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 research articles in peer-reviewed journals:

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.

Volkert, V.M., Sharp, W.G., Cole Clark, M., Ormand, H., Rubio, E.K., McCracken, C. & Bryan, L. (2019). Modified-bolus placement as a therapeutic tool in the treatment of pediatric feeding disorders: analysis from a retrospective chart review. Journal of Speech, Language, and Hearing Research, 62(9):3123-3134

Sharp, W.G., Burrell, T.L., Berry, R.C., Stubbs, K.H., McCracken, C.E., Gillespie, S.E., Scahill, L. (2019). The Autism MEAL plan vs. Parent Education: A Randomized Clinical Trial. The Journal of Pediatrics, 21: 185-192.

Sharp, W.G., Volkert, V.M., Stubbs, K.H., Berry, R.C., Cole Clark, M., Bettermann, E.L., McCracken, C., Luevano, C., McElhanon, B., Scahill, L. (2020). Intensive Multidisciplinary Intervention for Patients with Feeding Tube Dependence and Chronic Food Refusal: An Electronic Heath Record Review. The Journal of Pediatrics, 223: 73-80.

Rubio, E. K., Volkert, V. M., Farling, H., & Sharp, W.G. (2020). Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders. Journal of Applied Behavior Analysis, 53: 956-972.

Review articles

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.

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.

Sharp, W.G., Berry, R.C., Burrell, T.L., Scahill, L., & McElhanon, B.O (2020). Scurvy as a sequela of avoidant-restrictive food intake disorder in autism: a systematic review. Journal of Developmental & Behavioral Pediatrics.

Rubio, E. K., McMahon, M. X., H, & Volkert, V. M. (in press). A systematic review of physical guidance procedures as an open-mouth prompt to increase acceptance in children with feeding disorders. Journal of Applied Behavior Analysis. 

Contact information

Valerie M. Volkert, PhD, BCBA-D

Faculty members

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