Mixed-Methods Analysis of Parent Stress and Feeding Experiences for Children With ASD

The purpose of the study was to demonstrate the use of feeding histories to enhance the findings of surveys around difficulties related to feeding for children with ASD as described by parents. The multifaced nature of occupations require unique analytic frames (Clark and Lawlor 2009). In this presentation we make a unique theoretical contribution by combining life histories with survey data. We followed published survey studies on feeding, co-parenting, and family centered care (Thullen and Bonsall 2017, Bonsall et al 2021) with in-depth interviews. These previous studies on parents of children with ASD have identified a relationship between feeding and stress as well as a need for a family centered focus on feeding. We present feeding histories gathered from interviews with a smaller sample of participants to gain insight into contextual factors. This research is important because we provide a unique analytic frame to provide experience near insight into parents experience with feeding that can be applied to other forms of research.

DESIGN: This study is a mixed methods design, combining feeding histories with survey data (see Thullen and Bonsall 2017 and Bonsall et al 2021 for more on recruitment and demographics of the larger sample population). Feeding histories were created from interviews focused on a sampling of our participants from the survey study that included typical as well as unusual cases and represented the larger sample in terms of marital status and child’s age. Our concept of feeding histories is derived from life histories, a methodology used within occupational therapy to formulate significant life events into a coherent plot (Bonsall 2012). This study is unique in that we combine feeding histories with survey data to provide an experience near analysis of lived lives.

METHOD: In this presentation we use three feeding histories to describe the contextual factors that influence feeding. The three feeding histories presented were chosen to demonstrate a variety of perspectives, two feeding histories look at parents with high stress and one examines a non-typical case of high difficulty of feeding with low stress. Feeding histories were created by two researchers using transcripts from the interviews. By combining feeding histories with survey data from the Parenting Stress Index, Co-parenting Related Support, and the Brief Autism Mealtime Behavior Inventory, we get a closer look at the contextual factors influencing the numbers.

RESULTS: Our in-depth analysis of feeding histories demonstrates the importance of contextual factors. Strained co-parenting relationships such as separation or having a spouse with a disability led to increased parenting stress. For another mother, the stress of feeding difficulties was mitigated by a supportive partner when the mother described successful communication around co-parenting with her husband.

CONCLUSION: Combining feeding histories with survey data provides insight into contexts and experiences of parents of children with ASD. In particular, feeding histories demonstrate the complex intersection of child’s behavior and parental support. Feeding histories can be a valuable research tool, but also present a way to gather data about families to provide family centered support as well as identify feeding difficulties that otherwise may not be recognized. Implemented in practice, this study provides insight into the important contexts that influence feeding behaviors and should be addressed as part of therapeutic practice. In addition to practice implications researchers should consider difficulties within relationships such as multiple disabilities within one family or parenting relationships.

References

Bonsall, A. (2012). An examination of the pairing between narrative and occupational science. Scandinavian Journal of Occupational Therapy, 19, 92-103 https://doi.org/10.3109/11038128.2011.552119

Bonsall, A., Thullen, M., Stevenson, B., Sohl, K. (2021) Family-Centered Perspective on Addressing Feeding Concerns of Parents of Children with Autism Spectrum Disorder. OTJR: Occupation, Participation and Healthhttps://doi.org/10.1177/1539449220985906

Clark, F., & Lawlor, M. C. (2009). The making and mattering of occupational science. In H. S. Willard, E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.), Willard & Spackman’s occupational therapy (11th ed., pp. 2-14). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Thullen, M., & Bonsall, A. (2017). Co-parenting quality, parenting stress, and feeding challenges in families with a child diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 1-9. https://doi.org/10.1007/s10803-016-2988-x