title: Multidisciplinary intervention for childhood feeding difficulties.
abstract: OBJECTIVE
  The aim of the study was 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 to 6 years with autism spectrum disorder or with a nonmedically complex history were recruited. Feeding difficulties were confirmed based on clinical assessment. Participants were randomized to receive 10 OC or SysD sessions (parents could opt for intervention once per week, or intensively within a week). Immersive parent education was delivered across both arms. A 3-month review was provided to measure outcomes postintervention.
  
  
  RESULTS
  In total, 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. When the data were combined across both groups, however, 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% confidence interval -0.1 to 6.8, P = 0.06) compared with the SysD arm. There were limited differences in response observed between the autism spectrum disorder and nonmedically complex history 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 2 intervention approaches are effective. Further research is required in exploring these interventions across other subgroups, and examining outcomes for longer periods.
authors.affiliation: *Children's Nutrition Research Centre †Child Health Research Centre ‡School of Health and Rehabilitation Sciences §Children's Health Queensland, Royal Children's Hospital, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Marshall
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Hill
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.forename: Jenny
authors.initials: J
authors.lastname: Ziviani
authors.forename: Pamela
authors.initials: P
authors.lastname: Dodrill
mesh_terms: D000067877:Autism Spectrum Disorder / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003216:Conditioning, Operant; D003887:Desensitization, Psychologic; D005247:Feeding Behavior; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology / Q000628:therapy*; D005260:Female; D005502:Food; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D010348:Patient Care Team; D011446:Prospective Studies; D016896:Treatment Outcome