Mealtime Behavior Research Articles

A Double-Blind Randomised Controlled Trial of Prebiotic Supplementation in Children with Autism: Effects on Parental Quality of Life, Child Behaviour, Gastrointestinal Symptoms, and the Microbiome.

Modifying gut bacteria in children with autism may influence behaviour, with potential to improve family functioning. We conducted a randomised controlled trial to assess the effect of prebiotics on behaviour, gastrointestinal symptoms and downstream effects on parental quality of life. Children with autism (4-10yrs) were randomised to 2.4g/d of prebiotic (GOS) or placebo for six weeks. Pre and post stools samples were collected, and validated questionnaires used to measure change in social and mealtime behaviours, GI symptoms and pQOL. Linear mixed models evaluated group differences for behavioural variables, and Mann Whitney U tests were used to compare change between-groups for GI symptoms, differential abundance of genera and alpha diversity of the microbiome. Thirty-three parent-child dyads completed the trial. No group difference was seen for behavioural variables but both groups improved significantly from baseline. There was a medium effect size between groups for GI symptoms (d = 0.47) and pQOL (d = 0.44) driven by greater improvements in the prebiotic group. Bifidobacterium increased threefold following prebiotics (1.4-5.9%, p < 0.001) with no change in controls. Supplements were well tolerated, compliance with dose 94%. Prebiotics modify levels of Bifidobacterium and prove well tolerated but in this instance, resulted in only marginal effects on GI symptoms and pQOL. A larger sample of children with more severe symptoms could help to determine the potential of prebiotics in autism. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000615189 .

The buffet challenge: a behavioral assessment of eating behavior in adolescents with an eating disorder

ObjectiveEating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder.MethodWe recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded.ResultsAll adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented.ConclusionsOur initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

Functional analysis screening for inappropriate mealtime behavior

AbstractInappropriate mealtime behavior (IMB) is a class of food refusal behavior that is commonly observed in children with neurodevelopmental disorders or avoidant/restrictive food intake disorder. An abundance of research has demonstrated that IMB is commonly maintained by negative reinforcement in the form of escape from food or drink presentation. Given the common association between IMB and escape as a reinforcer, more efficient methods of conducting functional analyses have been called for. The present study examined the extent to which indirect assessments and a functional analysis screening process reliably predicted an escape function in three children with autism spectrum disorder who engaged in IMB. The results of the two assessments were then compared to a standard functional analysis. For all participants, the functional analysis identified an escape function, which corresponded with both the indirect assessment and screening. Additionally, within‐session analyses of screening sessions further validated the screening process. The functional analysis screening of IMB is discussed in terms of its efficiency, practicality, and experimental design. The results of this study offer a framework for efficiently assessing the function of IMB, while providing recommendations for future research.

Advancing assessment of responsive feeding environments and practices in child care.

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

FOOD INTAKE WAS TEMPORALLY ASSOCIATED WITH STAFF MEALTIME CARE APPROACHES AND BEHAVIORS OF RESIDENTS WITH DEMENTIA

Abstract Nursing home residents with dementia commonly experience low food intake, resulting in functional and nutritional consequences. Prior work supports associative relationships of resident behaviors and staff approaches with food intake, yet research on temporal relationships is limited. This study examined temporal associations of resident behaviors and staff approaches with food intake. Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analysis was conducted for resident behaviors and staff approaches as antecedents of resident successful food intakes in 5-, 10-, and 15-second time windows. Increased resident-initiated food intake was associated with preceding resident positive verbal behaviors, but not other resident behaviors or staff approaches. Decreased resident-initiated food intake was associated with preceding resident functional impairments and resistive behaviors, but not other behaviors or approaches. Increased staff-initiated food intake was associated with preceding staff person-centered verbal approaches, but not resident behaviors or other staff approaches. Decreased staff-initiated food intake was associated with preceding resident positive/neutral nonverbal behaviors and functional impairments, and staff task-centered care approaches. Findings confirm the importance of certain strategies in promoting food intake, including facilitating resident positive verbal communication, supporting functional impairments, responding to resistive behaviors, maximizing the use of person-centered care, and minimizing the use of task-centered care. Resident positive/neutral nonverbal behaviors which reflect resident active engagement during mealtime, do not facilitate staff-initiated food intake and may be an indicator of resident independence and readiness to initiate food intake. Further investigation is needed using larger diverse samples.

