Relations Between Caregiver Perceptions of Problematic Mealtime Behaviors and Caregiver Feeding Practices

Background:  Problematic eating behaviors are often reported in children with Autism Spectrum Disorders (ASD). Limited data exist regarding eating behaviors of children with ASD and even fewer findings characterizing caregiver feeding practices have been reported.

Objectives:  We report on a substudy of a multi-center study investigating the nutritional intake of children with ASD participating in the Autism Treatment Network (ATN).  The aims of the substudy are to explore caregivers’ perceptions regarding eating behaviors of their children with ASD and relate them to feeding practices that caregivers use to facilitate eating for children with ASD.

Methods:  Children 2 - 11 y enrolled in the ATN within the past year were eligible for this study. Participants were diagnosed with Autism, Pervasive Developmental Disorder- Not Otherwise Specified, or Asperger Disorder per DSM IV criteria and supported by the Autism Diagnostic Observation Schedule.  Caregivers completed a demographics survey, The Brief Autism Mealtime Behavior Inventory (BAMBI) to measure caregiver perceptions of mealtime behavior problems (Lukens & Linscheid, 2007), and The Child Feeding Questionnaire (CFQ), to capture caregiver feeding strategies (Birch et al. 2001). 

Results:  Thirty-six caregivers of children with ASD (10 girls, 26 boys; 24 white, 1 black, 1 Asian, 10 unknown; mean age 62.7 ± 4.8 mo; median caregiver education = college degree; median income = $50,000 - $74,999;) have participated to date. Scores from the BAMBI (see table below) compare favorably with reported means from previous studies (Lukens & Linsheid, 2007). In general, caregiver CFQ scores are similar to previously reported findings for parents of typically developing children (Birch et al. 2001) however Perceived Responsibility and Monitoring of children’s food intake were higher for caregivers of children with ASD. No differences in caregiver responses were noted across gender or demographic categories. Child age was associated with Mastery of Eating (r=.56, p<.01).

Child Food Refusal was negatively associated with Offering of New Foods and Urging of New Foods (r=-0.44 & r=-0.51, p<.01) and similarly robust associations were noted between child Limited Variety and caregiver Offering and Urging of New Foods. Higher scores for Disruptive Mealtime Behaviors were associated with lower scores for Urging New Foods (r=-.49, p<.01).

 

Parameter	Construct Score (X + s.d.)
BAMBI (Range) Disruptive Mealtime Behaviors (5-25) Food Refusal (5-25) Limited Variety (8-40) Total Score (18-90)	11.2 + 2.5 10.3 + 3.1 23.3 + 6.7 44.8 + 11.1
Child Feeding Questionnaire (Range 1 – 5) Perceived Responsibility Restriction Monitoring Pressure to Eat Mastery of Eating Structure & Routine Offering New Foods Urging New Foods	4.6 + 0.4 3.6 + 0.5 4.0 + 1.0 2.4 + 0.8 3.4 + 0.6 4.2 + 0.5 3.1 + 0.5 3.3 + 0.7

Conclusions:  Higher rates of food refusal and limitations in food acceptance are related to less frequent offering of and urging to try new foods. While the causality of this relationship cannot be determined, these data underscore the need to develop methods for caregivers to successfully expose their children with ASD to new foods.