Estimates suggest that atypical eating may occur at epidemic levels among children with autism spectrum disorders (ASD); however, lack of established assessment standards represents a significant barrier to determining the nature and prevalence of feeding problems in ASD. Past studies in this area have relied primarily on chart audits or study specific questionnaires to investigate feeding problems and nutritional intake among children with ASD, presenting a need to identify and evaluate standardized feeding measures with potential for widespread dissemination and replication.
To explore the relationship among three general methods (i.e., standardized questionnaires, estimates of nutrient intake, mealtime observation) applied in previous research to assess feeding related concerns in ASD.
We developed a multi-method assessment core for feeding problems in ASD, including the Brief Autism Mealtime Behavior Inventory [BAMBI], a food preference inventory (FPI), and structure mealtime observation, and administered this battery to a sample of 31 children with ASD. Data analysis explored the relationships among variables both within and between measures, as well as the relationship with ASD diagnostic indicators.
Most caregivers (81%) expressed concerns regarding their child’s eating habits. Selective eating patterns and food refusal were detected in the sample across measures, including high rates of problem behaviors and few bites accepted during the mealtime observation and more than a third of the foods on the food inventory identified as never consumed. The BAMBI's Limited Variety subscale positively correlated with the number of foods reported as never consumed and the percentage of the meal observation involving negative vocalizations. Finally, we did not detect a relationship between feeding measures and ASD characteristics as measured by the Social Responsiveness Scale (SRS).
This represents the first study comparing standardized questionnaires with direct mealtime observations. Findings are consistent with previous descriptions of children with ASD as exhibiting strong preferences for certain foods and displaying strong emotional responses when presented with non-preferred food. It also appears that degree of food selectivity, as captured by the BAMBI or FPI, among children with ASD may be an important indicator of a child’s emotional response to the presentation of novel and/or non-preferred foods during meals. Implications for practitioners interested in assessing feeding problems in children with ASD are discussed.
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