The Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA) -Development and Validation of a Self-Report Questionnaire Targeting Disturbed Eating Behaviours within the Autism Spectrum

Background:  The presence of eating and mealtime problems in autism spectrum disorders (ASD) is clinically acknowledged but rarely investigated in those with normal intelligence. Disturbed eating behaviour in ASD strongly influences everyday life of the individual but also contributes significantly to the caregiver burden. Examples of eating disturbances linked to ASD are selective eating, food neophobia, pica, rumination, overeating and polydipsia. Despite the clinical relevance, eating and mealtime problems have been scarcely explored within the autism spectrum and prior research has mainly focused on individuals with a concurrent intellectual disability (i.e. mental retardation).

Objectives:  The aim of the study was to develop and validate a web-based self-report questionnaire exploring disturbed eating in individuals with ASD and normal intelligence.

Methods:  Based on literature review and clinical experience a questionnaire pertaining to eating and mealtime problems within the autism spectrum was developed. The questionnaire was completed by individuals with ASD and normal intelligence, 15-25 years old (n=57; male:38, female:19), and by healthy age-matched controls (n=31; male:15, female:16). The validation focused on basic psychometric properties of reliability and validity. Statistical analyses comparing the two groups were also performed as well as a four week interval test-retest.

Results:  The instrument showed high levels of reliability, convergent and discriminant validity and scaling properties. Logistic regression analyses discerned areas of Simultaneous capacity and Social situation at mealtime as the best predictors of ASD. BMI did not differ between the ASD group and controls. Significant negative correlations were found between BMI and the subscales Eating behaviour and Social situation at mealtime in the ASD group, i.e. the more deviant eating behaviour the lower the BMI.

Conclusions:  The present study suggests that SWEAA is a reliable and valid instrument for assessing eating and mealtime problems in ASD.