b ehavioral procedures can be effective without

escape extinction to treat the feeding problems of participant(s) and they used positive reinforcement

procedures in the form of either differential reinf orcement of alternative behavior or noncontingent

reinforcement (e.g., Cooper ,Wacker, Comas, Peck, D rew, 1999; Brown, J. F., Spencer,Swift,

S.,2002; Wilder,Normand, & Atwell, 2005). Cooper et al.(1999) in their study shown that

increasing the quantity of contingent access to pre ferred foods (without escape extinction ) resulted

in increased acceptance for the participant who exh ibited food selectivity. Wilder et al.(2005) ,

demonstreted that could increase quantity of foods consumed by participants using noncontingent

reinforcement (i.e., continuous access to preferred stimuli throughout the meal).

Some previous research studies demo nstrated that the antecedent-based procedures are

effective treat the feeding problems of participan t (involved modifying variables that may increase

or decrease the aversive properties of the mealtime or food/drink presentations and thus, were used

to decrease the value of escape. The antecedent-bas ed procedures included :simultaneous

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Dealing with food selectivity in child with autis m

presentation of preferred and non preferred foods (Ahearn 2003;Buckley @Newchok 2005; Piazza

et al. 2003) ; stimulus fading (i.e.,gradually alte ring the concentration of paired preferred and non –

preferred foods) ( Tiger & Hanley 2006) and high-pr obability instructional sequences (Patel , Reed,

G.K., Piazza, C.C., Mueller, M., Bachmeyer, M.H., & Layer, S.A,2007) .

Ahearn (2003) in research increased accep tance of vegetables, nonpreferred foods with a

child diagnosed with autism in the absence of any p rogrammed consequences (i.e., neither escape

extinction for refusal behaviors or positive reinf orcement for food acceptance). The intervention

consisted on the non-preferred foods were added p referred condiments .Thus is ,simultaneous

presentation has been shown to be an effective stra tegy in increasing consumption of non-preferred

foods in the absence of escape extinction.Results o f these studies suggest that if the preferred food s

is identified, then an effective strategy may be t o provide to children simultaneously with non-

preferred foods.The explanation is that the strate gy may alter the aversive properties of the

nonpreferred food and thus the child’s motivation t o refuse the food (abolishing escape as

reinforcement) (Ahearn 2003; Buckley & Newchok 2005 ;Piazza et al. 2003). Another explanation

is that flavor-flavor conditioning may occur (i.e., properties of the preferred flavor or food may

produce conditional preference for the nonpreferred flavor or food),( Piazza et al. 2003).

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Dealing with food selectivity in child with autis m

Children who are highly selective wit h foods based on the brand, presentation, or flavor

of the food or who consistently do not eat a quanti ty properly for his age ,who do not eat the right

types of food,ussualy the foods that not provide substantial nutritional value when consumed alone

may be at risk for many problems of health, develo pmental. Obesity is another concern for parents.

Usually ,the children with feeding problems displa y inappropriate mealtime behaviors that cause

meals to be stressful for parents and they are avoi d to eating in public situation or events,social

opportunities..

The purpose of the current intervention is to descrease disruptions (expulsion and

inaprropriate behavior ) during meals by using simu ltaneous presentation of nonpreferred food and

ketchup (preferred food) and in the same time to i ncrease the consumption of food for a child

diagnosed with autism.

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Dealing with food selectivity in child with autis m

Method

Participant ,Setting and Matterials

The participant is L.C. is 8 –year –old boy who had been diagnosed with autism.He attended

a normal public school ,graduated first class.His d aily school schedule is 8:00 to 16:00 .He is

taking breakfast and lunch at school ,foods deliver ed from catering .His feeding history included

failure untill the age of 6 years to consume foods nothing but blended foods. A pediatrician had

indicated that child had not a medical problem ,non e of these medical problems ,such as food

allergies and gastro-esophageal reflux , that may affect feeding .Parents related that L.C is

selective eater and consume some foods but not othe rs, eg.potatoes ,sweets , cereals,also eat snack

foods, puree,all mixed foods .He is not eating prot eine ,vegetables,fruits solid or cooked. L.C was

also reported to request ketchup,sugar ,salt and w ould sometimes consume them alone without

other food.The pediatrician indicated that his weig ht is with 5-7 kg over normal limits.On many

occasions, classroom staff observed he expelling t he bites or vomiting at various locations of the

school and thus is ,they let L.C to stay at the tab le but not eating what he does not preffered till t he

coleagues are finishing the breakfast ,lunch. He co nsumed most of the foods from his existing

repertoire without incident, but when he was presen ted with bites of new or nonpreferred foods

