JOURNAL
REPORT
presented by Joyce de leon
Title: Methodological
Components for Evaluating
Intervention Effectiveness
of SOS Feeding Approach:
A Feasibility Study
Authors: Sarah A Schoen, Rachel
Balderrama , Emma Dopheide , Ariel Harris
, Laura Hoffman , Samantha Sasse
Background
Pediatric Feeding Disorder (PFD) has become
increasingly prevalent, affecting:
30–45% of typically developing children
Up to 80% of children with developmental
disabilities
46–89% of children with autism
Feeding is a complex occupation requiring
integration of sensory, motor, oral,
emotional, psychological, and social systems.
Children with sensory processing difficulties
often experience:
Food refusal
Food selectivity
Reduced food variety
Mealtime stress
Background
The Sequential Oral Sensory (SOS)
Approach to Feeding is a multidisciplinary,
sensory-based intervention designed to
improve feeding skills using:
Developmental progression
Systematic desensitization
Play-based food exposure
A structured “Steps to Eating”
hierarchy
Methodology
Study Design:
Feasibility / Pilot Study conducted over 4
years
Participants:
12 children
Ages 2–11 years
Diagnoses included:
Autism Spectrum Disorder
ADHD
Pediatric Feeding Disorder
Sensory Processing Challenges
Dyspraxia
Anxiety Disorders
Tools
01 Behavioral Coding Scheme
[Link], Interacts, Smells, Touches, Tastes, Eats
Videos coded in 10-second increments
02
Visual Analog Scale (VAS)
12-question parent-report tool
Parent competence, Child utensil use, Child
tolerance of new foods, Coping strategies, Age-
appropriate eating
Parenting Stress Index – Fourth Edition
03 101-item standardized parent-report questionnaire
Child Domain (e.g., adaptability, demandingness)
Parent Domain (e.g., depression, isolation,
competence)
Activities
Food Hierarchy-Based
Exposure
Children were introduced to five novel foods per
session.
Foods were presented according to
developmental progression:
Purees
Soft solids
Hard solids
Children progressed through the 32-step
hierarchy:
Tolerating food in room
Touching food
Smelling food
Tasting
Biting
Chewing
Swallowing
Play-Based
Desensitization
Food exploration
through play
Sensory engagement
(texture, smell, color)
Non-threatening
exposure
No pressure to eat
Parent Involvement
Collaborative goal
setting
Home meal video
recordings
Strategy
implementation
Coaching for carryover
Video-Based
Behavioral Probes
At home:
Meal duration
Utensil use
Caloric intake
Leaving table frequency
In clinic:
Frequency of “eats food”
“Tolerates smell”
“Touches food”
Results
The study showed that the SOS Approach to Feeding
improved children’s feeding behaviors, including
utensil use, food consumption, tolerance of novel
foods, and exploration of new foods. Parents also
improved in their ability to support their child during
meals and gained strategies to manage mealtime stress.
Preliminary findings suggested reductions in parental
stress and improvements in child adaptability and
compliance during eating.
Utilization
Therapists can use the structured food
hierarchy to gradually introduce new foods,
improve oral motor skills, and increase
tolerance for different textures and tastes.
Parent involvement can be emphasized, using
coaching and home strategies to reinforce
skills learned in therapy. Behavioral coding and
simple outcome measures like a Visual Analog
Scale (VAS) can be used to track progress
objectively, while monitoring parental stress
using tools like the Parenting Stress Index (PSI)
can guide additional support.
Thank You