using direct observation Examining the behavioral topography of home meals in families of children with autism spectrum disorder using direct observation Lauren O. Pollack MA1,2, Meredith L. Dreyer Gillette PhD1,3, Teresa Y.. Pan MA1,4, Susana R. Patton PhD, CDE1,5 1 Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri; 2University of Missouri-Kansas City, Clinical Psychology Program, Kansas City, Missouri; 3Children’s Mercy Kansas City, Kansas City, Missouri; 4University of Kansas, Clinical Psychology Program, Lawrence, Kansas; 5Department of Pediatrics, The University of Kansas Medical Center Background Past research has revealed parent-reported feeding problems in children with Autism Spectrum Disorder (ASD; Cermak, Curtin, & Bandini, 2010; Ledford & Gast, 2006), but little data on objectively measured family mealtime behaviors is available. Only two previous studies (Ahearn, Castine, Mault, & Green, 2001; Sharp, Jaquess, & Lukens, 2013) have published results on direct observation of eating behaviors of children with ASD in standardized laboratory settings. Data Analysis Paired sample t-tests were conducted to compare frequency of behaviors occurring during the meal halves. Results DINE Parent Mealtime Behaviors Meal Half 1 Mean (SD) Meal Half 2 t p Alpha Commands 2.30 (3.06) 3.05 (2.10) 0.79 .432 Beta Commands 4.30 (8.27) 4.55 (5.37) 0.27 .790 Coaxing 4.04 (4.97) 3.07 (5.71) 1.18 .242 Parent Talk 15.16 (11.87) 16.64 (12.71) 1.17 .248 Physical Prompts 2.10 (4.22) 2.04 (3.41) 0.10 .922 Reinforcement 0.59 (1.28) 0.95 (1.91) 1.47 .146 Results   DINE Child Mealtime Behaviors Meal Half 1 Mean (SD) Meal Half 2 t p Refuse Food 3.74 (5.16) 2.62 (3.46) 1.80 .076 Request Food 0.66 (1.73) 0.64 (1.52) 0.06 .951 Cry 0.29 (1.34) 0.16 (0.71) 0.80 .425 Child Talk 15.77 (14.30) 16.55 (14.42) 0.52 .604 Play 2.51 (0.87) 2.84 (0.98) 0.35 .729 Away 3.32 (7.87) 7.40 (14.69) 3.57 .001 Objective This study examined in-home mealtime behaviors in 73 families of young children with ASD and specifically how behaviors differ from the first to the second half of meals. Methods    Participants 73 children with ASD (M age= 5.36, range= 2.39-8.85) and their parent(s). Children were 76.7% male and 65.8% White. Measure 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: 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 Child mealtime behaviors: Refuse Food: Child lets parent know he/she does not want more food or complains about taste of food Request Food: Child asks for additional or new food Cry: Vocal distress that is not for food Child Talk: Vocalization or verbalization by child Play: Play with toys or use of food-related materials as play objects Away: Child is out of reach of main source of food Child eating behaviors: Bite: Taking of solid food into the mouth Sip: Bringing glass, cup, straw, or spoonful of liquid to the lips Spit-up: Child spits up, spits out, or purposely drops food from his/her mouth Feed: Parent attempts to put food in child’s mouth with no help from child Plate away: Child’s plate is moved out of reach Discussion Children showed more bites in the first half of the meal. Alternatively, in the second half, children were more likely to be away from their plates. Parents demonstrated consistent frequency of behaviors throughout the meal. Parents should be counseled to implement behavioral management techniques at the beginning of the meal (i.e., commands, verbal praise, ignoring) and consider terminating meals earlier if children are showing clear behavioral signs for being finished (e.g., away from the table). Future analyses will compare the topography of meals for families of children with ASD to the existing literature in families of same-age peers with cystic fibrosis or type 1 diabetes, two other pediatric conditions known to associate with parent-reported feeding problems. DINE Child Eating Behaviors Meal Half 1 Mean (SD) Meal Half 2 t p Bite 25.59 (20.99) 19.07 (10.81) 2.86 .005 Sip 2.14 (3.51) 3.04 (3.97) 1.52 .134 Spit-Up 0.34 (0.85) 0.36 (0.92) 0.10 .922 Feed 2.92 (9.37) 1.89 (5.88) 1.05 .297 Plate Away 0.29 (1.74) 0.66 (4.00) 0.76 .450 References Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified. Journal of autism and developmental disorders,31(5), 505-511. Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238-246. Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders a review. Focus on Autism and Other Developmental Disabilities, 21(3), 153-166. Sharp, W. G., Jaquess, D. L., & Lukens, C. T. (2013). Multi-method assessment of feeding problems among children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(1), 56-65. 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. 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: Lauren Pollack, M.A.; University of Missouri-Kansas City, Department of Psychology, 5030 Cherry St., Kansas City, MO 64110; laurenpollack@mail.umkc.edu