Mealtime Behavior Problems and Spousal Stress Among Children with ASD

Background: Children with ASD are reported to have atypical eating behaviors and problematic mealtime behaviors. It has been suggested that mealtimes provide structure and promote family unity, and that stressful mealtimes can contribute to family disharmony.  Emerging evidence suggests that mealtime behavior problems exhibited by children with ASD contribute to parental stress at mealtimes.  

Objectives: To describe changes in children’s mealtime behaviors and parental stress over time and to determine whether spousal stress is associated with mealtime behavior problems in children with ASD.

 Methods: We re-contacted parents of children with ASD (n=53) who participated in the Children’s Activity and Meal Patterns Study (CHAMPS). The original CHAMPS study included children with ASD and typically developing children ages 3-11 years. The average follow-up period was 6.5 years. Both the original CHAMPS study and the follow-up study included a parent questionnaire about family mealtimes that contained questions about mealtime behavior problems (score range 0-40) and spousal stress at mealtimes (score range 0-20).

Results: Seventeen of the 53 (32%) children with ASD who took part in the original CHAMPS study participated in the follow-up study.  Those who participated in the follow-up study did not differ in age or prevalence of mealtime behavior problems at baseline compared to those who did not participate.  However, parents who participated in the follow-up study were more likely to report higher levels of spousal stress than those who did not participate (p<0.001).  The mean (SD) child age at baseline was 6.9 (2.4) years; mean (SD) age at follow-up was 13.4 (2.6) years.  The mean (SD) score for spousal stress at baseline was 13.7 (4.0), which decreased to 10.1 (5.0) at follow-up (p<0.05).   The mean (SD) mealtime behavior problem score was 21.8 (5.9) at baseline, which declined to 15.6 (4.9) at follow-up (p<0.01).  At baseline, spousal mealtime stress was significantly correlated with mealtime behavior problems (r=0.67; p=.005); at follow-up this association weakened and was no longer statistically significant (r=0.37, p=0.17).

Conclusions: Our findings suggest a high prevalence of mealtime behavior problems and spousal stress at mealtimes among families of children with ASD and an association between the two. Over time, however, both mealtime behavior problems and spousal stress appear to improve.  Given that mealtimes are important for family cohesion, the challenges that children and families face at mealtimes may be important clinical targets. Larger studies that examine the nature of and course of these relationships is warranted.