Mealtime Behavior Research Articles

Identifying Associations Between Sensory Processing & Food Sensitivities

Abstract Date Presented 04/22/2023 This session reviews a study that examines the correlations between sensory processing, sensory systems, mealtime behaviors, and feeding in children with identified feeding difficulties. Primary Author and Speaker: Aimee Piller Additional Authors and Speakers: Taylor Tonks

Challenging Eating Behaviors in Young Children With Autism: An Investigation of the Role of Oral Sensitivity

Abstract Date Presented 04/22/2023 Children with autism have a high occurrence of challenging eating behaviors, which can lead to negative health consequences such as obesity and malnutrition. One of the underlying mechanisms implicated in these challenging eating behaviors is differences in oral sensory processing. Therefore, this study examined picky eaters with autism and compared child and parent mealtime behaviors between children with and without oral hypersensitivity. Primary Author and Speaker: Anna Wallisch Contributing Authors: Kelsey Thompson, Sallie Nowell, Jessica Meredith, Brian Boyd

How Mealtime Behaviors Affect Children With Autism Spectrum Disorder: A Preliminary Analysis of a Randomized Control Trial

How Mealtime Behaviors Affect Children With Autism Spectrum Disorder: A Preliminary Analysis of a Randomized Control Trial

CRUMB: a shiny-based app to analyze rhythmic feeding in Drosophila using the FLIC system.

Rhythmic feeding activity has become an important research area for circadian biologists as it is now clear that metabolic input is critical for regulating circadian rhythms, and chrononutrition has been shown to promote health span. In contrast to locomotor activity rhythm, studies conducting high throughput analysis of Drosophila rhythmic food intake have been limited and few monitoring system options are available. One monitoring system, the Fly Liquid-Food Interaction Counter (FLIC) has become popular, but there is a lack of efficient analysis toolkits to facilitate scalability and ensure reproducibility by using unified parameters for data analysis. Here, we developed Circadian Rhythm Using Mealtime Behavior (CRUMB), a user-friendly Shiny app to analyze data collected using the FLIC system. CRUMB leverages the 'plotly' and 'DT' packages to enable interactive raw data review as well as the generation of easily manipulable graphs and data tables. We used the main features of the FLIC master code provided with the system to retrieve feeding events and provide a simplified pipeline to conduct circadian analysis. We also replaced the use of base functions in time-consuming processes such as 'rle' and 'read.csv' with faster versions available from other packages to optimize computing time. We expect CRUMB to facilitate analysis of feeding-fasting rhythm as a robust output of the circadian clock.

Dysphagia, mealtime behaviors, and eating ability of persons living with dementia: A systematic review of psychometric properties of instruments

AbstractBackgroundIt is critical to use validated instruments to assess dysphagia, mealtime behaviors, and eating ability of persons living with dementia to evaluate the efficacy of mealtime care interventions. However, the characteristics and psychometric quality of such instruments are unknown. This systematic review aims to synthesize the quantity and quality of instruments that assess dysphagia, mealtime behaviors, and eating ability of persons living with dementia.MethodWe searched Pubmed, CINAHL, AgeLine, PsychINFO, and Cochrane Library for records published from January 1980 to July 30th, 2021. Records were eligible if they included any instrument that measures concepts of interest (i.e., dysphagia, mealtime behaviors, eating ability). Instruments were excluded if they assessed nutritional status only. Eligible instruments originally developed or later modified to measure concepts of interest were identified from eligible records. Eight characteristics of eligible instruments will be extracted: 1) development process, 2) concept/construct being operationalized, 3) sample and setting, 4) administration method, 5) description of items, 6) scoring format/interpretation, 7) reliability, and 8) validity. The Psychometric Assessment for Self‐report and Observational Tools (PAT), a newly developed psychometric quality assessment tool, will be used to evaluate the psychometric quality of eligible instruments.ResultIn total, 11,074 records were reviewed. Seventy‐nine eligible instruments were identified from 174 records. Fifteen instruments assessed swallowing ability; 5 assessed mastication ability; 6 assessed dysphagia; 24 assessed mealtime behaviors; 7 assessed eating ability; 22 assessed two or more concepts of interest.ConclusionA large number of instruments were developed and/or used to assess dysphagia, mealtime behaviors, and eating ability of persons living with dementia. All instruments’ psychometric properties will be further evaluated to inform the application and adaption of appropriate instruments for practice and research.

Temporal Relationships Between Nursing Home Staff Care Approaches and Behaviors of Residents With Dementia During Mealtimes: A Sequential Analysis.

