1. 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= ) 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),
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),
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),
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),
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,
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 HD (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;