DEVELOPMENT AND VALIDATION OF PERSON-CENTERED MEALTIME CARE KNOWLEDGE AND SELF-EFFICACY ASSESSMENTS

Abstract Person-centered mealtime care is individually tailored and directly delivered care that engages individuals in mealtime activities and addresses their needs and preferences. Person-centered mealtime care is associated with positive mealtime behaviors and outcomes in older adults with dementia. Existing tools that assess caregiver knowledge and self-efficacy of mealtime care have low psychometric quality, and few tools focus on person-centered mealtime care. This study developed and tested the Person-Centered Mealtime Care Knowledge and Self-Efficacy Assessments. The 20-item Knowledge Assessment (total score = 0-20, higher score = better knowledge) and 15-item Self-Efficacy Assessment (items are scored from 1 = strongly disagree to 5 = strongly agree; total score = 15 - 75; higher score = better self-efficacy) were developed based on literature and expert reviews and finalized based on content validity. Seventy-two nursing home direct care staff (n=72, age = 45±12.1 years; 8.5% male; 12.3% non-white; 93% provided dementia mealtime care; 89% experienced challenges during mealtime) completed the assessments. The two assessments showed adequate content validity (Scale-CVI = 0.95-1.00; item-CVI = 0.83-1.00) and acceptable-to-good internal consistency (Cronbach’s Alpha = .651 and .984 for Knowledge and Self-Efficacy Assessments, respectively). There was a weak and significant correlation between Knowledge and Self-Efficacy Assessments (rs = .262, p = .026). Findings provide preliminary psychometric evidence of the two assessments to measure caregivers’ knowledge and self-efficacy in providing person-centered mealtime care. Future validity testing and item-level testing using Item Response Theory is needed among larger populations of diverse caregivers to accumulate rigorous psychometric evidence.

The influence of food sensory properties on eating behaviours in children with Down syndrome

Developing new food products for children is challenging, particularly in vulnerable groups including children with Down syndrome (DS). Focusing on children with DS, the aim of this study was to study the influence of parent liking on acceptance of food products by children with DS and demonstrate the influence of food sensory properties on indicators of food acceptance, food rejection, and challenging eating behaviours. Children (ages 1158 months) with DS (n = 111) participated in a home use test evaluating snack products with varying sensory properties as profiled by a trained sensory panel. Parents recorded their children’s reactions to each food product; trained coders coded videos for eating behaviours. To understand the influence of each sensory modality on eating behaviour, ordered probit regression models were run. Results found a significant correlation between the parent liking and overall child disposition to the food (p < 0.05). From the regression analysis, the inclusion of all food sensory properties, including texture, flavour, taste, product shape and size, improved the percentage of variance explained in child mealtime behaviours and overall disposition over the base model (containing no sensory modalities), with texture having the largest influence. Overstuffing the mouth, a challenging eating behaviour, was most influenced by product texture (children ≥ 30 months), and product texture and size (children < 30 months). In both age groups, coughing/choking/gagging was most influenced by food texture and was associated with a product that was grainy and angular (sharp corners). In both age groups, product acceptance was associated with a product that was dissolvable, crispy, and savoury while rejection was associated with a dense, gummy and fruity product. These results suggest that a dissolvable, crispy texture, with a cheesy or buttery flavour are the sensory properties important in a desirable flavoured commercial snack product for children with DS; however, overall disposition must be balanced against mouth overstuffing.

