Research Proposal Development 101: Training Restricted Eaters

with ASD through Telehealth (TREAT): A Novel Intervention

Anne E. Kalomiris, M.A., Elizabeth G. Moore, BSN, RN, CNP, Maximilian Tokarsky, M.A., Karen Harpster, PhD, OTR/L, Karen Burkett, PhD, RN, PPCNP-BC

Background Methods Discussion

90% of children with autism spectrum Setting: The study intervention will take place in an outpatient hospital clinic setting. Participants receiving the Based on previous study results, we anticipate
disorders (ASD) experience feeding Telehealth intervention will also be provided video conferencing equipment and receive virtual guidance to implement the following potential impacts may occur:
difficulties (Kodak & Piazza, 2008) the intervention in their home.
Increased risk for nutritional deficits which Reduction of maladaptive meal time
Participants: A total of 30 children aged 4 to 6 years with a diagnosis of autism spectrum disorder (ASD) and their
may contribute to worsening ASD symptoms behaviors across settings among children
(Barnhill, Gutierrez, Marti & Hewitson, 2015; Ekstein, Laniado, & Glick, 2010; Galler, primary caregivers will be recruited.
Ramsey, Solimano, & Lowell, 1983, Kalunza-Czaplinska & Jowik-Pruska, 2016; Oates, who participate in TREAT intervention
Peacock, & Forrest, 1985)
Intervention: Improved caregiver efficacy and management
Extant behavioral interventions have been of child mealtime behaviors post-intervention
effective for increasing food intake (Johnson, Foldes,
DeMand, & Brooks, 2015 Generalizability of eating habit improvements
Direct instruction about parenting responses will be carried over to the home post-
to childrens feeding in the home is warranted telehealth implementation.
(Stough, Gillette, Robers, Jorgenson, & Pattoon, 2015)
Fewer nutritional deficits among children
whose caregivers successfully generalize
Telehealth intervention may help with
TREAT intervention to the home environment
generalizing skills to the home environment
(Baharav, 2010) An increase in meal time structure will reduce
Caregiver training: All caregivers, regardless of condition, who agree to participate in the study, will receive a caregiver stress and improve parent-child interactions
Telehealth incorporates technological education workshop for 1-2 hours, which will cover 8 topics related to picky eating.
during meals.
communication to allow feedback in vivo (Allen,
2011; Lindgren, 2015; Pickard, 201; Vismara, 2012) Intervention Protocol: Each group will include 16 feeding intervention sessions, 2 sessions per week. For both groups, Children completing the TREAT intervention
the first session each week will be a video recorded, center-based, group feeding session. During this session, the will increase in the variety of foods they are
Our previous research showed that caregiver children with ASD will participate in the child-centered play-based feeding intervention while the primary caregiver willing to try.
education with a group-based snack time observes the intervention from a two-way mirror. Following each treatment session, the primary caregiver will complete
intervention resulted in increased # of foods a follow-up questionnaire about new foods swallowed at home.
eaten/tried (See Results). Telehealth is cost-
effective, accessible and can enhance skill Control group (Standard of Care-SOC): This group will participate in a second video recorded, center-based, group
generalization into the home, thus we feeding as described above.
developed a research proposal that Intervention (TREAT) group: The participants in the TREAT group will attend one center-based, group feeding session Future Directions
combines our previous research with a (described above) and one Telehealth feeding session per week for 8 weeks. Caregiver/child dyads will be provided
telehealth intervention for R03 submission to with an iPad to be utilized for the duration of the study for the Telehealth intervention and the weekly home video
NIH (June) recording. Future research will strive to investigate these
methods in a larger sample in a controlled clinical
Aims Primary Outcomes: New Foods Accepted Secondary Outcomes: Feasibility of Intervention & Moderators of Severity trial to increase generalizability
Telehealth should be examined as a technological
tool to incorporate into additional therapies (e.g.,
Specific Aim 1: Compare the effectiveness of
behavioral, physical, occupational) for children with
the TREAT intervention with a clinic-based
Previous Results from Group-Based Snack Time Intervention: Foods Eaten at Home autism spectrum disorders to assist with
intervention (control group) on improving the generalizing diverse interventions to the home and
acceptance of new foods in preschool children maintaining gains
with ASD Results from previous study (standard of care/control group) proposed in methods above demonstrating efficacy of controls. Dissemination of findings for application in clinical
practice
Aim 1.a Assess the feasibility, (i.e, acceptability, Snack Time Foods Eaten at Home by Subject
satisfaction) of a Telehealth snack time 14

intervention protocol in preschool aged children 12

Acknowledgements
with ASD
Number of Snack Time Foods Eaten at

Subject 2
10
Subject 3
Subject 5
Aim 1.b. Explore the severity level of autism 8 Subject 6 This proposal development project was funded by The
symptoms, behavior, food selectivity, and Subject 8 Maternal and Child Health Bureau Grant T73MC00049
Subject 10
sensory processing difficulties as moderators of 6
Subject 12 and T73MC00032. We would also like to thank the
Home

the relationship between TREAT intervention and 4

Subject 14
Subject 15
UC/UCEDD faculty for their assistance with this project.
Subject 16
food acceptance. Subject 17
2
Subject 20

Specific Aim 2: Investigate the use of therapeutic 0

strategies executed by caregivers in the home

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 References
Week of Intervention
during snack time.
References available upon request.