Investigating the impact of autistic children's feeding difficulties on caregivers

Abstract

Introduction Many autistic children and their families experience difficulties around mealtimes possibly arising from a range of child-related characteristics and environmental factors. Autistic children's sensory profiles can contribute to their feeding difficulties and they are more likely to have a limited range of foods with fewer fruits and vegetables and higher carbohydrates in their diet. Reduced dietary variety, food neophobia, rigidity around eating and need for sameness has been positively correlated with the diagnostic criteria of restricted and repetitive patterns of behaviours, interests, or activities. However it is important to understand the impact of these feeding difficulties on mealtime participation and on caregivers. This study aimed to investigate the influence of children's autism characteristics, sensory profiles, and feeding difficulties on caregiver-reported impact at mealtimes. Material and Methods Participants were 80 children (5-12 years) with a diagnosis of Autism Spectrum Disorder and their caregivers. Caregivers completed an online survey including examining demographic characteristics, and a range of standardized parent reported tools examining (a) their children's autism characteristics (Social Communication Questionnaire; SCQ), (b) their children's sensory needs (Sensory Profile 2-short form), (c) their children's feeding difficulties (Behavioural Paediatrics Feeding Assessment Scale; BPFAS), and (d) caregiver-reported impact (Feeding-Swallowing Impact Survey; FS-IS). Results Of the caregivers who completed the survey, 96.3% (n = 79) were the child's mother; 86.3% (n = 69) of children were male with 83.8% (n = 67) with co-occurring diagnoses. 68.8% (n = 55) of children had clinically significant feeding difficulties using the BPFAS. Children with clinically significant feeding difficulties had higher levels of caregiver-reported impact related to daily activities, worry and feeding difficulties in comparison to children without clinically significant feeding difficulties (FS-IS; U = 257.000, z = -4.471,p < 0.01;). Spearman's rank correlation showed a statistically significant, moderate correlation between BPFAS total frequency score and FS-IS Daily activities score, rs (98) = 0.56, p < 0.01 indicating that as the frequency of feeding difficulties increased, the impact of these feeding difficulties on caregivers also increased. Using multiple regression, a model comprising the three child-related factors was statistically significant (F(1,78) = 87.75,p < 0.001,adj.R2 = 0.52), with children's feeding difficulties being the strongest predictor with a moderate effect size (0.49).Discussion/Conclusion Autistic children's feeding difficulties had a greater impact on caregivers than autism or sensory profiles, with frequency of feeding difficulties and the caregiver impact of these feeding difficulties positively correlated. The findings demonstrate that efforts to understand and address feeding difficulties in autistic children must extend beyond the children to include their families.