The Impact of the Schmetterling-NBI Program on Selective Eating Behavior: Evaluation of creative therapeutic interventions across three families of children with Autism Spectrum Disorder

This study aimed to evaluate the effectiveness of the Schmetterling–NBI Program, a creative behavioral intervention designed to address food selectivity in young children with Autism Spectrum Disorder (ASD), characterized by food refusal and limited dietary variety. The program integrates established behavioral strategies with innovative components, including imitation chaining, shaping, and therapist–guided exoskeleton modeling. Three children diagnosed with ASD (YY, RR, and JJ) participated in a single–case experimental design conducted at home. The Childhood Autism Rating Scale, Second Edition (CARS-2) was used to assess the severity of autism symptoms, while the Child Eating Behavior Questionnaire (CEBQ) measured changes in eating behaviors. Results from the Tau-U statistical analysis indicated substantial increases in food acceptance across all participants, with the highest improvements observed in food responsiveness, enjoyment of food, and food fussiness. Although CARS-2 scores remained within the severe classification range, notable percentile reductions suggested clinically relevant improvement in core autism symptoms. These findings support the Schmetterling–NBI Program as an individualized, evidence–based approach to enhancing dietary diversity and reducing maladaptive feeding behaviors in children with ASD, contributing to the growing body of literature supporting early, personalized behavioral interventions.