4. Discussion
4.1. Parental concern regarding feeding behaviors in children with ASD
The results of the present study identify feeding difficulty as an area of concern for parents of children with ASD. This
concern is greater than the feeding concern for their other children.
4.2. Acceptance of food
Thirty-nine percent of participants were classified as low on acceptance. This percentage is lower than a previous study
using similar behavior observations, which found over half of the participants were categorized as low on acceptance
(Ahearn et al., 2001). Additionally, Ahearn et al. (2001) classified only 13% of the participants as high on acceptance,
compared to almost 39% in the current study. One possibility for this
finding is a difference in the sample of participants
participating in the studies. Over a quarter of the sample of participants in the previous study lived in community or group
homes whereas in the present study all child participants lived at home with their families. It is possible that we recruited
participants for the current study who were generally higher functioning compared to the participants recruited by Ahearn
et al. (2001) which may impact feeding behaviors.
4.3. ASD symptomatology and feeding problems
The main purpose of the current study was to determine if autism symptomatology was related to feeding problems.
Although the autism composite score of the PDD Behavior Inventory was positively correlated with the Brief Autism
Mealtime Behavior Inventory total raw score, the results of this
finding are difficult to interpret given the
finding that the
Brief Autism Mealtime Behavior Inventory did not relate to any of the behaviors coded during mealtime observations. There
are several possibilities for these
findings.
The
first possibility is that autism symptomatology is not related to feeding difficulties, at least not as defined as
percentage of foods consumed. This
finding replicates a previous study that used different measures of autism and feeding
difficulties (Schreck et al., 2004). Children with higher Autism Composite Scores, however, did spend a greater amount of
time during the mealtime observation engaging in negative vocalizations. Additionally, scores on the Brief Autism Mealtime
Behavior Inventory Autism Scale also correlated with duration of negative vocalizations. Perhaps children with more severe
autism are not necessarily more selective in the foods they consume, but engage in a greater duration of problem behavior
(e.g., cry for longer durations or exhibit aggression) when refusing to consume a nonpreferred food. This indicates that
perhaps individuals with more severe autism are not necessarily more likely to need feeding intervention, but when feeding
difficulties occur, because of the duration of refusal behaviors, evidence-based intervention may be necessary. It also may be
difficult for parents of children who cry for longer durations to follow through with a feeding intervention, and these parents
may need more assistance
Second, it is possible that because the meal was conducted in a clinic-like setting, it may not be representative of what
typically occurred in the home. This possibility seems unlikely, however, given that we conducted two sets of mealtime
observations. Behaviors observed during the examiner-led meal were highly predictive of behaviors observed during the
parent-led meal, indicating that child mealtime behaviors may be trans-situational. Although the parent-led meal was likely
to be more structured than a typical home meal (i.e., there was a time limit per food, and the parents presented food items
one small piece at a time), we instructed the parent to interact with his or her child and feed him or her as would be done
typically in the home. It appears that the mealtime behavior of children with autism is similar across feeders and perhaps
across settings, supporting the use of observation of mealtime behaviors in a controlled research setting.
A second aim of the study was to examine if children’s specific autism symptoms were related to different types of feeding
difficulties. None of the children in this study consumed the required proportion of pureed foods to table-texture foods for
classification as texture selective, so this analysis could not be completed. In a similar study, only one participant out of
30 met this definition of texture selectivity (Ahearn et al., 2001). Although many parents of children with autism report that
foods with a specific texture may be nonpreferred, it is likely that these children are not just consuming pureed foods.
Perhaps they may prefer naturally softer foods and reject foods that require more chewing, or demonstrate texture
preferences other than for smooth purees. Additionally, some of the foods we presented in pureed texture are not typically