Sensory Differences and Mealtime Behavior in Children With Autism Open Access

PURPOSE: The aim of this study was to investigate the association between mealtime behavior problems and sensory differences in children with autism spectrum disorder (ASD) compared with their typically developing (TD) peers. The following research questions were addressed: (1) Do children diagnosed with ASD demonstrate significantly greater sensory differences when compared with their age-matched TD peers, (2) do children diagnosed with ASD show significantly greater difficulty in mealtime behavior compared with their age-matched TD peers, and (3) are there significant correlations between sensory differences and mealtime behaviors in the ASD and TD groups?

BACKGROUND: Self-care tasks or activities of daily living, such as grooming, eating, and dressing, are essential tasks for children to acquire as they mature. There is increasing evidence that children with ASD experience challenges in these daily routines and, further, that sensory differences often interfere with their ability to develop skills in these important daily routines. Eating difficulties are a frequent problem for children with autism and may affect children’s physical health, family mealtimes and milieu, and participation in the educational setting. Many published research studies have established a link between ASD and sensory differences. Between 69% and 95% of children diagnosed with ASD are estimated to demonstrate sensory symptoms, including sensory seeking and avoiding behaviors, self-stimulation, and unusual sensory interests. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2014) now includes hyper- or hyporeactivity to sensory input in the diagnostic classification for ASD. However, there is limited research that has investigated the relationship between sensory differences found among children with ASD and difficulties with the self-care activity of eating.

DESIGN: The study utilized a cross-sectional, quantitative research design and consisted of a nonrandomized sample of convenience with data obtained from survey instruments (parent-report and child-report questionnaires).

PARTICIPANTS: A total of 68 children between ages 5 and 12 yr comprised the sample. An experimental group of 34 children with ASD and a similarly aged control group of 34 children identified as TD participated in this study. Inclusion criteria for the children with ASD and TD were for age 5–12 yr and residence in an English-speaking household. In addition, the sample of children with ASD was also required to have a formal diagnosis of ASD determined by a physician and medical–behavioral specialist with expertise in ASD (per caregiver report).

Exclusion criteria for the children with ASD were presence of comorbid diagnoses (such as cerebral palsy or other motor coordination difficulties), and for the TD children, without indication of receiving special education services or report of a known diagnosis of autism or other developmental or physical disabilities. Participation in this study was voluntary.

METHOD: Once eligibility was established and informed consent and assent were obtained in writing, the parents or caregivers were given the survey research packet, which consisted of the study description; a demographic form; and four questionnaires that included the (a) Short Sensory Profile (SSP), ( b) Sensory Eating Checklist (SEC), (c) Touch Inventory for Elementary School Aged Children (TIE), and (d) Brief Autism Mealtime Behavior Inventory (BAMBI). When completed, the parents/caregivers either mailed the completed packet of surveys to the researcher in a stamped, self-addressed envelope provided by the investigator to a secure and designated address or they were hand-delivered back to the researcher at a mutually agreed-on time and location scheduled with the parent/caregiver.

ANALYSIS: Test scores were analyzed using the computer software SPSS Version 19. Group means and medians, respectively, were calculated for linear and ordinal data with respect to participant age, gender, race/ethnicity, types and numbers of services received, motor, language and social development. Independent-samples t tests were conducted to compare the mean test scores between both samples for linear measurements. The Mann–Whitney U test was calculated to determine group differences for ordinal measurements. Correlational analyses were conducted to determine association between the variables eating behaviors and sensory processing. The criterion for statistical significance was set at .05 for all results in the study.

RESULTS: Overall, sensory differences and mealtime behavior problems were prominent in the group with ASD. On all measures, the ASD sample had higher (more problematic) mean scores than the TD sample on sensory and mealtime behavior measures. When examining between-group differences on the sensory measures, significant differences were found between groups for mean scores on the SSP (ASD mean [M] = 114.5, standard deviation [SD] = 27.7; TD M = 171.7, SD = 26.07), TIE (ASD M = 46.73, SD = 11.74; TD M = 35.58, SD = 7.96), and SEC (ASD M = 66.02, SD = 18.05; TD M = 33.27 SD = 8.09), with the ASD group showing greater sensory differences.

When examining between-group differences in mealtime behaviors, significant differences were found on the BAMBI total (ASD M = 44.39, SD = 10.83; TD M = 30.08, SD = 7.90). The ASD group exhibited greater mealtime behavior problems than the controls. Thus, analysis for both Research Questions 1 and 2 confirmed that the ASD sample showed significantly greater sensory differences and mealtime behavior problems than the TD sample.

Results also indicate a strong to moderate positive correlation between eating behaviors (BAMBI) and sensory measures (SSP, SEC, and TIE; rs = .528–.813). There was also a moderate to strong correlation among sensory measures (rs = .726–.943) for both groups combined. When correlations were run separately for each group, moderate to strong correlations were detected between eating behaviors (BAMBI) and sensory measures (SSP, SEC, TIE) for the ASD group (rs = .378–.747. In contrast, the TD sample revealed a low to moderate correlation between eating behaviors and sensory measures (TD: rs = .153–.622). Results of correlational analyses for separate groups between sensory measures revealed a moderate to strong correlation for the ASD sample (.697–.895) and moderate correlation for the TD sample (.516–.653).

DISCUSSION: This study is among one of the first to investigate the relationship between mealtime behavior and sensory differences in children with ASD compared with their TD peers. Additionally, there were multiple measures administered to assess both eating behaviors and sensory processing characteristics among both groups. This study is unique in that it also examined the relationships among sensory differences and mealtime behaviors.

Correlational analyses supported the association of mealtime behavior problems and sensory differences. There were moderate to strong positive correlations between the mealtime behavior measure (BAMBI) and each of the three sensory measures (SSP, TIE, SEC) for children with ASD. The results of this study have the following implications for occupational therapy practice: Children with ASD experience significantly more difficulty in mealtime behaviors than TD children, sensory differences in children with ASD may be one factor that interferes with mealtime behavior, and sensory differences and mealtime problem behaviors may be reduced by occupational therapy interventions.

As Ayres (1979) originally elucidated, occupational therapy interventions that directly address underlying sensory differences may contribute to functional improvements such as greater mealtime success, increased comfort, and less stress during mealtimes.

References

American Psychiatric Association. (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychatric Publishing.