Construct Validity of the Feeding Assessment for Children With Autism

PURPOSE: Feeding challenges are estimated to occur in up to 89% of children with autism spectrum disorder (ASD). Restrictive feeding patterns and preferences may lead to nutrient-deficient diets, limited participation in family mealtimes, challenging behaviors, and increased caregiver stress during mealtime. Currently, the few tools that exist to assess feeding challenges in children with ASD are limited in scope and lack validity and reliability evaluation. The Feeding Assessment for Children With Autism was developed to provide a more complete understanding of feeding disorders in children with ASD, and the purpose of this study was to confirm its construct validity for use in research and clinical settings.

METHOD: An exploratory methodological research design was used to determine construct validity of the assessment tool. Nonprobability convenience sampling was used to recruit participants aged 2–12 with a diagnosis of ASD and parent-reported feeding challenges through the Interactive Autism Network. Exclusion criteria included primary hearing, visual, or physical impairment; seizure activity in the past 12 mo; and other conditions known to co-occur with ASD. A total of 406 caregivers participated in the survey and received a $5 gift card for completion.

The Feeding Assessment for Children With Autism is a 51-question caregiver-report questionnaire developed to characterize feeding challenges in children with ASD. Questionnaire items are believed to be related to four underlying constructs: sensory (13 items), behavior (17 items), health (11 items), and oral–motor (10 items). Confirmatory factor analysis, internal consistency, model fit indices, factor loadings, and a between-factor correlation matrix were conducted to determine construct validity.

RESULTS: Primary analysis confirmed that a four-factor model was appropriate for the questionnaire items. Internal consistency was good at .87, indicating that all questionnaire items are highly related to the overall construct of feeding. Confirmatory model fit indices indicated moderate fit of questionnaire items into the four predetermined constructs. Factor loadings for all four theoretical factors were adequate and statistically significant (p < .001), with all loadings >.22. All between-factor correlations were significant (p < .02), with small to medium positive Pearson r correlations. Behavior had medium positive correlations with both oral–motor (.45) and sensory (.30).

CONCLUSION AND IMPACT STATEMENT: Findings of the study provide preliminary confirmation of the construct validity of the Feeding Assessment for Children With Autism, providing researchers and clinicians with a comprehensive and psychometrically sound assessment tool to address children’s unique feeding challenges. Relatively small correlation magnitudes indicate that questionnaire items successfully targeted the four unique feeding challenges. The highest between-factor correlations were seen between behavior and all other factors, in particular oral–motor and sensory. This finding lends support to the hypothesis that mealtime behaviors observed in children with ASD are in response to other challenges these children face, including sensory responsiveness, underlying health concerns, and delayed oral–motor skills.

This tool allows for more detailed characterization of feeding challenges with this population and therefore can help optimize individualized and targeted interventions for children with ASD. Individualized interventions promote child participation in family mealtime and help foster the associated social and emotional benefits for the child and family.

References

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