Cross-Cultural Adaptation, Validation, and Factor Analysis of a Persian Version of the Behavioral Pediatric Feeding Assessment Scale.

Objective: The aim of this study was to investigate the reliability and validity of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in children with neurodevelopmental disorders. Material and Methods: The reliability study was conducted by investigating the reliability of parallel forms and the internal consistency of the instrument. The criterion validity of BPFAS was examined by checking the correlations between the BPFAS and 'Children's Eating Behavior Questionnaire (CEBQ)' and 'Depression, Anxiety, Stress Scale'. Results: Cronbach's alpha internal consistency coefficients were acceptable for the subscales of the BPFAS (α>0.70). There were negative correlations between BPFAS and CEBQ subscales related to access to food, and positive correlations between BPFAS and CEBQ subscales related to food rejection (p<0.05). Positive correlations were found between emotional status of the parents and the frequency of the parent's problem behavior on one hand, as well as the frequency of poor strategy and the perception of the negative food behaviors of the child on the other hand (p=0.008; 0.034; 0.001, respectively). There was a correlation between children's weight and the increase in the frequency of negative feeding behaviors of the parents and the child (p=0.018; 0.043, respectively). Conclusion: It is concluded that the BPFAS can be used as a valid and reliable scale for children with neurodevelopmental disorders. The Turkish validity and reliability studies of the scale for different developmental disorders will make a significant contribution to the widening of its usage area.

Introduction: This study was planned to determine maternal attitudes' effect on behavioral pediatric feeding assessment in mothers with children aged 6-9 years. Methods: The sample consisted of 196 mothers with children aged 6-9 years. The Behavioral Pediatric Feeding Assessment Scale and the Hamel Maternal Attitude Scale were employed to assess behavioral pediatric feeding and maternal attitudes, respectively. Results: A significant correlation was found between the Behavioral Pediatric Feeding Assessment Scale total scores and the “authoritarian” subscale of the Hamel Maternal Attitude Scale. There were significant differences in the participants’ Behavioral Pediatric Feeding Assessment Scale scores in terms of children's ages and family types. Conclusion: As a result, it was determined that the mother's feeding behavior of her child is affected by both the factors related to her child, the environment in which she lives, and her own attitude.

The factor structure and validity of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; Crist & Napier-Phillips, 2001) were examined in preschoolers with autism spectrum disorder (ASD). Confirmatory factor analysis was used to examine the original BPFAS five-factor model, the fit of each latent variable, and a rival one-factor model. None of the models was adequate, thus a categorical exploratory factor analysis (CEFA) was conducted. Correlations were used to examine relations between the BPFAS and concurrent variables of interest. The CEFA identified an acceptable three-factor model. Correlational analyses indicated that feeding problems were positively related to parent-reported autism symptoms, behavior problems, sleep problems, and parenting stress, but largely unrelated to performance-based indices of autism symptom severity, language, and cognitive abilities, as well as child age. These results provide evidence supporting the use of the identified BPFAS three-factor model for samples of young children with ASD.

Neonatal feeding performance is related to feeding outcomes in childhood

Preschool feeding disorders are common and debilitating and are associated with a range of developmental and medical issues. Parent report allows assessment of feeding in a naturalistic environment over time, with advantages over time-limited, clinic-based observations. However, little is understood about the limitations and advantages of current parent-report measures. We aimed to systematically review the psychometrics and clinometrics of parent-administered feeding questionnaires. Five search engines were used to identify questionnaires that met inclusion criteria, i.e. being norm-or criterion-referenced, child focused, appropriate for preschool children, and measured two or more feeding domains (e.g. dysphagia/oral motor delay, food refusal). In total 3535 abstracts were identified and 215 full-text articles were evaluated. Five questionnaires met the criteria. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was the most reliable questionnaire identified, with good test-retest reliability and internal consistency. More predictive and concurrent validity data was available for the BPFAS, the Mealtime Behavior Questionnaire, and the Montreal Children's Hospital Feeding Scale than for other measures. Further research is needed on the psychometric properties of feeding questionnaires used in research and clinical practice. To date, the BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children.

