Improving food selectivity through occupational therapy consultation: A case study in a Japanese special needs school

Food selectivity is a common and challenging issue among children with autism spectrum disorder (ASD), often leading to nutritional deficiencies and difficulties participating in communal mealtimes such as Japan’s standardized school lunch (kyūshoku). This single-case study examined the effectiveness of a consultation-based occupational therapy (OT) intervention to improve food acceptance in a school setting. It involved a 7-year-old nonverbal boy with ASD and intellectual disability who was attending a special needs school in Japan. Over four months, occupational therapists provided consultation to the classroom teacher using baseline assessments, observations, and collaborative planning. Intervention strategies included the use of familiar dishware, pairing new foods with preferred items (bread), donburi-style mixed rice presentation, and a low-pressure, supportive approach. Changes in food acceptance and mealtime behavior were measured using the Autism Spectrum Disorder Mealtime Behavior Questionnaire and a food checklist, completed pre- and post-intervention. The number of school lunch items accepted by the child increased from 4 to 24, and the Food Selectivity score decreased from 4.0 to 2.4. Qualitative teacher reports indicated reduced anxiety, improved participation, and heightened curiosity during mealtimes. OT-informed, teacher-led, trust-based, low-pressure and culturally adapted interventions, can significantly improve food variety and mealtime behavior in children with ASD, especially in communal eating settings.