Parents’ Definition of Food Selectivity in Children With Autism Spectrum Disorder

PURPOSE: The purpose of the study was to examine how parents of young children with autism spectrum disorder (ASD) define food selectivity within the context of family mealtime.

BACKGROUND: Feeding challenges are prevalent in children with ASD with the most common being food selectivity. However, food selectivity is inconsistently defined in the literature and therefore creates challenges when attempting to evaluate the problem and examine intervention effectiveness, which are essential aspects of occupational practice.

DESIGN: A narrative interview approach was used to determine how families with children with ASD define selective eating within the context of mealtime.

PARTICIPANTS: Ten families with a child ages 2–7, diagnosed with ASD, and reported to be a selective eater were included in the study. A convenience sample was obtained by recruiting through a research registry and local clinics. Families were excluded if the child had specific comorbid conditions, primary sensory impairments, psychotic disorders, or recent seizure activity.

METHOD: Families participated in two to three semistructured interviews each lasting 1–2 hr in the home. An interview guide was used with interviews, and field notes being audiotaped were transcribed.

ANALYSIS: Thematic analysis, using the six phases reported by Braun and Clark (2006), was used to capture and report a rich description of parents’ perceptions of their child’s selective eating. To establish rigor, the following processes took place: self-examination, review with the larger research team during analysis, and stakeholder checks for clarification.

RESULTS: Five themes were identified to describe parents’ definition of selective eating: limited repertoire of food, sensory aversion, food jags, nutrition quality, and mealtime rigidity; the themes were grouped into two overarching constructs, Food Properties and Mealtime Socialization. Food Properties were defined as specific interactions between the child characteristics and food, which included three themes (limited number of foods in diet, sensory aversion, and food jagging). Mealtime Socialization, including mealtime rigidity and nutrition quality, referred to the cultural context, values, and beliefs of parents regarding food and mealtime. Food Properties and Mealtime Socialization contributed to the child’s eating behaviors and parent’s perception of their child’s selective eating.

DISCUSSION: Findings provided a contextual understanding of the contributing factors parents consider when identifying their child as a selective eater. Although findings support a unique framework to understanding selective eating in young children with ASD, a singular definition was not identified. Selective eating in children with ASD is a complex construct that will need to consider multiple dimensions in order to adequately capture and define a child’s selective eating in a mealtime context.

IMPACT STATEMENT: This study provided a framework to begin to understand how parents define their child’s selective eating. Clinicians must consider the complex interaction among child characteristics, food properties, parental perspectives, and societal norms when treating a child with ASD and selective eating.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. http://dx.doi.org/10.1191/1478088706qp063oa

Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110, 238–246. http://dx.doi.org/10.1016/j.jada.2009.10.032

DPhar, S., Zazpe, I., Sanchis, A., Gonzalez, A., & Varela, M. (2014). Food selectivity in autism spectrum disorders: A systematic review. Journal of Child Neurology, 29, 1554–1561. http://dx.doi.org/10.1177/0883073813498821