Parental Feeding Style, Parenting Stress, and Child Mealtime Behaviors in Cystic Fibrosis.

Nutrition and weight gain significantly contribute to overall health outcomes in children with cystic fibrosis (CF). Strong emphasis is placed on these entities by the CF team, which can cause stress for parents and impact parent and child mealtime behaviors. The current study sought to investigate the relationship between parental feeding style, parenting stress, and parent and child mealtime behaviors in families of children with CF. Forty-five parents of a child with CF between the ages of 2 and 10 years were recruited during a CF clinic appointment. They completed surveys assessing child mealtime behaviors, parental feeding style, and parental stress. Medical data including body mass index (BMI) were collected from the medical record. There was a significant difference in behavioral feeding scores based on feeding style (F3,41 = 13.48, p<.001), with authoritarian parents reporting significantly greater mealtime behavior problems than all other parents. There was also a significant difference in parenting stress based on parental feeding style (F3,41=4.11, p<.05), with authoritarian parents showing more stress than authoritative parents (Mdiff=23.70, p<.05). Correlation analyses showed a positive relationship between behavioral feeding problems and parent stress, r(45)=0.403; p<.01. Data suggest parents using an authoritarian feeding style experience more stress and behavioral feeding problems than other parents. More feeding problems were also associated with more stress. Findings help determine how pediatric psychologists can intervene to support positive parenting behaviors that reduce children's mealtime behavior problems and parental stress, thus improving health outcomes in this vulnerable population.

Eating and Sensory Features of Children With Autism Spectrum Disorder and Their Typically Developing Peers.

Impaired sensory processing is associated with eating problems. There seem to be no previous studies that compare those who have autism spectrum disorder (ASD) with eating problems (ASD-W) and those with ASD without eating problems (ASD-WO) with typically developing (TD) groups. Comparisons are expected to provide further knowledge to guide the intervention programs. To investigate differences among ASD-W, ASD-WO, and TD groups in eating and sensory features; to detect associations between sensory and eating behaviors and any most involved sensory dimensions; and to search for age-related differences in sensory and eating features in ASD. Nonrandomized comparison study. Questionnaires administered as parent interviews. A total of 165 children were recruited: 117 with ASD and 48 TD children. Standardized questionnaires: the Brief Autism Mealtime Behaviors Inventory for eating problems; the Short Sensory Profile and the Sensory Experience Questionnaire for sensory problems. The ASD-W group showed generalized, impaired eating behaviors and turned out to be the most impaired with regard to sensory responsiveness. No differences in feeding behaviors were found between the ASD-WO and TD groups. All children with ASD showed sensory hyper- or hyporesponsiveness. Four main sensory dimensions were found to be associated with eating behaviors in ASD. No age differences were found in the eating and sensory behaviors of children with ASD. Differing eating and sensory profiles were found between the ASD and TD groups, especially in children with ASD-W. Early eating interventions using sensory stimulations are strongly recommended. What This Article Adds: This study reports novel information derived from the comparisons of children with ASD with eating problems and those with ASD without eating problems with typically developing groups of children.

Eating and Mealtime Behaviors in Vietnamese Children with Autism Spectrum Disorder: A Study Using the Brief Autism Mealtime Behaviors Inventory

Background: There has been an increase in the number of children with autism spectrum disorder (ASD), in whom problems with eating behaviors are often present. The use of a standardized questionnaire to assess the eating behaviors of children with ASD in Vietnam has not been paid due attention. Objective: This study aims to assess eating behaviors in children with ASD aged 3-11 years using the Brief Autism Mealtime Behaviors Inventory (BAMBI), thereby providing additional evidence to inform interventions in ASD children in Vietnam. Methods: An online survey using the BAMBI was conducted with parents of 85 children with ASD and parents of 175 typically developing (TD) children between April 2020 and April 2021. Results: The study revealed a higher risk of eating behavior problems among children with ASD compared to TD children (p &lt; 0.0001). The differences between the two groups were statistically significant in 17 out of 18 items of the BAMBI. The study results also point out that in autistic children, the scores of 4/8 behaviors in the “limited variety” group were highest, which exceeded three points, while none of the behaviors relating to “food refusal” or “features of autism” reached three points. Conclusion: Future studies using direct observations with larger samples are needed to further investigate eating disorders among children with ASD.

