Feeding a Child with Autism Spectrum Disorder: Mothers' Strategies and Beliefs

Background:

From the moment of their child’s birth, mothers commence the intricate dance of responding to their child in order to meet his or her feeding needs.  This can be particularly challenging when the child has Autism Spectrum Disorder (ASD) as 46-89% of children with ASD have feeding challenges (Ledford & Gast, 2006). The frequency of feeding challenges is greater than in typically- developing peers (Schreck, Williams, & Smith, 2004). While the descriptive studies have provided information on the types of feeding challenges for children with ASD, there is no research  investigating how feeding challenges develop, change over time, and what mothers do to ensure that their children with ASD have adequate nutrition.

Objectives: The research questions are: For mothers, what is the process of feeding their children with ASD from infancy to school age? What challenges do the mothers face? What strategies have been used?  How successful were these strategies?

Methods: This study used a constructivist grounded theory approach. Grounded theory is the method of choice when pursuing a question that is process oriented, when there is change over time, and the research purpose is to identify social processes (Richards & Morse, 2007). Participants were eight mothers of children aged five to nine years with a confirmed diagnosis of ASD and feeding challenges.  Mothers whose children had a co-morbid diagnosis that could independently affect feeding were excluded from the study.  Interactive interviews in the family home were recorded, transcribed and analyzed (Charmaz, 2006). Field notes were recorded following each interview. The goal is to develop theory for clinical practice through the analysis of the data. Appropriate ethics approval was obtained.

Results:

Results are presented as themes derived from the interview and field note observational data.  Themes including parental belief systems and family values, mothers’ roles, stress around feeding, impact on family and extended family, and strategies mothers use are reported along with supporting quotes. Strategies ranged from common approaches such as gradually and persistently offering new foods to novel approaches such as presenting new foods at a restaurant buffet.  Parental beliefs and values influenced and shaped the strategies used by mothers, for example the value placed on calm family mealtimes or the belief that food choices influenced their child’s behaviours.

Conclusions:

There are few studies specifically investigating ASD and feeding challenges. Findings from this study will help to determine appropriate areas for foci in assessment and appropriate treatment interventions. There is evidence to suggest that  health care professionals need to consider the cognitive, affective and behavioural domains of family functioning (Wright & Leahey, 2005) when devising interventions to address difficulties within the feeding process. Preliminary data analysis suggests there is no standardized intervention for feeding difficulties and an individualized approach needs to be based on the child’s needs and the family’s beliefs and values and offered within a trusting, mutually respectful parent-professional relationship. This study will be of interest to those interested in understanding the experiences of families living with the challenges of ASD in order to more appropriately support them.