Mealtime Structure in Families with Children with ASD

Background: Feeding challenges are highly prevalent among children with autism spectrum disorders (ASD) with up to 89% reported to have feeding difficulties impacting development, health, and social interactions, specifically parent–child relationships. These feeding difficulties create tension and disruption around mealtimes and have been shown to significantly increase parental stress within and outside feeding experiences.

Objectives: The purpose of this study was to examine how parents of children with ASD structure their mealtime routines using a grounded theory approach.

Methods: Families (n=16), primarily mothers, with a child with ASD, ages 2-8 years, participated in 2-3 semi-structured interviews, each lasting 1 to 2 hours in the home environment.  Audio-recorded interviews and field notes were transcribed verbatim and used for data analysis. A grounded theory approach was used, including initial identification of codes and themes to organize data. Axial coding was used to draw connections among the concepts and categories that built on identified themes. Lastly, selective coding was used to describe the central phenomena of the data and develop a theory on family mealtime construction. In-depth interviewing, triangulation, and member-checking (i.e., verifying and clarifying information with participants at follow-up interviews) were used to establish scientific rigor in the qualitative data.

Results: Family construction of mealtimes are a dynamic and adaptive process that involved the interplay of five themes: Values (guiding principles and beliefs shaped by family culture, traditions, religion, and personal experiences), Balancing Demands (what parents prioritize with regards to feeding and mealtime in the context of their busy lives and family schedules), Parent Strategies (strategies individual parents implement with their children in varying mealtimes contexts that are guided by their values and realities of their daily schedules), Mealtime Happenings (actual mealtime process), and Adaptability (interactions and adaptations that occur based on child behaviors and context). Themes were used to construct a grounded theory to describe the process of how parents with children with ASD structure their mealtime routines. Figure 1 shows the relationship and interaction among the themes that describes the elaborate mealtime construction that arises in response to a child’s feeding disorder. Many factors influence how parents of children with ASD attempt to structure their mealtime routines and consequently the actuality of the family mealtime experience, including parental values, balancing family demands, and the individual responses of the child to implemented parental strategies. In the described model, parent strategies were often the mediator between how the child behaviorally responded in mealtime contexts and the parent’s attempt to balance family demands and values.  Due to the complexity of mealtime construction in the presence of having a child with ASD and feeding challenges, parents were required to have constant adaptability to create “successful” family mealtimes.  

Conclusions: Five distinct themes were identified and used to create a model of family mealtime construction using a ground theory approach. The explicit identification of mealtime routines will lead to targeted family-centered interventions that can be based on individualized family goals, values, and behaviors that can improve child eating and mealtime behaviors while decreasing parental stress.