The Impact of Homestyles-2 Nutrition Education Curriculum on Family Mealtime Behaviors, Supports, and Perceptions of Parents/Caregivers of Children Ages 6 to 11

The Impact of Homestyles-2 Nutrition Education Curriculum on Family Mealtime Behaviors, Supports, and Perceptions of Parents/Caregivers of Children Ages 6 to 11

Food Selectivity in Children with Autism Spectrum Disorder: A Statistical Analysis in Southern Italy.

This paper focuses on autism spectrum disorder (ASD) and food selectivity, both of which are prevalent in the pediatric population. In this context, the authors paid attention to food selectivity and its possible correlation with the atypicality of sensory processes, outlining the useful rehabilitation treatments to draw on. This research included the parents or caregivers of pediatric patients diagnosed with autism spectrum disorder and placed within a therapeutic clinic. The sample is composed of 111 children, males and females, aged between 2 and 10 years, and includes 60 children diagnosed with autism and 51 children with normotypical development, similar in characteristics but without the disorder. The standardized questionnaire, "Brief Autism Mealtime Behavior Inventory", was developed to examine behavior during meals, especially in children with ASD. The "Brief Sensory Profile", and the "Child Oral and Motor Proficiency Scale", were also administered. The results obtained from the analysis lead to evidence of eating and food selectivity difficulty. Additionally, our study demonstrates that food selectivity can be caused by extreme sensory modulation and sensory problems related to the smell, texture, color, and temperature of food. In fact, the results obtained emphasize the correlation between food selectivity and the sensory domains of taste and smell. Furthermore, this research highlights a correlation between motor skills and eating skills, particularly regarding food selectivity, which is closely associated with atypical and disruptive behaviors during meals.

Convenience Over Nutrition for Recreation League Youth Sport Team Snack and Mealtime Choices

Fifty-six percent of school-aged children participate in team sports, yet there is limited evidence on how participation in youth sports impacts the dietary behaviors of participants and their families. Our team surveyed parents and caregivers of children participating in recreation league youth sports (n = 178) to assess the foods and beverages offered as team snacks and factors that influence team snack choices. Juice was the most popular beverage, and crackers were the most popular snack reported by parents. Convenience, followed by cost and child preference, were the most frequently reported factors influencing team snack choices. Survey items also included factors that influence mealtime behaviors on game and practice days. Convenience, followed by nutrition and taste, were most frequently reported as factors that influenced mealtime behaviors. Almost half of parents said their family’s eating habits changed as a result of recreational youth sports activities, and more than half said their family often or always eats dinner outside of the home on game and practice days. Professionals who work with this age group and their parents, including extension agents, can tailor education to encourage healthy team snacks and promote strategies to make healthy meals accessible on evenings with youth sports.

A Scoping Review of Tools to Assess Diet in Children and Adolescents with Autism Spectrum Disorder.

Eating is considered one of the activities of daily living most affected by autism spectrum disorder (ASD) in children and adolescents and, therefore, needs to be thoroughly assessed using specific tools. The aim of this scoping review was to describe the most widely used tool to assess diet in children and adolescents with ASD. A search was conducted on PubMed, Scopus, EMBASE, Web of Science and PsycINFO databases. Two authors screened the articles and included all randomized or non-randomized studies published in English or Spanish in the last five years in which the diet of children and adolescents with ASD was assessed. Fifteen studies were included in this review. Mealtime behaviour was the most assessed variable in the included studies (n = 7). Thirteen different assessment tools were identified to evaluate the diet of children and adolescents with ASD, mainly at ages 2-12 (n = 11). The Brief Assessment scale for Mealtime Behavior in Children (BAMBI) and 24-h recalls were the most commonly used dietary assessment tools in the included studies. Our results can help professionals in the selection of an optimal scale to assess diet in children and adolescents with ASD.

