1. Results Correlations of Parent Self-Reported Mealtime Behaviors and HEI-2010 PMAS dimension of Daily Fruit and Vegetable Availability was associated with greater HEI-2010 score (r=.428, p=.010). This relationship held with each item within the subscale, such that greater HEI- 2010 score was associated with: “You gave the child fruit each day” (r=.383, p=.023) “You ate fruit each day” (r=.335, p=.049) “You ate vegetables each day” (p=.357, p=.035) Parent Self-Reported and Observed Mealtime Behaviors Related to Healthier Eating Teresa Y. Pan MA 1,2, Meredith Dreyer Gillette PhD 1,3, Susana R. Patton PhD, CDE 1,4 1 Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri; 2 University of Kansas, Clinical Psychology Program, Lawrence, Kansas; 3 Children’s Mercy Kansas City, Kansas City, Missouri; 4 Department of Pediatrics, The University of Kansas Medical Center Background Children with Autism Spectrum Disorder (ASD) exhibit more problems with mealtime behavior and specific food preferences than typically developing peers (Provost et al., 2010). Food selectivity can relate to poor nutrition in children with ASD. As such, diet quality and food variety are common reasons for referral for nutritional services (Bowers, 2002; Cornish, 1998; Herndon, 2009). Prior research has used parent-reported mealtime behaviors; however, direct observation of parent behavior during mealtimes could better inform future feeding interventions. Discussion In children with ASD, parent self-reported behaviors of providing availability of fruits to the child, and parent eating of fruits and vegetables are related to healthier eating. Additionally, observed parent behaviors of greater number of total and interrupted commands and reinforcement during a meal are related to healthier eating. Treatments should focus on improving eating habits of the whole family and increasing interaction between parent and child during mealtimes. Some specific strategies that may be effective could include positive reinforcement when a child takes bites of new foods and increasing the availability of fruits and vegetables. Consistent with existing research showing that children with ASD can benefit from parent modeling (Ingersoll, Lewis, & Kroman, 2007; Stone, Ousley & Littleford, 1997), behavioral interventions should instruct parents on how to model eating new foods and eating fruits and vegetables and how to encourage child imitation of these behaviors in order to help children with ASD eat more healthfully. Acknowledgments The authors wish to thank the parents and children who participated in our study and contributed the data for the current analyses. We would like to also like to acknowledge funding from the National Institutes of Health R21 HD076116 (to S.R.P.). For more information contact: Teresa Y Pan, M.A.; University of Kansas, Department of Psychology, 1415 Jayhawk Blvd, Lawrence, KS 66045; typan@ku.edu Methods Participants 35 children with ASD (Mage= 5.77) and their parents. Children were 71.4% male and 54.3% White. Measures Healthy Eating Index (HEI-2010): A measure of diet quality based on the U.S. Dietary Guidelines for Americans. The total HEI-2010 score is based on a sum of the component scores data taken from a three day diet record that parents were asked to complete. HEI-2010 scores have a maximum of 100 points. Component scores include Total Fruit, Whole Fruit, Total Vegetables, Greens and Beans, Whole Grains, Dairy, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids, Refined Grains, Sodium, and Empty Calories. Parent Mealtime Action Scale (PMAS): A 31-item self-rating scale in which parents rated frequency that they engage in a variety of mealtime and food related behaviors. Subscales scores include Snack Limits, use of Positive Persuasion, Daily Fruit and Vegetable Availability, Insistence on Eating, Snack Modeling, Special Meals, Fat Reduction, and Many Food Choices. Dyadic Interaction Nomenclature for Eating (DINE): A behavioral coding system for mealtime behaviors, including child eating behaviors, child behaviors, and parent behaviors (Stark et al, 1995). Parent mealtime behaviors were recorded and included : Parent Alpha Commands: Parent orders/suggestions to eat Beta Commands: Parent orders/suggestions to eat with no opportunity for compliance (interrupted commands) Coaxing: Offers of food, evaluation of food, coaching Physical Prompts: Physical action by parent to assist or indicate to child to eat/drink Reinforcement: Positive verbal or physical behavior by parent following child’s eating/drinking References Bowers L. An audit of referrals of children with autistic spectrum disorder to the dietetic service. J Hum Nutr Diet. 2002;15:141- 144. Cornish E. A balanced approach towards healthy eating in autism. J Hum Nutr Diet. 1998;11:501–509. Herndon AC, DiGuiseppi C, Johnson SL, Leiferman J, Reynolds A. Does nutritional intake differ between children with autism spectrum disorders and children with typical development? J Autism Dev Disord. 2009;39:212–222. Ingersoll, B., Lewis, E., & Kroman, E. (2007). Teaching the imitation and spontaneous use of descriptive gestures in young children with autism using a naturalistic behavioral intervention. Journal of Autism and Developmental Disorders, 37(8), 1446-1456. Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children: Comparison of children with autism spectrum disorder and children with typical development. Physical and Occupational Therapy in Pediatrics, 30, 220- 233. Stark, L. J., Jelalian, E., Mulvihill, M. M., Powers, S. W., Bowen, A. M., Spieth, L. E.,... Hovell, M. F. (1995). Eating in preschool children with cystic fibrosis and health peers: Behavioral analysis. Pediatrics, 95, 210-215. Stone, W. L., Ousley, O. Y., & Littleford, C. D. (1997). Motor imitation in young children with autism: What's the object?. Journal of abnormal child psychology, 25(6), 475-485. Data Analysis Pearson correlations were used to evaluate the association between HEI-2010 scores, PMAS dimensions, and DINE parent behaviors. Objective This study evaluated whether self-reported and observed parent mealtime behaviors are associated with an index of healthy eating. Parent Mealtime Action Scale Subscales HEI-2010 Score r Snack Limits.117 Positive Persuasion-.165 Daily Fruit & Veg Availability.428* Use of Rewards.011 Insistence on Eating.080 Snack Modeling-.164 Special Meals-.118 Fat Reduction.195 Many Food Choices.095 *p <.05 Results Correlations of DINE Parenting Behaviors and HEI-2010 Several DINE parent behaviors were associated with greater HEI-2010 score: Beta (interrupted) commands (r=.407, p=.015) Reinforcement (r=.354, p=.037) Total commands (r=.365, p=.031). DINE Parenting Behaviors HEI-2010 Score r Alpha Commands.176 Beta Commands.407* Coaxing.266 Physical Prompts.194 Reinforcement.354* Total Commands.365*