Optimal dyadic interactions are critical to quality mealtime care and outcomes. Prior work supports associative relationships between staff approaches and individual mealtime behaviors, yet evidence on temporal relationships is limited. This study examined temporal associations between staff approaches and resident behaviors during mealtimes. Videotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analyses using 5-, 10-, and 15-second time windows were conducted for resident positive, neutral, and challenging behaviors as antecedents as well as consequences of staff person-centered and task-centered approaches. Residents exhibited positive verbal (35.0%) and positive/neutral nonverbal (12.6%) behaviors, as well as challenging behaviors including functional impairments (27.7%) and resistive behaviors (24.7%). Staff primarily used person-centered approaches (54.1% verbal, 40.3% nonverbal); task-centered approaches were less frequent (5.6%). Immediately (within 5 seconds) after staff person-centered approaches, resident positive/neutral and resistive behaviors were more likely, and functional impairments less likely. After staff task-centered approaches, resident positive verbal and resistive behaviors were less likely. After resident positive/neutral behaviors, staff person-centered approaches were more likely. After resident functional impairments, staff person-centered verbal approaches were less likely, and task-centered approaches more likely. After resident resistive behaviors, all staff approaches were more likely. The strength of temporal relationships diminished in 10-second and 15-second time windows. Staff-resident positive interactions were associated with more subsequent positive interactions. Person-centered care was associated with fewer subsequent resident functional impairments and more subsequent resistive behaviors. Resident resistive behaviors were associated with more subsequent person-centered and task-centered care. Findings confirm the importance of facilitating positive staff-resident interactions and managing functional impairments using person-centered care. Resistive behaviors require additional awareness and attention beyond commonly used person-centered care approaches. Further investigation of temporal relationships is needed using larger diverse samples.

A Survey of Community Providers on Feeding Problems in Autism Spectrum Disorder.

Feeding problems, ranging from mild to severe, are common in children with autism spectrum disorder. We conducted a 15-item online survey of community providers to gather information on service demand and current treatment approaches for this clinical population. Respondents, speech-language pathologists, occupational therapists, registered dietitians, and Board-Certified Behavior Analysts, were recruited via e-mail listservs, professional conferences, continuing education programs, social media and electronic newsletters. The survey included questions about professional discipline, years in practice, patient population served, feeding problem types, therapeutic approaches, and level of interest in parent-mediated interventions. A total of 541 community practitioners responded to the survey; 419 provided usable data. Across all providers, 97% (n = 406) reported seeing children with ASD and feeding problems. Of these, 90% (n = 367) offered treatment. Providers (n = 23) who did not treat feeding problems cited "insufficient training." Most common presenting problems included limited dietary variety, texture sensitivity, and disruptive mealtime behavior. Although treatment approaches varied across disciplines, 89.3% indicated openness to parent-mediated treatment. These results indicate a high demand for treatment of children with ASD and feeding problems across disciplines. Food selectivity was the most common problem. Treatment approaches varied across disciplines. Dissemination and implementation of evidence-based, parent-mediated intervention is warranted.

Clinical Outcomes from an Interdisciplinary Outpatient Feeding Treatment Pilot Program.

Many children with developmental disabilities experience feeding challenges, including food refusal and food selectivity. Feeding concerns are often multifaceted and, therefore, an interdisciplinary approach to treatment is needed. A pilot of an interdisciplinary outpatient feeding program was conducted in a hospital medical center by psychologists and occupational therapists. The pilot program focused on caregiver training and improvements in targeted feeding goals in both the clinic and home settings. Treatment outcomes from this pilot program found increases in bite acceptance, decreases in inappropriate mealtime behaviors, increases in caregiver-reported number of foods consumed, and mastery of most individualized feeding goals for children who participated in the treatment program. Additionally, caregivers reported decreased concerns related to feeding and increased confidence in addressing their child's feeding concerns after participation in the treatment. Caregivers also reported high levels of satisfaction with this pilot program and reported the intervention to be feasible.

Associations among permissive parenting, family mealtime behaviors, nutrition, and blood glucose in children with type 1 diabetes

ABSTRACT We examined relations among permissive parenting, mealtime behaviors, nutrition, and HbA1c in pediatric type 1 diabetes (T1D). Sixty-three children (Mage = 10.3, SD = 1.9) with T1D and caregivers completed surveys. Permissive parenting significantly negatively correlated with vegetable consumption (r=-0.27, p = .03). It was positively correlated with child resistance to eating (r = 0.48, p < .01), parent aversion to mealtime (r = 0.51, p < .01) and mealtime disturbance (r = 0.48, p < .01). Child resistance to eating did not mediate the relation between permissive parenting and HbA1c or permissive parenting and vegetable consumption. Because permissive parenting relates to eating behaviors, parent-child interventions promoting healthy eating and more effective parenting in T1D should be explored.