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Dealing with food selectivity in child with autis m

(irrespective of texture), he typically expellled.T he parents desires is to descrease food refusal and

increase the acceptance of food (vegetables ,fruits etc) because this refusal of food affect child’s

ability to properly function at home, school where all children taking lunch and other social

settings, (party ,celebrations ) impacting physical , social and psychological development and are

concern for his weight that is increasing .All sess ions were conducted by regular therapist in child , s

home, in a kitchen room (2 m by 3 m) that contained table and the foods , materials necessary to

conduct the assessment 4 days per week during 4 we eks ,2 sessions per day. Baseline and

intervention phases , were implemented by the parti cipant’s regular tutor.

Response Measurement ,Interobserver Agreement and P rocedure

Target behaviors were defined as follo ws:

Expulsion was defined as spitting the food out of his mouth after acceptance.Examples of expulsion

included spitting food out of the mouth, pulling fo od out of the mouth after acceptance. Data also

were collected for consumption item food and inappr opriate behavior. Consumption was defined as

swallowing item food without expulsion (i.e., not v isible in the mouth ).

Inappropriate behavior was defined as any response that interrupted the p resentation of food :

negative vocalization,turn head ,cover mouth after presentation. Head turning was defined as

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Dealing with food selectivity in child with autis m

moving the head away from midline after spoon prese ntation. Negative vocalizations were defined

as making negative statements(e.g., ‘‘I don’t want it,’’ ‘‘no’’it is disgusting,,) above normal

conversational tone that lasted for 3 s or more .Da ta on child target responses were collected using a

paper-and-pencil. Consumption , expulsions were col lected via event recording either the behavior

occurred or did not occur during each bite present ation and were recorded once for each bite

presentation.Data for event-recording measures were converted to percentage of trials by dividing

the number of occurrences of the behavior by the nu mber of bite presentations multiplied by 100%.

Inappropriate behaviors were recorded as the freque ncy of occurrence and then were converted to a

rate by dividing the total number of responses by t he total number of minutes per session.

A second observer simultaneously but independently collected data during baseline and

intervention . Interobserver agreement on occurrenc e and nonoccurrence of responses

was calculated by dividing the number of agreements by the number of agreements plus

disagreements and multiplying by 100%. For inapprop riate behaviors recorded as frequency

measures,the total number of inappropriate behavior s per bite presentation was compared by

dividing the smaller frequency by the larger freque ncy and multiplying by 100%.Interobserver

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Dealing with food selectivity in child with autis m

agreement data for consumption was 93%, for expul sion was 90%, for inappropriate behavior

was 85%.During the functional analysis, a second observer simultaneously but independently

recorded data of sessions. IOA was 100% for consum ption, 83% for expulsion and 90% for

inappropriate behavior .

General Procedure

Prebaseline assessmen t. Eating behavior was observed for 5 days and his par ents were interviewed

about his eating behavior at hom e. Motivation Assessement Scale /MAS (table 1,Apendi x A) was

conducted with mother of L.C,who reported that L.C s problem behavior occured most frequently in

demand task ,when he was asked to eat new kind of f oods ,also an ABC assessement was conducted

The therapist gave the parents a list of foods that they sayed are eating (almost 20 items for eac h

category :fruits,vegetables,protein ,starch and oth ers ,(table 2,Apendix B ) and asked them to

indicate foods reported eaten by the them but not by the child (see table 2,text highlight color).

Selection of food texture(not too strong) and bite size(small) was based on the child’s skills and on

his history with eating .Fruits ,vegetables,protei n were targeted for intervention per parental

request.Fruits: banana ,peach,apple ;vegetables :to mato ,cucumber ,and broccoli,beans boiled

;protein :eg (boiled,fried),yogurt ,and meat :chick en ,fish for a total of list foods identified by the

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Dealing with food selectivity in child with autis m

parents as foods they would like their child to ea t.The mother with grandmother made a list with

the most preffered foods and the foods that L.C ref uses to eat (table 3,Apendix C).The foods which

the child avoided, were referred to as ‘‘ nonpreferred foods .’’ and there are all fruits ,all vegetables

