Problematic Mealtime Behaviors Identified in Chinese American Children with ASD

Background: Up to 89% of children with ASD have been reported to have some type of eating problems which can include limited food variety, food neophobia, rigid routines around mealtimes in the form of using the same utensils or dishes, food refusal, and difficulties with texture. Research is needed to better understand feeding difficulties in diverse population to improve intervention strategies and parent education programs tailored to particular culture and context.

Objectives: To assess parents’ perceived mealtime behaviors of their children with ASD, particularly in Chinese American population resided in New York City.

Methods: Thirty one Chinese American parents who enrolled in a parent education program participated in the Brief Autism Mealtime Behavior Inventory (BAMBI) questionnaire. The BAMBI is a validated assessment tool with 18 items asking mealtime behaviors typically displayed in children with ASD. The questionnaire was provided both in English and Chinese languages to accommodate participants’ needs. Response options were 5-point Likert-type answers (Never to almost every meal). In addition, parents were asked to identify whether or not each item was a problem for their family. Descriptive statistics and correlation coefficients were calculated, using SPSS statistical software. Higher scores represent more problematic mealtime behaviors.

Results: The following describes mean score for each mealtime behavior category: “prefers crunchy foods”=3.8 (SD 1.1), “unable to remain seated”=3.3 (SD 1.4), “eating only soft foods”=2.8 (SD 1.3), “limited variety”=2.8 (SD 1.3), “selective eating”=2.8 (SD 1.1), “inflexible mealtime”=2.6 (SD 1.4), “prepared in a particular way”=2.3 (SD1.2), “food refusal”=1.9 (SD 0.8), “aggressive behaviors”=1.3 (SD 0.5) on a 5-point scale. Top 5 behaviors identified as a problem by Chinese American parents were: (1) 54%, only prefers “crunchy” foods (e.g. snacks, crackers); (2) 48%, not willing to try new foods; (3) 46%, does not remain seated at the table until the meal is finished, (4) 44%, dislikes certain foods and won’t eat them, and (5) 39%, does not accept or prefer a variety of foods. There was a significant association between food refusal and aggressive behaviors at mealtime (r=0.7; p<0.01).

Conclusions:  To our knowledge, this is the first study examining Chinese American parents’ perceived mealtime behaviors of their children with autism. Chinese Americans often eat differently than typical Americans do. Our findings may aid in developing appropriate intervention strategies and educational resources tailored to Chinese American population and have implications for other ethnic groups.