Diet, growth, nutritional status and predictors of severity of feeding difficulties in autistic children with co-occurring pediatric feeding disorder

Feeding difficulties in Asian children with autism spectrum disorder

The Behavioural Paediatrics Feeding Assessment Scale (BPFAS) was commonly used to assess the children's feeding behaviours. Assessing behaviours is extremely beneficial in understanding the child's mental state and tracking further developmental aspects. This scale was available in the majority of languages; which is not available in Telugu, the language spoken by the Indian states of Andhra Pradesh and Telangana. However, cultural and lingual aspects should be considered when assessing certain aspects of children's behaviour. In this context the current study aimed to adapt the BPFAS scale into Telugu. This study included 380 parents of children with autism spectrum disorders (ASD). The children ranged in age from 1 to 8 years. Parents were instructed to fill out the questionnaire correctly. The obtained scores were examined using reliability, independent t test, and one way ANOVA. The results revealed a Cronbach's alpha of 0.729, indicating that the BPFS-Telugu is acceptable and can be used clinically. The independent t test revealed that there is a high significant difference between total scores, a significant difference between frequency scores, and no significant difference between problem scores. One-way ANOVA was used to compare severity, and the results show that there is a significant difference between total scores, a high significant difference between problem scores, and no significant difference between frequency scores. The independent test for frequency score revealed a highly significant difference between ASD children with and without behavioural problems, as well as problem scores. Overall, 55.5 % (frequency scores) and 55.1% (problem scores) of ASD children were identified with behavioural issues during feeding time. Finally, the authors stated that BPFAS in Telugu is clinically acceptable and can be used to assess for behavioural issues during feeding time.

Parents of children with a chronic illness that has a nutrition treatment component often report mealtime behavior problems. Although research suggests that parents of young children with type 1 diabetes mellitus (T1DM) perceive more mealtime behavior problems than parents of controls, no study has examined the pattern of mealtime behaviors reported by parents of children with T1DM. We examined parents' perceptions of mealtime behaviors of children with T1DM using the Behavioral Pediatric Feeding Assessment Scale (BPFAS). We hypothesized that parents of young children with T1DM would describe similar mealtime problems as has been found in families of children with clinical feeding problems. Data from 85 families of children with T1DM (mean = 5 +/- 1.5 years) were used. Factor analysis for children with T1DM identified a 6-factor solution. Four factors (child refusal, picky eater, stalling, food texture) were similar to factors identified in children with clinical feeding problems. Two unique factors, reflecting strict dietary requirements and intense disruptive behavior, were identified for children with T1DM. Consistent with our hypothesis, we conclude that patterns of mealtime behaviors appear similar for children with T1DM and children with clinical feeding problems. However, for young children with T1DM, unique problems exist, related to a strict feeding schedule consistent with the diabetes diet. Within routine diabetes care, the BPFAS is a valid and clinically useful tool to assess dietary adherence and mealtime behaviors in children. Monitoring via the BPFAS can identify families in need of behavioral interventions to improve mealtime functioning.

To identify the tools used to assess eating behaviors in individuals with Autism Spectrum Disorder (ASD) and summarize their distribution, citation rates, journal publication, JCR scores, and psychometric properties. A literature review was conducted to identify studies on eating behavior in individuals with ASD. The search included various descriptors and combinations of keywords in databases such as Medline/PubMed, Science Direct, Scopus, SciELO, and Web of Science. The studies were filtered to focus on articles published in the last five years. Thirty-seven relevant studies were identified and analyzed to summarize the tools used, their distribution in the literature, citation rates, and psychometric properties. Thirty-seven relevant studies were identified. The Journal of Autism and Developmental Disorders published the most studies (5). The Brief Autism Mealtime Behavior Inventory (BAMBI) was the most frequently used instrument, appearing in 15 studies, followed by the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in 8 studies. Both instruments demonstrated solid psychometric properties, with BAMBI showing good internal consistency (α = 0.88) and BPFAS a Cronbach's alpha of 0.82. Most of the instruments used in studies on eating behavior in individuals with ASD demonstrate satisfactory psychometric properties. BAMBI and BPFAS stand out for their widespread use but are limited to covering only specific age ranges.

ABSTRACTThis study compared the problem‐solving strategies among 20 mothers whose infants were diagnosed with a feeding disorder against 20 matched controls. The mothers from the two groups were matched for age and level of education. All mothers completed two questionnaires: the Behavioral Pediatric Feeding Assessment Scale and the Parenting Stress Index (R.R. Abidin, 1990). To measure maternal problem‐solving skill, the Parent Means‐End Problem‐Solving Instrument (D.M. Bryant &amp; B.H. Wasik, 1994) was administered. As expected, statistically significant differences were related to the number and frequency of feeding problems reported and difficulties with mealtime management. Furthermore, mothers of children with a diagnosed feeding disorder demonstrated fewer problem‐solving skills and made use of more “high‐control solutions” (e.g., forcing the child to comply or punishing the child). In contrast, parents of children without feeding disorders preferred to implement more indirect problem‐solving strategies (e.g., planning to remove the child from the situation). Mounting evidence has suggested that difficulties in parenting a child with a diagnosed nonorganic feeding disorder stem from both child‐ and parent‐related factors. The current study provides tentative early evidence for the role of maternal high‐controlling problem‐solving strategies in a small sample of children diagnosed with this disorder.

