The impact of the Schmetterling NBI Program on selective eating behavior: evaluation of creative therapeutic interventions across three families of children with autism spectrum disorder.

内容摘要

Children with autism spectrum disorder (ASD) frequently exhibit selective eating behaviors characterized by food refusal and limited dietary variety, which can lead to nutritional deficiencies and impaired family functioning. This study evaluated the effectiveness of the Schmetterling Nutritional Behavior Intervention (NBI) Program, a creative behavioral intervention integrating established behavioral strategies with innovative components, including imitation chaining, shaping, and therapist-guided exoskeleton modeling. Three children (YW, RA, and JK) diagnosed with autism spectrum disorder (ASD) participated in a single-case experimental design. The study employed the Childhood Autism Rating Scale, 2nd Edition (CARS-2) assessing autism symptom severity, while the Child Eating Behavior Questionnaire (CEBQ) measured changes in eating behavior. Substantial increases in food acceptance were observed across all participants, with the highest improvements in food responsiveness, enjoyment of food, and food fussiness. Tau-U analysis revealed large and significant intervention effects for both therapist-implemented and parent-implemented sessions. Although CARS-2 scores remained within the 'severe' classification range, notable percentage reductions suggested clinically relevant improvements in core autism symptoms. These findings support the Schmetterling NBI Program as an individualized, evidence-based approach to enhancing dietary diversity and reducing maladaptive feeding behaviors in children with ASD. Children with autism spectrum disorder (ASD) commonly demonstrate selective eating patterns, including food refusal and restricted dietary repertoire, which may contribute to nutritional deficits and compromised family dynamics. This investigation examined the efficacy of the Schmetterling Nutritional Behavior Intervention (NBI) Program, a novel behavioral intervention that synthesizes established behavioral methodologies with innovative components such as imitation, shaping procedures, and therapist-guided training. Utilizing a single-case experimental design, three children diagnosed with ASD (YW, RA, and JK) were assessed with the Childhood Autism Rating Scale, Second Edition (CARS-2) to evaluate autism symptom severity, and the Child Eating Behavior Questionnaire (CEBQ) to measure alterations in feeding behavior. Results indicated substantial improvements in food acceptance across all participants, with pronounced enhancements in food responsiveness, enjoyment of food, and reductions in food fussiness. Tau-U statistical analysis demonstrated large and significant intervention effects for both therapist-administered and parent-implemented sessions. Although CARS-2 scores remained within the severe classification range, notable percentage reductions indicated clinically meaningful improvements in core autism symptomatology. These findings support the Schmetterling NBI Program as an individualized, evidence-based intervention for promoting dietary diversity and reducing maladaptive feeding behavior among children with ASD. Replicating our preliminary findings in a larger sample and finding evidence-based tailored interventions for children with ASD pose important challenges for future research.