,all kind of meat .Foods that he ate were listed as preferred foods (pretzels

,chips,honey,sweets,ketchup,puree, potatoes fries , cream soup, pate ,roe , melted cheese any kind of

food that texture is like a cream).For this interve ntion we start with one item food , chicken

meat(boiled) ,was chosen from a representative list of foods representing for three food groups

(i.e.,fruits,vegetables and protein the starch cate gory parents were not agree be consumed often ) ,

it was presented in each session. Item food was cut into 0,5cm- 0,5 cm pieces (bites) .Each session

was 10 min long, and bites of food were presented o nce every almost 30 s.Each session consisted of

15 trials. Breaks ( 10 min) were provided between e ach session, during which the child was allowed

to watch on tv or read a book etc.One bite was pres ented per trial.To start a session, the child was

brought to table and instructed to sit down. The th erapist sat across from the child.A trial began

when an initial spoonful of food (i.e., one that ha d not been placed in the mouth) was presented at

L.C’s lips and ended after the food was swallowed ( i.e., not visible in the mouth).

During baseline the therapist held a bite (0,5 cm by 0,5 cm) of the target item,chiken meat , on

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Dealing with food selectivity in child with autis m

a spoon 3 cm from L.C ’s mouth and said, ‘‘Take a b ite.’’ The therapist have provided no

differential consequences for innapropriatte behav ior . Food items were neutrally removed if L.C

did not initiate acceptance of the presentation of the food item. If he initiated acceptance from food

delivery, he was given 30 s to consume the bite.If L.C accepted the bite, the therapist provided

verbal praise (e.g., ‘‘good job taking your bite’’) .

Functional analysis . The functional analysis consisted of conditions play ,escape,attention

tangible , conducted to demonstrate that inappropri ate behavior was maintained, at least in part, by

negative reinforcement in the form of escape from b ite presentations as was hiphotesed . During the

functional analysis, the therapist followed the gen eral procedures described by Iwata et al.

(1982/1994). Acceptance of bites of food result ed in praise (e.g., ‘‘good eating’’) across all

experimental and baseline conditions and presentati on of another bite of item food. Expulsion and

inappropriate behaviors resulted in one of three t ypes of consequences (negative reinforcement,

positive reinforcement in the form of attention, or positive reinforcement in the form of tangible

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Dealing with food selectivity in child with autis m

items), depending on the condition in effect.The pu rpose of these conditions was to simulate a

situation in which the parent removed the bite (i. e., allowed escape) when the child engaged in

inappropriate behavior, provided attention or coaxi ng to motivate the child to eat, attempted to

motivate their child to eat by providing them with preferred items, activities, or food and in play

condition to observe inappropriate behavior when t he child had free access to attention and

preferred items.

Play condition .As in baseline describe above ,toys were availabl e and therapist engaged in

conversation with the child throughout the session. Engaging in inappropriate behavior was not provid e

with consequence. The spoon remained 3 cm from the child’s lips following inappropriate behavior , at

the end of the 30-s interval, the therapist removed the spoon and presented a new bite of food to the

child.

Attention condition Inappropriate behavior resulted in brief ( 10 s) a ttention, in the form

‘‘you like this’’,‘‘don’t be upset , you’ll be okay ’ and the item food remained 3 cm from the

child’s lips ,at the end of the 30-s interval, the therapist removed the food and presented a new bite

of food to the child. Toys were not available durin g these sessions .

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Dealing with food selectivity in child with autis m

Escape . Toys were not available during these sessions.The t herapist sat with the child and

delivered continuous demands to take a bite of foo d. When child engaged in an inappropriate behavior,

the food was removed for the 30-s interval and new bite of food was presented . The therapist did

not provide any other consequence following the chi ld’s inappropriate behavior .

Tangible. Inappropriate behavior resulted in the presentation of a tangible item (preferred toys, foods)for

30 s,it was not provide consequence following inappropriate be havior and therapist did not interact

with the child if the child had a toy. The spoon with the original bite of food remained 3 cm from

the child’s lips following inappropriate behavior a nd for the duration of the 30-s interval. At the end

of the 30-s interval,the therapist removed the spoo n and the tangible item and presented a new bite

of food.In addition, the results of a functional an alysis indicated that inappropriate behavior was

maintained by negative reinforcement and attention .

Treatment for consumption consisted simultaneous presentation that involves presenting a less

preferred food at the same time as a more preferred food. Simultaneous Presentation .This condition

was identical to baseline except that 3 drops of k etchup ,the preffered food, was placed on the

spoon with the target food –chiken meat and present ed simultaneously to L.C. The ketchup was the

item food preferred used during the simultaneous presentation sessions and selected prior baseline

acorddind to parents .