Examining adaptations necessary to support the implementation of a parent-mediated intervention for children with autism spectrum disorder and moderate feeding problems.

Moderate feeding problems and disruptive mealtime behaviors are common in children with autism spectrum disorder. Although parent-mediated interventions are able to support feeding problems in autistic children, most research has occurred within specialty clinics when delivered by highly trained clinicians. Thus, the fit of these interventions within community settings is not clear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to improve its fit and use within community settings. Participants were 14 multidisciplinary providers who attended one of the three intensive workgroups that included focus groups about the fit of MEAL Plan in their practice setting. Qualitative analysis was used to determine the main themes that came up within the focus groups. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, how providers might adapt their delivery of MEAL Plan, billing and insurance considerations, administrator support for MEAL Plan, and the content and format of ongoing training and consultation. By proactively considering and responding to these factors, it may be possible to enhance MEAL Plan so that it is better able to be delivered and sustained within community practices that support autistic children.

CRUMB: a shiny-based app to analyze rhythmic feeding in Drosophila using the FLIC system

Rhythmic feeding activity has become an important research area for circadian biologists as it is now clear that metabolic input is critical for regulating circadian rhythms, and chrononutrition has been shown to promote health span. In contrast to locomotor activity rhythm, studies conducting high throughput analysis of Drosophila rhythmic food intake have been limited and few monitoring system options are available. One monitoring system, the Fly Liquid-Food Interaction Counter (FLIC) has become popular, but there is a lack of efficient analysis toolkits to facilitate scalability and ensure reproducibility by using unified parameters for data analysis. Here, we developed Circadian Rhythm Using Mealtime Behavior (CRUMB), a user-friendly Shiny app to analyze data collected using the FLIC system. CRUMB leverages the ‘plotly’ and ‘DT’ packages to enable interactive raw data review as well as the generation of easily manipulable graphs and data tables. We used the main features of the FLIC master code provided with the system to retrieve feeding events and provide a simplified pipeline to conduct circadian analysis. We also replaced the use of base functions in time-consuming processes such as ‘rle’ and ‘read.csv’ with faster versions available from other packages to optimize computing time. We expect CRUMB to facilitate analysis of feeding-fasting rhythm as a robust output of the circadian clock.

Integrative analysis of γδT cells and dietary factors reveals predictive values for autism spectrum disorder in children

BackgroundAutism spectrum disorder (ASD) includes a range of multifactorial neurodevelopmental disabilities characterized by a variable set of neuropsychiatric symptoms. Immunological abnormalities have been considered to play important roles in the pathogenesis of ASD, but it is still unknown which abnormalities are more prominent. MethodsA total of 105 children with ASD and 105 age and gender-matched typically developing (TD) children were recruited. An eating and mealtime behavior questionnaire, dietary habits, and the Bristol Stool Scale were investigated. The immune cell profiles in peripheral blood were analyzed by flow cytometry, and cytokines (IFN-γ, IL-8, IL-10, IL-17A, and TNF-α) in plasma were examined by Luminex assay. The obtained results were further validated using an external validation cohort including 82 children with ASD and 51 TD children. ResultsCompared to TD children, children with ASD had significant eating and mealtime behavioral changes and gastrointestinal symptoms characterized by increased food fussiness and emotional eating, decreased fruit and vegetable consumption, and increased stool astriction. The proportion of γδT cells was significantly higher in children with ASD than TD children (β: 0.156; 95% CI: 0.888 ∼ 2.135, p < 0.001) even after adjusting for gender, eating and mealtime behaviors, and dietary habits. In addition, the increased γδT cells were evident in all age groups (age < 48 months: β: 0.288; 95% CI: 0.420 ∼ 4.899, p = 0.020; age ≥ 48 months: β: 0.458; 95% CI: 0.694 ∼ 9.352, p = 0.024), as well as in boys (β: 0.174; 95% CI: 0.834 ∼ 2.625, p < 0.001) but not in girls. These findings were also confirmed by an external validation cohort. Furthermore, IL-17, but not IFN-γ, secretion by the circulating γδT cells was increased in ASD children. Machine learning revealed that the area under the curve in nomogram plots for increased γδT cells combined with eating behavior/dietary factors was 0.905, which held true in both boys and girls and in all the age groups of ASD children. The decision curves showed that children can receive significantly higher diagnostic benefit within the threshold probability range from 0 to 1.0 in the nomogram model. ConclusionsChildren with ASD present with divergent eating and mealtime behaviors and dietary habits as well as gastrointestinal symptoms. In peripheral blood, γδT cells but not αβT cells are associated with ASD. The increased γδT cells combined with eating and mealtime behavior/dietary factors have a high value for assisting in the diagnosis of ASD.

