Development and Validation of the Autism Eating Profile Questionnaire

Background: Many children with autism spectrum disorders (ASD) exhibit a variety of eating/feeding problems, making eating a recurrent challenge. Despite recent research and developments in this area, there is a lack of thorough validated and reliable tools that specifically assess eating problems in children with ASD. The Autism Eating Problems and Patterns Questionnaire (AEPQ) was developed as a new and comprehensive assessment of children with ASD with the aim of better understanding the nature and sometimes the source of eating problems in this population.  

Objectives: (1) To construct a questionnaire that will assess the eating problems and patterns of children with ASD (2) To determine the questionnaire's reliability and validity in two ways:  a. examination of the internal consistency of the questionnaire’s domains; and b. ascertaining its discriminative validity.  

Methods:  A 3-phase study was conducted: 1) construction of the questionnaire, including content validity and factor analysis 2) ascertaining internal consistency reliability, and 3) ascertaining discriminative validity by comparing the reports of parents of children with ASD to those of parents of typically developed children. Parents of 69 boys with ASD, mean age of 4 years and 10 months, and 85 typically developed children matched by age and gender, completed the AEPQ which includes three parts: (a) personal details and general information relating to eating habits, as well as medical and family history (b) a Likert scale part that addresses seven domains of eating problems, and (c) a food list aimed at assessing the actual diet of the child by means of types, variety of eaten foods. Cronbach’s alpha coefficient was used to examine the domain scale’s internal consistency. To test whether differences existed between the children with and without ASD, a Multiple Analysis of Variance (MANOVA) was conducted, followed by a series of ANOVA tests to investigate the differences between the two groups in the various questionnaire's domains. 

 Results: Factor analysis of the 46 items revealed seven factors that constructed seven different domains, namely: chewing and swallowing problems, food avoidance, eating selectivity, sameness and rigidity in eating, eating rituals, excessive eating and mealtime behavior problems. Internal consistency reliability of the AEPQ's seven domains range from a high to very high (Cronbach's alpha of r=.82 to .94).The MANOVA showed significant differences between the groups in their eating habits )F (6,69) =24.13 ,p<0.001, η²=.65( ; scores of children without developmental disabilities were significantly lower than the scores of children with HFASD in all of the questionnaire's domains, thus establishing the questionnaire's discriminant validity  

Conclusions: The AEPQ presents a clear factor structure and is a reliable and valid tool for the assessment of eating problems, specifically various kinds of food selectivity of children with ASD. By generating a thorough profile of eating habits and problems that specifically relate to the characteristics of ASD, it may support clinical decision-making regarding interventions aimed at improving the eating problems of children with ASD.