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Dealing with food selectivity in child with autis m

Results and Disscusion

The results of study on functional ana lysis of feeding disorders suggest that negative

reinforcement in the form of escape from eating pla ys a major role in the maintenance of

inappropriate mealtime behavior (Piazza, Fisher, et al., 2003). The results of MAS are shown in

table 1 ,(Apendix A) .The behavior occurs when dema nds are placed on a child to eat nonpreferred

foods ,the primary hypothesis is that the problem b ehavior is maintained by escape .During

observation of eating behavior of L.C was noticed and recorded that grandmother and mother

removes undesired food items or terminates meals wh en L.C refuses to eat nonpreffered

food, therefore the child may be more likely to dis play inappropriate behavior during meals to

escape or avoid less preferred food items . That is , the child’s inappropriate mealtime behavior may

be shaped and maintained by negative reinforcement (i.e., contingent removal of food presentation).

The results of the naturalistic observations sugge sted that parent also provide attention (in the

form of coaxing(e.g., ‘‘you like this’’)) or repri mands (e.g.,‘‘don’t throw food’’), when L.C

displayed inappropriate behavior.The results of ina ppropraite behavior during functional analysis

are shown in figure 1,Apendix D. High levels of ina ppropriate behavior is in escape condition

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Dealing with food selectivity in child with autis m

L.C engaged in many inappropriate behavior also in attention condition and suggest that the

child’s behavior was sensitive to positive reinforc ement in the form of attention. Inappropriate

behavior was high in the escape condition then atte ntion condition and never occured in play

condition .Figure 2 ,Apendix E ,shows on top panel ,the percentage of bites expelled , consumed

bites of nonpreferred food ,chiken meat .L.C did no t consume any bite of nonpreferred

food in baseline phases and engaged in disruptions .He accepts the item targhet bites with the first

sesion but imediatly expelled . The child engaged in inappropriate behavior (negative vocalization

,turn head ,cover the mouth ) during baseline at hi gh level,all long session after he has seen the foo d

he engaged in negative vocalization , and descrease after intervention started,dispayed on botom

panel of figure 2.. The intervention started after 10 sessions baseline. When ketchup was added,

consumption increased immediately to 100% and expul sions descrease . During intervention it can

be see some fluctuations of expulsions ,that it is supposed that the meat was not enough

boiled.These results should be interpreted in light of three potential limitations. First, only 1

participant was used in this investigation.Second , was not follow up and other enviromental settings

,transition to L.C s family to see if the child ma int the skill . Parents ,nanies are often

responsible for providing most meals to children an d it is important after treatment, the therapist

instruct mother ,nany etc to conduct feeding inter ventions escape and attention (including coaxing,

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Dealing with food selectivity in child with autis m

reprimands, and comfort or concern) as parental res ponses to food refusal.Third,even the result

shows descrease of expulsion and increase so high l evel of consumption ,it was not conducted an a

preference assessment that could demonstrate pref erence for specific condiment

,preffered food used in the simultaneouspresentatio n method,the ketcup ,it was choosen according

the parents related be the preffered item food .It is interesting to see if the child will consume it em

targhet with other kind of preffered food .L.C ,s r efusal of nonpreferred item may be hyphotesed

also to aversive flavor, texture, smell or access t o other preferred foods. By adding of a preferred

food ,ketchup ,was modified the probability of co nsumption. Even that negative reinforcement

(escape from eating) plays in the maintenance of fe eding problems a principal and major role , as in

the studies as mention above ,this intervention sho wn that this procedure was effective in the

absence of escape extinction .The child demonstret ed a high precentage of correct trails but it is

important to note that he entered the intervention with food acceptance and many in consumption

repertoire in that he acquiered fast the food targh et ,tutor that working with him knew very

well the history of child and the child present a g ood compliance with therapist .

Future research may be study if this procedure woul d be effective with children who refuse all solid

food ,with more difficulties feeding disorders.

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Dealing with food selectivity in child with autis m

References

Ahearn, W.H. (2003). Using simultaneous presentatio n to increase vegetable consumption in a

mildly selective child with autism. Jou rnal of Applied Behavior Analysis, 36, 361 – 365.

