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

Abstract

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.

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Notes

  1. 1.

    Female sex was not exclusionary.

  2. 2.

    Chronological age inclusion criteria were 8–12 years. Two 12-year-olds were determined to be eligible for the study but were unable to participate due to logistical/scheduling conflicts.

  3. 3.

    It should be noted that BUFFET may be effective for children with these conditions or restricted diets; however, these conditions lead to selective eating that requires medical oversight and management. The decision was made to focus this initial trial on children without any externally determined factors driving selective eating. Future trials can examine the inclusion of children with co-occurring conditions, paired with interdisciplinary collaboration and oversight from pertinent medical professionals.

  4. 4.

    Due to a clerical error, one BUFFET group (n = 4) did not complete the global satisfaction ratings at their outcome assessment visit. Follow-up efforts were made: one family was quickly reached following the outcome assessment to complete the questionnaire, one family was reached too late for valid completion of these ratings, and two families were lost to follow-up.

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Acknowledgements

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.

Funding

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

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Correspondence to Emily S. Kuschner.

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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.

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

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Kuschner, E.S., Morton, H.E., Maddox, B.B. et al. The BUFFET Program: Development of a Cognitive Behavioral Treatment for Selective Eating in Youth with Autism Spectrum Disorder. Clin Child Fam Psychol Rev 20, 403–421 (2017). https://doi.org/10.1007/s10567-017-0236-3

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Keywords

  • Autism spectrum disorder
  • Feeding
  • Picky eating
  • Cognitive behavior therapy
  • Intervention
  • Sensory