Clinical Child and Family Psychology Review

, Volume 20, Issue 4, pp 403–421 | Cite as

The BUFFET Program: Development of a Cognitive Behavioral Treatment for Selective Eating in Youth with Autism Spectrum Disorder

  • Emily S. Kuschner
  • Hannah E. Morton
  • Brenna B. Maddox
  • Ashley de Marchena
  • Laura Gutermuth Anthony
  • Judy Reaven


Selective eating (often referred to as “picky” eating) is common in individuals with autism spectrum disorder (ASD) across the lifespan. Behavioral interventions are widely used to treat selective eating; however, most of these programs are time intensive, have not been evaluated for use in outpatient settings, and do not typically include youth beyond early childhood. Despite the functional impact and risk for negative outcomes associated with selective eating, there are no empirically supported treatments available for older children, adolescents, or adults, either with or without ASD. To address this treatment gap, we developed BUFFET: the Building Up Food Flexibility and Exposure Treatment program. BUFFET is a 14-week, multi-family group cognitive behavioral treatment for selective eating in children (8–12 years) with ASD. In this paper, we will (1) discuss the theoretical conceptualization of BUFFET, (2) describe the treatment content and structure, (3) present feasibility data from the initial pilot trial, and (4) consider next steps in treatment development.


Autism spectrum disorder Feeding Picky eating Cognitive behavior therapy Intervention Sensory 



This study was supported by a grant from Autism Speaks (8130; PI: Kuschner). The authors gratefully acknowledge the families who participated in this study. We thank the BUFFET Stakeholder Advisory Board and Dr. Julie Worley for guidance during treatment development. We also thank Ligia Antezana, Dana Kamerling, Rebecca Murray, Jeremy Rudoler, and Kelsey Spielman for their help with facilitating treatment groups. Finally, we thank Dr. Colleen Lukens for review of a draft of the manuscript.


This study was funded by Autism Speaks (#8130; PI: E. Kuschner).

Compliance with Ethical Standards

Conflict of interest

Dr. Kuschner, Dr. Maddox and Ms. Morton declare no conflicts of interest. Dr. de Marchena reports that her work on this project was (in part) supported by the National Institute of Neurological Disorders and Stroke (#T32NS007413). Dr. Anthony receives royalties from the Unstuck and On Target program, currently published by Paul Brookes Publishing (Cannon et al. 2011; Kenworthy et al. 2014). Dr. Reaven receives royalties from the Facing Your Fears program, currently published by Paul Brookes Publishing (Reaven et al. 2011).

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Center for Autism ResearchThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Department of Psychology, Binghamton UniversityState University of New YorkBinghamtonUSA
  4. 4.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of Behavioral and Social SciencesUniversity of the SciencesPhiladelphiaUSA
  6. 6.Division of Pediatric NeuropsychologyChildren’s National Health SystemWashingtonUSA
  7. 7.JFK Partners, Department of PsychiatryUniversity of Colorado, Anschutz Medical Campus, School of MedicineDenverUSA

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