Feeding Challenges in Children With Autism and the Relationship With Parent and Child Outcomes

PURPOSE: The presence of feeding problems in children with autism spectrum disorder (ASD) is well documented. Feeding challenges in children with ASD are highly heterogeneous and more research is needed to understand the differential relationships between different types of feeding challenges to specific sensory patterns, parenting stress, and overall adaptive behaviors. The following research questions were addressed in this descriptive study: (1) What is the differential relationship between areas of feeding challenges as measured by the Feeding Assessment for Children with ASD and the child’s adaptive functioning and parenting stress in children with ASD? (2) How do sensory patterns contribute to areas of feeding challenges in children with ASD?

DESIGN: A descriptive cross-sectional survey study of a national sample (N = 396) of caregivers of children with ASD (2-12 years). Participants were recruited through a national database of families of children with ASD.

METHOD: Questionnaires collected data on the child with ASD’s feeding challenges (Feeding Assessment for Children with Autism), functional skills (Scales of Independent Behavior-Revised; SIB-R), family demographic information, ASD symptom severity (Social Responsiveness Scale; SRS-2), sensory response patterns (Sensory Experiences Questionnaire; SEQ 3.0), and parenting stress (Parenting Stress Index Short Form; PSI-SF). Multiple regression models were used to assess the ability of four feeding challenge constructs of the Feeding Assessment for Children with Autism (sensory, behavior, health, oral motor) to predict parent stress (PSI-SF), and child functional independence (SIB-R: Standard score and support score) while controlling for household income, chronological age, and ASD symptom severity (SRS-2).

RESULTS: The behavior feeding construct significantly predicted PSI-SF total stress and all subtests. The oral motor and behavior feeding construct significantly predicted the level of support needed for the child (SIB-R support). Whereas, child’s broad independence (SIB-R standard score) was predicted by the oral motor feeding construct alone. Sensory patterns (SEQ 3.0 Seeking, Hyper, Hypo, and EP) were examined to predict the four feeding constructs. The Seeking, Hyper, and Hypo sensory patterns predicted the oral-motor and behavior constructs. While the Hyper construct was the only predictor of both the health and sensory feeding constructs.

CONCLUSION: The relationship between increased behavior and sensory response suggests children with higher sensory challenges may present with behavioral concerns in response to their sensory experiences. The relationship between increased sensory responsiveness and increased oral motor challenges may suggest that more severe sensory challenges may be indicative of overall difficulty and lower motor functioning including oral motor functioning. Additionally, the relationship between increased hyper response to sensory stimuli and increased health feeding concerns suggests that hyper response patterns may meet a child’s sensory needs and help modulate their health-related symptoms.

CONCLUSION: The findings of this study suggest children with ASD demonstrate unique patterns of feeding challenge and sensory response, which are significantly connected to parenting stress and adaptive behavior. Further, these study findings suggest that existing literature and potentially occupational therapy practitioners may be overlooking the impact that oral motor and health have on feeding challenges in children ASD. Characterizing the relationship between areas of feeding challenge and parent and child outcomes for children with ASD may allow for the development of family-centered feeding interventions aimed at specific areas of challenge.

References

Schreck K., Williams K., & Smith A. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34(4), 433-438. https://doi.org/10.1023/B:JADD.0000037419.78531.86

Ausderau, K., Sideris, J., Furlong, M., Little, L., Bulluck, J.C., & Baranek, G.T. (2013). National survey of sensory features in children with ASD: Factor structure of the sensory experience questionnaire (3.0). Journal of Autism and Developmental Disorders, 44(4), 915-925. https://doi.org/10.1007/s10803-013-1945-1

Ausderau, K., Al- Heizan, M., Dammann, C., & Hope, S. (under review). Construct validity of the feeding assessment for children with autism. Manuscript in preparation.