To examine the emergence and trajectory of feeding difficulties in young children who are later diagnosed with autism spectrum disorder (ASD). The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was administered to a sample of 93 toddlers with an older sibling with ASD-the high-risk group-and 62 toddlers with no known familial ASD-the low-risk group-as part of a larger infant sibling study. The BPFAS was completed by parents at 15, 18, 24, and 36 months of age. At 36 months, participants underwent a diagnostic assessment and were classified into 1 of the following 4 outcome groups: ASD, nontypical development, high-risk typically developing, and low-risk typically developing. The BPFAS was scored for total frequency of feeding difficulties and autism-specific factor scores previously described in the literature. The frequency of feeding difficulties increased significantly more rapidly in the ASD group between 15 and 36 months of age, and by 36 months, they exhibited a significantly higher total frequency score than all other groups. Analysis of the factor scores revealed a similar pattern for the food acceptance and mealtime behavior domains but no significant differences in the medical/oral motor domain. Feeding difficulties develop significantly more rapidly in children with ASD, with longitudinal monitoring revealing the steeper trajectory earlier than can be detected with cross-sectional analysis. Children with ASD are at risk of health and social consequences of poor feeding behavior that may potentially be minimized if addressed early and appropriately.

Introduction: Children and adolescents with autism spectrum disorder (ASD) often present sleep and eating problems. However, the relationship between these two factors has seldom been studied. Objective: This paper aimed to examine the association between sleep disturbances and feeding problems in children and adolescents with ASD. Methods: This cross-sectional observational study assessed feeding behaviors using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and assessed sleep problems with the Sleep Disturbance Scale for Children (Bruni scale). Bivariate analyses and multivariate logistic and linear regression analyses were performed. Results: Sleep disturbances were significantly associated with autism severity (p = 0.003), but not with BPFAS subscale scores. Multivariate logistic regression indicated that sleep disturbances were independently associated with autism severity (p = 0.01; OR = 0.23; 95% CI: 0.06–0.77) and the BPFAS frequency subscale score (p = 0.01; OR = 1.04; 95% CI: 1.01–1.07). A secondary logistic regression identified five BPFAS items significantly associated with sleep disturbances: difficulty chewing (p = 0.02, OR = 0.12, 95% CI 0.02–0.74), voluntary attendance at meals (p = 0.01, OR = 0.60, 95% CI 0.39–0.90), tantrums during meals (p < 0.001; OR = 2.08, 95% CI 1.21–3.56), poor appetite (p < 0.001; OR = 2.63, 95% CI 1.43–4.82), and the caregiver’s perception that the child’s eating habits negatively affected their health (p = 0.03; OR = 1.53, 95% CI 1.03–2.40). No significant associations were found with age, sex, medical comorbidities, behavioral disorders or genetic factors. Conclusions: The findings suggest that greater autism severity and more pronounced feeding behaviors are independently associated with an increased risk of sleep disturbances in children and adolescents with ASD. Specific maladaptive mealtime behaviors, such as poor appetite, tantrums, and chewing difficulties, may serve as predictors of sleep problems, highlighting the need for integrated screening and early intervention strategies.

The current study presents results of an exploratory factor analysis (EFA) of the Behavioral Pediatric Feeding Assessment Scale (BPFAS) in a sample of rural children with overweight and obesity. Relationships between mealtime behavior and health outcomes are also explored. EFA was used to assess the fit of the BPFAS in a group of 160 treatment-seeking children (Mage = 9.11, SD = 1.77) living in rural Midwest communities. Correlations were also computed between factor scores and select health variables (child body mass index z-score and diet variables). The EFA identified a 5-factor solution as the best fitting model (Tucker-Lewis Index = .96, root mean square error of approximation = .05), although several items (i.e., 7 of 25) did not load on any factor. 2 factors were correlated with health variables of interest. Study results suggest that certain items on the BPFAS may not be appropriate for use with rural children with pediatric overweight or obesity. Implications for future research and practice are discussed.

The aim of this study was to define swallowing and feeding-related problems among typically developing children aged between 2 and 6 years. The presence of food selectivity, limited appetite, chewing dysfunction, and dysphagia signs was questioned and scored as "absent" or "present" according to parent report. Children were divided into 2 groups: children with swallowing and feeding disorders and children without swallowing and feeding disorders. The Turkish version of the Behavioral Pediatrics Feeding Assessment Scale (T-BPFAS) was used to evaluate feeding behaviors of children, and Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact on caregivers. A total of 234 children were included. Food selectivity was defined in 62.4% (n = 146), limited appetite in 26.9% (n = 63), and chewing dysfunction in 7.3% (n = 17). The most common dysphagia-related sign was coughing. There were significant differences between groups in terms of both T-BPFAS and T-FS-IS (P < .001). In conclusion, children with typical development have experienced a wide range of swallowing and feeding-related problems, which have an impact on mothers' perceptions regarding feeding and their quality of life.