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Feeding and Nutrition

Marcus Autism Center established this lab to discover new methods to prevent, mitigate and/or treat atypical relationships children have with food.

The Feeding and Nutrition Lab combines expertise from psychology, dietetics, biostatisitics, clinical trials, medicine and speech-langauge pathology to expand the research base regarding the cause, consequences and remediation of childhood feeding problems. Estimates suggest as many as 5 percent of children experience chronic feeding concerns, with prevalence significantly higher among children with complex medical and/or developmental histories. Our lab was established to better understand factors that disrupt typical eating for children while concurrently engaging in innovative research to discover new methods to prevent, mitigate and/or treat atypical relationships with food. Feeding difficulties of this magnitude fall under the broader psychiatric definitaiton of avoidant-restrictive food intake disorder (ARFID), which can manifest as severe weight loss, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and/or marked interference with psychosocial functioning. Our research spans each of these manifestations in the following manner:

Cause:

For most people, food is viewed as a positive and pleasing experience and the skills and behaviors associated with eating unfold naturally. This process, however, can be disrupted by medical, developmental and/or psychiatric conditions that contribute to food refusal that may pair eating with pain, discomfort or other aversive consequences. Our lab’s focus on causal mechanisms involves improving early detection and assessment methodology while also looking at new and innovative ways to determine the mechanisms that establish and maintain chronic food refusal.

Consequences:

Poor dietary intake can produce negative outcomes that may involve weight loss, nutritional deficiencies and/or experienced-based oral-motor/skill-related deficits. Infants and children with feeding disorders also may have impaired cognitive and emotional development or compromised immune functioning and may require recurrent hospitalizations and medical intervention (e.g., feeding tube placement). In addition to effects on the child, feeding disorders also impact the larger family system, with meals frequently described by caregivers as stressful and chaotic. Our lab’s approach to better understanding the effects of feeding disorders involves looking at the behavioral, nutritional, skill-based and medical consequences on the child as well as the psychosocial impact on the family.

Remediation:

Our lab seeks to develop new and innovative models of treatment in order to increase access to care, improve community readiness and lessen barriers to care to meet a growing unmet need, and reduce the cost and length of intervention. Our approach involves testing our treatments in a format that promotes evaluation and replication, i.e., treatment manuals. We also look toward technological solutions to innovate this line of research, such as the use of algorithm-based decision-making to guide clinical care and standardize treatment delivery.

Associated studies

Integrated Eating Aversion Treatment Manual-Parent Version (iEAT)

Autism MEAL Plan: Parent Training to Manage Eating Aversions and Limited Variety

D-cycloserine and Treatment of Feeding Disorders

Technology-Supported Behavioral Feeding Intervention

Recent accomplishments

Published and accepted research articles (clinical, basic science, other) in refered journals:

  1. Berry, R.C., Novak, P., Withrow, N., Schmidt, B., Rarback, S., Feucht, S., Criado, K.K., & Sharp, W.G. (2015). Nutrition Management of Gastrointestinal Symptoms in Children with Autism Spectrum Disorders: Guideline from an Expert Panel. Journal of the Academy of Nutrition and Dietetics, 115 (2), 1919-1927.
  2. Sharp, W.G., Trumbull, A., & Lesack, R. (2015). Blending to treat expulsion in a child with food refusal. Behavioral Interventions, 30(3), 247-255.
  3. Sharp, W.G., Stubbs, K.H., Adams, H., Wells, B.M., Lesack, R.S., Criado, K.K., Simon, E.L., McCracken, C. E., West, L.L., Scahill, L.D. (2016). Intensive manual-based intervention for pediatric feeding disorders: Results from a randomized pilot trial. Journal of Pediatric Gastroenterology and Nutrition, 62(4), 658-667.
  4. Sharp, W.G., Allen, A., Stubbs, K.H., Criado, K.K., Sanders, R., McCracken, C.E., Parsons, R.G., Scahill, L.D., & Gourley, S.L. (2017). Successful pharmacotherapy for the treatment of severe feeding aversion with mechanistic insights from cross-species neuronal remodeling. Translational Psychiatry, e1157, doi:10.1038/tp.2017.126.
  5. Criado, K.K., Sharp, W.G., McCracken, C.E., Devinck-Baroody, O., Dong, L., Aman, M.G., McDougle, C.J., McCracken, J.T., Arnold, L.E., Weitzman, C., Leventhal, J.M. Vitiello, B., Scahill, L. (2018). Overweight and Obese Status in Children with Autism Spectrum Disorder and Disruptive Behavior. Autism, 22(4): 450-459.
  6. Sharp, W.G., Postorino, V., McCracken, C.E., Berry, R.C., Criado, K.K., Burrell, T.L., & Scahill, L.D. (2018). Dietary intake, nutrient status, and growth parameters in children with autism spectrum disorder and severe food selectivity: An electronic medical record review. Journal of the Academy of Nutrition and Dietetics, 118 (10), 1943-1950.
  7. Sharp, W.G., Burrell, T.L., Berry, R.C., Stubbs, K.H., McCracken, C.E., Gillespie, S.E., Scahill, L. (In Press). The Autism MEAL plan vs. Parent Education: A Randomized Clinical Trial. The Journal of Pediatrics.

Review articles:

  1. Sharp, W.G., Jaquess, D.L., Morton, J.S., & Herzinger, C. (2011). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13, 348-365.
  2. Mulle, J.G., Sharp, W.G., & Cubells, J.F. (2013). The gut microbiome: A new frontier in autism research. Current Psychiatry Reports, 15, 337-346.
  3. Sharp, W.G., Berry, R.C., McCracken, C., Nuhu, N.N., Marvel, E., Saulnier, C.A., Klin, A., Jones, W., & Jaquess, D.L. (2013). Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature. Journal of Autism and Developmental Disorders, 43(9): 2159-2173.
  4. McElhanon, B.O., McCracken, C., Karpen, S., & Sharp, W.G. (2014). Gastrointestinal Symptoms in Autism Spectrum Disorders: A Meta-analysis. Pediatrics, 133(5): 872-883.
  5. Sharp, W.G., Volkert, V.M., Scahill, L., McCracken, C.E., & Barbara McElhanon, M. (2017). A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care? The Journal of Pediatrics, 181: 116-124.
  6. Postorino, V., Sharp, W.G., McCracken, C.E., Bearss, K., Burrell, T.L., Evans, A.N., Scahill L. (2017). A systematic review and meta-analysis of parent training for disruptive behavior in children with autism spectrum disorder. Clinical Child and Family Psychology Review, 20(4): 391-402.
  7. Burrell, T.L., Johnson, C., Whitehouse, C., & Sharp, W. (2018). Parent Training for Feeding Problems in ASD. In C.R. Johnson, E.M. Butter, & L. Scahill (Eds.), Parent Training for Autism Spectrum Disorder, (173-202). Washington, D.C. American Psychological Association.
  8. Sharp, W.G. & Stubbs, K.H. (2019). Avoidant/restrictive food intake disorder: A diagnosis at the intersection of feeding and eating disorders necessitating subtype differentiation. International Journal of Eating Disorders, 52(4): 398-401.

 

Contact information

T. Lindsey Burrell, PhD

Lindsey.Burrell@choa.org

Faculty members

William Sharp, PhD
T. Lindsey Burrell, PhD
Larry Scahill, MSN, PhD
Scott Gillespie, MS
Courtney E. McCracken, PhD
Valerie M. Volkert, PhD
Rashelle Berry, MPH, MS, RD