Differences in Mealtime Behaviors, Food Security, and Weight Concerns Between Neurotypical Youth and Youth with Autism Spectrum Disorder

Differences in Mealtime Behaviors, Food Security, and Weight Concerns Between Neurotypical Youth and Youth with Autism Spectrum Disorder

Self-determination and co-operation in supported mealtimes involving people with severe intellectual disabilities

Purpose People with severe intellectual disabilities are often supported during mealtimes. However, little information exists about how they and care staff co-ordinate their mealtime behaviours. Method Four people with severe intellectual disabilities and 12 members of care staff participated in this research. Video data were collected from two services for people with intellectual disabilities. Approximately 30 eating or drinking interactions were filmed, totalling approximately 9.5 h of footage. This footage was analysed using conversation analysis (CA). Ethnographic notes were made. CA is a fine-grained systematic approach which allows examination of how mealtimes are achieved, looking closely at verbal and non-verbal behaviours. Results Results show how people with severe intellectual disabilities can demonstrate whether they are ready, or not, for a mouthful of food or drink despite their limited language abilities. Ways in which readiness and unreadiness were demonstrated are outlined and staff responses are also considered. Conclusions There are wider implications for self-determination among people with severe intellectual disabilities. Examples provided suggest that people with severe intellectual disabilities can, and do, make decisions about how fast they eat and when they prefer to complete other activities. Respecting these decisions, carers better support the autonomy of individuals with severe intellectual disabilities.

The Mealtime Behavior Problems of Children with Developmental Disabilities and the Teacher's Stress in Inclusive Preschools.

With an increasing number of children with developmental disabilities entering inclusive preschools, preschool teachers face more behavioral problems in class. Preschool teachers typically attempt to address mealtime behavior problems of children with and without developmental disabilities simultaneously in class. This study used qualitative research to identify the stress triggers of preschool teachers addressing the mealtime behavior problems of children with developmental disabilities. Five preschool teachers attended semi-structured interviews. The results indicated that most children with developmental disabilities had problems with eating only preferred foods, using eating utensils appropriately during mealtime, becoming distracted from eating, and becoming frustrated with the classroom routine. Although solving these problems triggered stress in the preschool teachers, their stress was mainly in response to the children's parents, other children's imitation of inappropriate mealtime behaviors, and classroom schedule time management. Most of the preschool teachers stated that they had insufficient support. Preschool teachers require specialized information and strategies for improving the mealtime behaviors of children with developmental disabilities.

Short report: The role of oral hypersensitivity in feeding behaviors of young autistic children.

Feeding problems are common among autistic children and are linked to negative health consequences. Therefore, understanding feeding problems and factors that influence these behaviors is important for developing supports for children and families. While certain sensory processing patterns are commonly associated with feeding problems, less is known about the link between sensory processing and feeding behaviors in autism, as well as how parent behaviors and feelings during mealtime differ based on child sensory preferences. This research examined two groups of young autistic children who were reported to be picky eaters by their parents: those with and those without oral hypersensitivity. Children with oral hypersensitivity had more difficulty with food acceptance and their parents reported more negative feelings around feeding their child. However, the two groups of children (oral hypersensitive and not) did not differ in their medical/oral motor symptoms, mealtime behavior, or parent use of strategies at mealtimes. This research supports the need for personalized treatment strategies based on the child's sensory preferences to support both the child and parent in managing mealtimes.

Using an intensive interdisciplinary telehealth model to treat pediatric feeding disorders.

The necessity of treatment using telehealth was apparent during the novel coronavirus (COVID-19) pandemic, as many practitioners were forced to use telehealth as a primary mode of service delivery. Although the telehealth model has been studied for different populations, little is known about its success when applied with children with feeding disorders and complex medical histories. The purpose of this study was to evaluate the efficacy of using a telehealth model from the onset of treatment. All 5 children who participated engaged in low levels of acceptance and high levels of inappropriate mealtime behavior during baseline. Caregivers were taught to implement the treatment with high integrity using behavioral skills training. Procedural integrity increased posttraining, and as a result acceptance increased and inappropriate mealtime behavior decreased. Treatment gains maintained during follow up at 1 month and 1 year. These data are discussed in relation to alternative ways of providing treatment in locations where intensive feeding programs are not available.

Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder

The aim of this study was to evaluate the interaction between gastrointestinal (GI) disorders, sleep problems, and challenging behaviors in children with a diagnosis of Autism Spectrum Disorder (ASD) and their effect on parental stress. The secondary objective was to assess the frequency and type of GI and feeding disorders in a sample of children with ASD through a multidisciplinary assessment and, finally, to investigate families' perceptions and satisfaction with the proposed multidisciplinary approach. All children underwent a comprehensive gastroenterological and neuropsychiatric evaluation supported by standardized questionnaires. Pediatric gastroenterologists, specifically trained in Applied Behavior Analysis (ABA), provided advice for parent-delivered behavioral intervention for food selectivity. Thirty-six children with an autism diagnosis (29 males, age 4.5 +/-2.2 years, mean +/- SD) were enrolled. A positive correlation between sleep problems and aggressive behavior was found, and this association was stronger in children experiencing more problematic mealtime behaviors (b = 0.788, p = 0.014). Sleep difficulties were associated with stereotyped behaviors and parent-perceived stress. Parents interviewed about the gastroenterology visit perceived this multidisciplinary approach as helpful in addressing food selectivity. This study shows that sleep and mealtime issues can have a synergistic negative impact on ASD symptoms. A multidisciplinary approach and an integrated assessment of GI, feeding problems, and sleep disorders could be helpful in diagnosing comorbidities and to provide targeted advice to parents.

Strategies to Promote Positive Mealtime Behavior in Early Childhood

Picky eating and problem behavior during meals are commonly reported issues among young children, particularly toddlers (Manikam & Perman, 2000). It is estimated that up to 50% of children under the age of 5 experience difficulties during mealtimes (Benjasuwantep et al., 2013). These difficulties may include tantrums when nonpreferred foods are presented, turning their head away from bites, pushing food away, crying, spitting out bites of nonpreferred food, and holding bites in the mouth. Over time, these behaviors can lead to significant limitations in the variety and amount of foods that children consume, thus compromising their growth and development. While there are a variety of reasons a child may engage in these problem behaviors, the food refusal or selectivity often persists after other contributing factors have been resolved (Dobbelsteyn et al., 2005). A behavior analytic approach can be used to address mealtime problem behavior. These interventions are focused on changing aspects of the child’s environment and caregiver response in order to change the child’s behavior during meals. This approach has been well-evaluated in the literature, and many regard it to be the most effective intervention for treating children’s problem behavior during meals (Kerwin, 1999). The scope of this paper was to provide evidence-based behavior analytic recommendations to caregivers, teachers, and other early childhood therapeutic providers. Recommendations provided in this article are applicable to a variety of feeding difficulties that may present in early childhood. While recommendations discussed in this paper have been supported in the literature, research lacks a comprehensive instructional guide of best practices that can be used by providers with limited expertise or experience in feeding concerns.

Nutritional status and eating behavior of children with autism spectrum disorders in Vietnam: A case-control study.

Background: Atypical eating behaviors and feeding issues are common in children with autism spectrum disorder (ASD). Aim: This study aims to evaluate the nutritional status and eating behavior of the ASD and typically developing groups. Methods: A case-control study was conducted from January to April 2019 in Nghe An, Vietnam. A total of 93 children in each group participated in the study with their main caregivers. We applied the Children's Eating Behavior Inventory (CEBI) to evaluate the eating behaviors of children. Results: Overweight and obesity in ASD children accounted for 41.9%. The CEBI score and %CEBI of the ASD group was higher than that of the control group (104.0 ± 14.2 and 91.3 ± 8.3; 24.1 ± 21.4 and 5.0 ± 11.8, respectively). Most of the adverse mealtime behaviors of ASD children focused on excessive duration (52.7%), distraction (40.9%), and food refusal (39.8%). In total 88.2% of caregivers had to comfort their ASD children at every meal, followed by threatening, scolding, or punishing children if they refused to eat (57.0%). Conclusion: Being overweight/obese and having eating behavior difficulties were prevalent among ASD children in Vietnam. Safer alternatives, such as lifestyle measures and seeking help from a nutritional therapist, can help ASD children reduce weight and modify their erroneous feeding habits.