Date Presented 04/22/2023
Feeding challenges in a national sample of autistic children (N = 427) are characterized, including early feeding challenges, independent feeding, mealtime routines, caregiver strategies, and reported food and environmental sensitivities.
Primary Author and Speaker: Brittany St John
Additional Authors and Speakers: Alana Wooley, Hsiang-Ting Chen, Karla Ausderau
BACKGROUND: Up to 84% of autistic children experience feeding challenges that often negatively impact health, nutrition, developmental, family and social outcomes. Current literature and intervention focus on the sensory and behavioral components of feeding challenges. Feeding concerns reported by caregivers demonstrate that current understandings of feeding challenges and approaches to intervention are not comprehensive and frequently do not meet the families’ needs and expectations. Comprehensive characterization of the presentation of feeding challenges is needed to understand the multiple contributing factors related to feeding challenges and to understand how feeding challenges are embedded in children’s environmental and family context.
PURPOSE: The purpose of this study is to (1) characterize the presentation of feeding challenges in young autistic children in a large national sample; and (2) identify predictors of feeding challenge severity and area of feeding challenge (sensory, behavioral, oral motor, and health subscale scores).
METHOD/DESIGN: This study uses data from the Feeding and Eating in AutiSm Together (FEAST-US) survey; a national cross-sectional survey of caregivers of autistic children (ages 2 to 12 years) who present with feeding challenges in the United States. 427 caregiver responses to the FEAST-US are included in the analysis.
RESULTS: Descriptives from FEAST items related to early feeding challenges, independent feeding, family mealtime routines, caregiver strategies and responses, mealtime schedule and length, reported food and environmental sensitivities, diet variety, and progression of feeding challenges over time are presented. Sensory-based feeding challenges were the most common among the sample. Age caregivers reported onset of feeding challenges was significantly lower than the age of autism diagnosis. Multivariate linear regression identified early feeding challenges (e.g., difficulty with breast/bottle feeding, difficulty transitioning to baby foods, difficulty transitioning to table foods) and child continuing to restrict their diet over time were significant predictors of feeding challenge severity (FEAST Total Score) and classification of feeding challenges (sensory, behavior, oral motor, and health subscales).
CONCLUSIONS: This study demonstrates the complexity and variability of feeding challenges for autistic children, highlights the importance of attending to early feeding challenges, and emphasizes the need for comprehensive family-centered assessment and intervention for feeding challenges. Understanding the heterogeneous presentation of feeding challenges for autistic children as described by their caregivers can inform a holistic and family-engaged approach to feeding evaluation and intervention. Comprehensive characterization of the presentation of feeding challenges supports the central role of occupational therapy practitioners in family-centered feeding intervention.
References
Leader, G., Tuohy, E., Chen, J. L., Mannion, A., & Gilroy, S. P. (2020). Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(4), 1401–1410. https://doi.org/10.1007/s10803-019-04357-7
Bonsall, A., Thullen, M., Stevenson, B. L., & Sohl, K. (2021). Parental Feeding Concerns for Children With Autism Spectrum Disorder: A Family-Centered Analysis. OTJR: Occupation, Participation and Health, 41(3), 169–174. https://doi.org/10.1177/1539449220985906
St. John, B. M., Hladik, L., Novak, P., Gartland, S., & Ausderau, K. K. (2022). Assessment and treatment of Feeding challenges in children with autism. In S. Marcus & S. Breton, Infant and Child Feeding and Swallowing: Occupational Therapy Assessment and Intervention (2nd ed.). American Occupational Therapy Association, Incorporated.
Leader, G., Tuohy, E., Chen, J. L., Mannion, A., & Gilroy, S. P. (2020). Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(4), 1401–1410. https://doi.org/10.1007/s10803-019-04357-7