Further examination of behavior during extinction‐based treatment of pediatric food refusal

AbstractResearchers have demonstrated the effectiveness of extinction‐based treatments to reduce challenging behavior. Although bursts and temporary increases in emotional responding may occur in some basic and applied studies, recent studies on their prevalence have shown that side effects are far from ubiquitous. Woods and Borrero (2019) determined that bursts of inappropriate mealtime behavior and increases in emotional responding occurred in 30% of data sets during extinction‐based treatment of pediatric feeding difficulties. In the current study, we conducted a retrospective consecutive‐controlled case series by evaluating treatment graphs of inappropriate mealtime behavior, negative vocalizations, active acceptance, and mouth clean for 60 children admitted to an intensive day‐treatment feeding disorders program. We discuss the implications of these findings and provide general recommendations for the use of extinction‐based treatment.

Weight Status, Dietary Intake, and Mealtime Behaviour Among Autism Spectrum Disorder Children in Klang Valley, Malaysia

Introduction: Nutrition is one of the important contributors to the well-being of children with disability. Given the various data on the nutritional status of autism spectrum disorder (ASD) children, it is imperative to conduct a detailed nutritional assessment of the local population. This study compares ASD with typical developing (TD) children to determine the weight status and association of mealtime behavior with dietary intake in Klang Valley, Malaysia. Methods: A total of 106 children aged five to nine years old participated in this cross-sectional study. Sociodemographic were assessed through self-administered questionnaires. The body weight and height were collected; the body mass index (BMI) was calculated. A three-day food record and a Brief Autism Mealtime Behavior Inventory (BAMBI) data were obtained from the caretakers. Results: More than one-third (39%) of the ASD children were overweight or obese compared to TD children (23%). However, there is a significant difference (X2=10.29, p=0.03) when TD children were categorized as stunted and severely stunted. Meanwhile, the total energy intake was statistically significant (X2=9.53, p=0.008). The majority (88.2%) of ASD children experience problems in mealtime behavior characteristically limited food acceptance with a mean score of (28.78±6.80). Mealtime behavior was not associated with energy, carbohydrate, protein, and fat when the p&gt;0.05. Conclusion: Even though there was no association of mealtime behavior with dietary intake, the BMI was significantly influenced by excessive daily calorie consumption. Because of growth parameters influence physical development, nutritional intervention program should be carried out in order to improve nutritional status of AS children.

Feeding behaviours in infancy of children later diagnosed with autism spectrum disorder

Background: Autism spectrum disorder, the fastest growing childhood neurodevelopmental diagnosis, shows good outcomes with early intervention. The search for behavioral early markers is an important area of research. Studies of breastfeeding and weaning behaviours in autism have reported characteristic patterns which could be early indicators of this condition. Methods: The study was a cross sectional survey of breastfeeding and weaning patterns during the first year of life in 50 children aged 15 months to 5 years, including 25 with ASD and 25 Neurotypical children. A semi-structured interview schedule and the brief assessment of mealtime behavior in children scale was used to elicit feeding history from their mothers. Data was analysed using descriptive statistics and tests of significance. Results: There were significant differences in the patterns of early feeding of children with ASD, compared to the NT children. 64% ASD children showed dysregulated vigorous sucking during breastfeeding, without knowing when to stop. 52% of them breast fed for more than 40 minutes per feed. 68% continued to breastfeed beyond the age of 2 years. A significant proportion of ASD children also showed weaning difficulties such as limited variety (40%), food refusal (36%) and disruptive mealtime behaviour (32%). Conclusions: Children with ASD show significantly more challenging breastfeeding and weaning behaviours in infancy, compared to NT children. These patterns could be identified by parents and health workers in early child development as possible early signs of ASD and prompt referral for further diagnostic evaluation.