Bart M. Sevin, Ch. S. Gullotta ,B.J. Sierp ,L. A. R , and L.J. Miller .(2002).Analysing of response

covariation among multiple topographies of food refusal .Journal of Aplied Behavior

Analysis ,35,65-68

Brown, J. F., Spencer, K., & Swift, S.(2002). A par ent training programme for chronic food refusal:

A case study.British Journal of Learni ng Disabilities, 30, 118 – 121.

Buckley, S.D., & Newchok, D.K. (2005).An evaluation of simultaneous presentation and

differential reinforcement with response cost to reduce packing. Journal of Applied Behavio r

Analysis, 38, 405 – 409.

Coe, D. A., Babbitt, R. L., Williams, K. E., Hajimi halis,C., Snyder, A. M., Ballard, C., et al. (1997) .

Use of extinction and reinforcement to i ncrease food consumption and reduce expulsion.

Journal of Applied Behavior Analysis, 30 , 581–583.

Cooper, L.J., Wacker, D.P., Brown, K.,McComas, J.J. , Peck, S.M., Drew, J., et al. (1999). Use of a

concurrent operants paradigm to evaluat e positive reinforcers during treatment of food

refusal. Behavior Modification , 23 , 3 – 40.

Lerman, D.C., Iwata, B.A., & Wallace, M.D.(1999). S ide effects of extinction:Prevalence of

bursting and aggression during the tr eatment of self-injurious behavior. Journal of Appl ied

Behavior Analysis, 32, 1-8.

Munk, D. D., & Repp, A. C. (1994). Behavioral asses sment of feeding problems of individuals with

severe disabilities. Journal of Applie d Behavior Analysis, 27, 241–250.
Patel, M., Reed, G.K., Piazza, C.C., Mueller, M., B achmeyer, M.H., &Layer, S.A. (2007). Use of a

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Dealing with food selectivity in child with autis m

high probability instructional sequen ce to increase compliance to feeding demands in the

absence of escape extinction. Behavio ral Interventions , 22 , 305 – 310.

Peter A. Girolami, James H. Boscoe, and N Roscoe (2 007). Descreasing expulsions by a child with

feeding disorder .Using a brush to p resent and represent food Journal of Apllied

BehaviorAnalysis, 40, 749–753

Piazza, C.C., Patel, M.R., Santana, C.M., Goh, H., Delia, M., & Lancaster, B.M.(2002). An

evaluation of simultaneous sequent ial presentation of preferred and non-preferred foo d to

treat food selectivity. Journal of Applied Behavior Analysis, 35 , 259 – 270.

Piazza, C.C., Fisher, W.W., Brown, K.A., Shore, B.A ., Patel, M.R., Katz, R.M.,et al. (2003).

Functional analysis of inappropria te mealtime behaviors. Journal of Applied Behavior

Analysis, 36, 187 – 204.

Riordan, M. M., Iwata, B. A., Finney, J. W., Wohl,M . K., & Stanley, A. E. (1984). Behavioral

assessment and treatment of chronic food refusal by handicapped children. Journal of

Applied Behavior Analysis, 17, 327–3 4

Sevin, B. M., Gulotta, C. S., Sierp, B. J., Rosica, L. A., & Miller, L. J. (2002). Analysis of respons e

covariation among multiple topograph ies of food refusal. Journal of Applied Behavior

Analysis, 35, 65–68.

Tiger, J.H., & Hanley, G.P. (2006).Using reinforcer pairing and fading to increase the milk

consumption of a preschool child . Journal of Applie Behavior Analysis, 39, 399 – 40 3.

Wilder, D.A., Normand, M., & Atwell, J.(2005). Nonc ontingent reinforcement as treatment for food

refusal and associated self-injury. Jou rnal of Applied Behavior Analysis , 38 , 549 – 553.

Williams, K. E., & Seiverling, L. (2010). Eating pr oblems in children with autism spectrum
disorders. Topics in Clinical Nutrition, 2 5, 27–37.

