Treatment of Feeding Problems in Children With Autism

Fifty well characterized children will be randomly assigned to either the 20 week PT-F or a
waitlist control group. Study assessments evaluating feeding and mealtime behaviors,
nutritional intake, daytime behaviors, repetitive behaviors, sensory sensitivities, parent
stress and parent-child interactions will be completed at Baseline, Week 10, and Week 20
timepoints. Treatment Fidelity forms will be completed by the therapist at the end of each
treatment session to assess achievement of session goals and parent adherence during each
session.

Inclusion Criteria

1. Males and females >=2 and < 8 years of age.

2. At least one participating parent resides with the child >50% of time.

3. Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis of Autism
Spectrum Disorder as established by clinical assessment, corroborated by the Autism
Diagnostic Interview - Revised (ADI-R) and Autism Diagnostic Observation Schedule -
2nd Edition (ADOS2).

4. A total score of > 54 on the Brief Autism Mealtime Behavior Inventory. A score of 54
is one standard deviation above the mean for the ASD group, as reported by the
developers.

5. A receptive language level of 12 months or greater. [Rationale: diagnostic uncertainty
of ASD in children functioning below 12 months of age and the need for the child to
understand simple instructions in PT-F].

6. Medication free or stable medications and/or supplements (no changes in past 6 weeks
and no planned changes during study period). [Rationale: Many children with ASD are on
medications to target associated behaviors. These include stimulants and atypical
antipsychotics. Excluding these children could result in a non-representative sample
of children with ASD and feeding problems. We will require that the feeding problems
pre-date the initiation of medications / supplements].

Exclusion Criteria

1. Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis of Rett's
Disorder or Childhood Disintegrative Disorder.

2. Presence of a known serious medical condition in the child influencing the management
of diet and treatment impacting diet or appetite (e.g., current or past
gastroesophageal reflux disease, significant food allergies, diabetes, cystic
fibrosis, celiac disease, endocrine disorder, genetic disorders known to impact growth
or appetite). [Rationale: these children may require different treatments than the
behaviorally based parent training intervention].

3. Significant oral motor dysfunction (i.e., unable to safely chew and swallow age
appropriate textures).

4. Presence of known psychiatric diagnosis in the child that would require a different
treatment (e.g., psychotic disorder, major depression).

5. Inpatient hospitalization.

6. Being fed via nasogastric or gastrostomy tube in the past year.

7. On medication or supplements specifically targeting appetite.

8. Insufficient proficiency of English language prohibiting comprehension of PT-F.
[Rationale: Parents will need sufficient command of English to benefit from the
English materials].