The Efficacy of the Global Intensive Feeding Therapy on Feeding and Swallowing Abilities in Children with Autism Spectrum Disorder: A Pilot Study.

The present investigation aims to explore the efficacy of Global Intensive Feeding Therapy (GIFT) on feeding and swallowing abilities in children with autism spectrum disorder (ASD). GIFT was developed as an intensive rehabilitation approach, divided into 30 sessions for 2 weeks, three times a day. GIFT focused on (a) encouraging desensitization; (b) widening the food repertoire (in terms of both variety and quantity); (c) reducing inappropriate mealtime behaviors; and (d) encouraging the development of appropriate chewing and swallowing abilities. GIFT was preliminarily implemented among 11 children with a diagnosis of ASD. To measure the efficacy of GIFT, the Karaduman Chewing Performance Scale (KCPS), the Brief Autism Mealtime Behavior Inventory (BAMBI), and food repertoire were investigated using Wilcoxon signed-rank test in three different times: baseline (T1), after treatment (T2), and one month after treatment (T3). Using Bonferroni correction, statistically significant differences were found between T1 and T2 for behavioral issues, as measured with BAMBI (p = 0.007), as well as for chewing abilities as measured with KCPS (p = 0.005) and for food acceptance (p = 0.005). These improvements were maintained after a month of follow-up, thanks to the collaboration of families and/or primary caregivers. In conclusion, GIFT seems to be an effective approach to improving behavioral issues, food acceptance, and chewing abilities in children with ASD.

Brief Autism Mealtime Behavior Inventory (BAMBI): Italian Translation and Validation.

Food selectivity is among the most common problems for children with Autism Spectrum Disorder (ASD). The present study aims to validate the Brief Autism Mealtime Behavior Inventory (BAMBI) in an Italian population of children with ASD. BAMBI was translated and cross-culturally adapted following international guidelines, then we investigated internal consistency as measured by Cronbach's alpha and test-retest reliability, as measured by the Intraclass Correlation Coefficient (ICC) in a sample of both children with ASD and with typical development (TD). A total of 131 children were recruited in a clinical and community sample. Internal consistency revealed significant data for both TD and ASD children, with a Cronbach's Alpha of 0.86 and 0.71, respectively. Test-retest reliability showed excellent values for each item of the BAMBI (range 0.83-1.00). Furthermore, we investigated differences in gender and body max index; however, no significant differences were found among groups. In conclusion, the Italian version of the BAMBI showed good internal consistency and test-retest reliability and it can be used for clinical and research purposes.

Association between feeding/mealtime behavior problems and internalizing/externalizing problems in autism spectrum disorder, other neurodevelopmental disorders and typically developing children.

The aim of current study was to examine the nature and prevalence of feeding problems and mealtime behavior problems in children with autism spectrum disorder (ASD) comparing to children with other neurodevelopmental disorders (NNDs) and TD children. We also investigated the impact of intelligence quotient (IQ) and/or emotional and behavioral problems on feeding and mealtime behavior problems. Participants completed the following tests: Social Communication Questionnaire (SCQ), Child Behavior Checklist (CBCL), Brief Autism Mealtime Behavior Inventory (BAMBI) and Behavioral Pediatric Feeding Assessment Scale (BPFAS). Children with ASD showed more feeding and mealtime behavior problems including food refusal (P<0.001, P<0.001) and limited variety of foods (P=0.014; P=0.018) compared with NDDs and TD children. ASD group showed more problems in mealtime behavior (P=0.034) and parent behaviors (P=0.028) compared to TD group. Internalizing (P=0.003) and externalizing (P=0.008) problems were positively related to parent frustration during mealtime in ASD group. These results suggest that routine screening for feeding and mealtime behavior problems among children with ASD is necessary to prevent dietary inadequacies that may be associated with eating habits.