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Dealing with food selectivity in child with autis m

Apendix A
Motivation Assessment Scale

Name L.C
Date June 2012
Behavior Description >refusal food
0=Never, 1=Almost Never, 2=Seldom, 3=Half the Time, 4=Usually, 5=Almost Always, 6=Always
Questions Answers
1. Would the behavior occur continuously, over and over, if
this person were left alone for long periods of tim e? (For
example, several hours) 0 1 2 3 4 56
2. Does the behavior occur following a request to p erform a
difficult task? 0 1 2 3 4 5 6
3. Does the behavior seem to occur in response to y ou
talking to other persons in the room? 0 1 2 3 4 5 6
4. Does the behavior ever occur to get a toy, food, or
activity that this person has been told that he or she can't
have? 0 1 2 3 4 5 6
5. Would the behavior occur repeatedly, in the same way,
for very long periods of time, if no one were aroun d? (For
example, rocking back and forth for over an hour.) 0 1 2 3 4 5 6
6. Does the behavior occur when any request is made of this
person? 0 1 2 3 4 5 6
7. Does the behavior occur whenever you stop attend ing to
this person? 0 1 2 3 4 5 6
8. Does the behavior occur when you take away a fav orite
toy, food, or activity? 0 1 2 3 4 5 6
9. Does it appear to you that this person enjoys pe rforming
the behavior? (It feels, tastes, looks, smells, and /or sounds
pleasing.) 0 1 2 3 4 5 6
10. Does this person seem to do the behavior to ups et or
annoy you when you are trying to get him or her to do what
you ask? 0 1 2 3 4 5 6
11. Does this person seem to do the behavior to ups et or
annoy you when you are not paying attention to him or her?
(For example, if you are sitting in a separate room ,
interacting with another person.) 0 1 2 3 4 5 6
12. Does the behavior stop occurring shortly after you give
this person the toy, food, or activity he or she ha s 0 1 2 3 4 5 6

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Dealing with food selectivity in child with autis m

requested?
13. When the behavior is occurring, does this perso n seem
calm and unaware of anything else going on around h im or
her? 0 1 2 3 4 5 6
14. Does the behavior stop occurring shortly after (one to
five minutes) you stop working or making demands of this
person? 0 1 2 3 4 5 6
15. Does this person seem to do the behavior to get you to
spend some time with him or her? 0 1 2 3 4 5 6
16. Does the behavior seem to occur when this perso n has
been told that he or she can't do something he or s he had
wanted to do? 0 1 2 3 4 5 6

Table 1. Results after conducted M A S with mother s L.C .

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Dealing with food selectivity in child with autis m

Apendix B

Table 2 . List of foods items .The text highlight c olor indicates what family is eating but the child refuses

starch / Others Proteine
Meat etc vegetables fruits
1 snacks Cereals integrals cucumber apple
2 rice almond peppe r pear
3 macaroni Soup fish tomato Red melon
4 Cereal flakes Soup meat beans banana
5 muffins Eg boiled peas nectarina
6 peanuts milk zuchinni Whitw grapes
7 rolls yourght lentil apricot
8 Bars cereals cheese Bean pods peach
9 pretzels Meat chiken green ananas
10 chips Beef meat salade strawberies
11 cookies fish cabbage raspberry
12 Salade sauce Milk with cacao carrot cherry
13 bombons Lamb meat potatoe visine
14 Peanut butter Chiken liver onion plums
15 mustar d chickpeas garlic Yellow melon
16 mayonesse Turkey meat broccoli Red grapes
17 sweets butter cauliflower walnut
18 condiments Cream soup spanach
19 pickles Food cooked with
meat mushrooms
20 roe Grill
pumpink
21 puree Sea food
22 Ice cream
23 pizza
24 sausage

24
Dealing with food selectivity in child with autis m

Apendix C

Table 3. The list with nonpreferred and preferred foods of L .C

Nonpreferred foods Preferred foods
All fruits ketchup
All vegetables solid All kinds of sweets
Chiken meat,fish,beef,pork pate
All vegetables cooked Soup cream
Egg sboiled puree
Egg sfied roe
youghrt Melted cheese
seeds Potatoes fries
pretzels ,chips
honey
sugar

25
Dealing with food selectivity in child with autis m

Apendix D

0510 15 20 25 30 35 40
Attention Play Demand Tangible
Figure 1 .Results of L.C functional analysis .Inapp ropriate behavior consist
of head turning,negative vocalisation,cover mouth du ring meal time Inappropriate mealtime behavior per minute

26
Dealing with food selectivity in child with autis m

Apendix E

Figure 2.Percentage occurence of consumption of chi cken meat and expulsions of L.C top and
inappropriate mealtime behaviors per minute (botom panel) 010 20 30 40 50 60 70 80 90 100
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Baseline Simultaneous Presentation
Sessions Expulsions
Consumption Precentage occurence
01234567
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Baseline Simultaneous presentation
Sessions Inaproppriate behavior per minute