Keith E. Williams

A Comparison of Eating Behaviors between Children with and without Autism.

Although clinicians typically assume that feeding problems co-exist with a diagnosis of autism, no previous research has compared the eating behavior of children with autism to typically developing children. This study compared caregiver report of eating problems of children with and without autism on a standardized questionnaire. The questionnaire included items pertaining to food refusal and acceptance patterns as well as food presentation requirements. Caregivers were also asked to complete a food inventory that indicated the number of foods eaten within each food group for both the child and the family. Results indicated children with autism have significantly more feeding problems and eat a significantly narrower range of foods than children without autism.

The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight.

A new and comprehensive Parent Mealtime Action Scale (PMAS) was developed to identify dimensions of mealtime behaviors used by parents, then examined for its usefulness to explain variance in childrens diet and weight status. Exploratory factor analysis with 2008 mothers and two confirmatory factor analyses with 541 mothers and 439 fathers produced a 31-item scale with nine dimensions. Mothers reported more gentle PMAS actions like setting SNACK LIMITS, ensuring DAILY FV AVAILABILITY, and using FAT REDUCTION and POSITIVE PERSUASION during meals, whereas fathers reported more forceful PMAS actions like INSISTENCE ON EATING. Seven PMAS dimensions explained variance in childrens diet and weight status even when in competition with three well-known predictors (genetic risk, exercise, television). Children with healthier diets and weight had parents who often ensured DAILY FV AVAILABILITY and used FAT REDUCTION, POSITIVE PERSUASION, and INSISTENCE ON EATING during meals, but who rarely showed SNACK MODELING, allowed children too MANY FOOD CHOICES, or made them SPECIAL MEALS different from the shared family meal. Parents also may respond to childrens overweight by using more FAT REDUCTION. The PMAS offers a new research, clinical, and educational tool to guide parents in actions most associated with childrens diet and weight status.

Food refusal in children: A review of the literature

Food refusal is a severe feeding problem in which children refuse to eat all or most foods presented and exhibit problems with growth. This review discusses the definition, etiology, and interventions pertaining to food refusal. The interventions utilized for food refusal typically consist of several treatment components. These treatment components are reviewed and implications for future interventions are discussed.

Practice does make perfect. A longitudinal look at repeated taste exposure.

Previous research has found that 10-15 exposures to a novel food found can increase liking and consumption. This research has been, however, largely limited cross-sectional studies in which participants are offered only one or a few novel foods. The goal of the current study uses a small clinical sample to demonstrate the number of exposures required for consumption of novel foods decreases as a greater number of foods are added to the diet. Evidence that fewer exposures are needed over time may make interventions based upon repeated exposure more acceptable to parents and clinicians.

Combining repeated taste exposure and escape prevention: An intervention for the treatment of extreme food selectivity

Repeated taste exposure has been used to introduce novel foods in several settings, but none of these efforts have targeted clinical populations. This study describes an intervention that combines repeated taste exposure and escape prevention in the treatment of extreme food selectivity in two children with autism. Future applications of repeated taste exposure are discussed.

Parent mealtime actions that mediate associations between children's fussy-eating and their weight and diet

The present study evaluated parent mealtime actions that mediate associations between childrens fussy-eating and their weight and diet. Participants included 236 feeding-clinic children in three diagnostic groups: 50 with autism, 84 with other special needs, and 102 without special needs. Childrens weight was measured as body mass index percentile (BMI%), with only 26.4% of the present sample found to be underweight (BMI% less than 10). Parents reported childrens diet variety as the number of 139 common foods accepted, childrens FUSSINESS with the Child Eating Behavior Questionnaire, and their own use of four actions from the Parent Mealtime Action Scale: POSITIVE PERSUASION, INSISTENCE ON EATING, SNACK MODELING, SPECIAL MEALS. Multiple regression found that only SPECIAL MEALS explained variance in childrens BMI% and diet variety. For children without special needs, mediation analysis revealed that variance in childrens BMI% explained by FUSSINESS was accounted for entirely by the parents preparation of SPECIAL MEALS. For all diagnostic groups, mediation analyses revealed that variance in childrens diet variety explained by FUSSINESS was accounted for by the parents use of SPECIAL MEALS. We conclude that although the parents use of SPECIAL MEALS may improve BMI% in fussy-eating clinic children, it may also perpetuate their limited diet variety.

Feeding Disorder of Infancy or Early Childhood: How Often Is It Seen in Feeding Programs?

To date, there is little consensus in the literature on defining childhood feeding disorders. The definition of feeding disorder of infancy and early childhood included in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]) assumed the disorder is due to a nonorganic etiology. The goal of this study was to examine the prevalence of feeding disorder of infancy and early childhood as defined by the DSM–IV–TR in a sample of 234 children referred to a feeding program. The results showed only 19 of these children met the DSM–IV–TR definition. The implications of this finding are discussed.

Validation of the parent mealtime action scale (PMAS) when applied to children referred to a hospital-based feeding clinic

The purpose of this study was to validate the Parent Mealtime Action Scale (PMAS) when applied to a clinical sample of 231 children with feeding problems and then to examine its association with demographic variables, diet, and weight. Parents completed questionnaires that included the PMAS, the Child Eating Behavior Questionnaire, and measure of diet variety. Confirmatory factor analysis revealed good fit for the nine dimensions of parent mealtime action found in the original PMAS study. Results from the present study suggest that the PMAS provides a valid tool for measuring parent mealtime actions of hospital samples of children with feeding problems.

Brief Assessment of Mealtime Behavior in Children: Psychometrics and Association With Child Characteristics and Parent Responses

The present study examined psychometric properties of the Brief Autism Mealtime Behavior Inventory (BAMBI) when applied to a population of children with feeding problems. The new scale was renamed the Brief Assessment of Mealtime Behavior in Children (BAMBIC) for wider clinical usefulness. Parents completed questionnaires with the original BAMBI, the Child Eating Behavior Questionnaire, and the Parent Mealtime Action Scale. The revised BAMBIC developed with factor analysis had stronger psychometrics than the original scale and produced three subscales of feeding problems: Limited Variety, Food Refusal, and Disruptive Behavior. More Limited Variety was reported for boys than girls, and more Food Refusal was reported for younger children and children with special needs.

Brief, Intensive Behavioral Treatment of Food Refusal Secondary to Emetophobia

Emetophobia, a fear of vomiting, has been reported in both adults and children but is not well documented. This study describes the treatment of an 8-year-old girl who developed emetophobia and food refusal after an acute illness. The intervention consisted of an exposure-based treatment conducted over 7 days at a feeding program. The girl was discharged consuming all of her nutrition by mouth, and her gastrostomy tube feedings were eliminated.