Results

Mealtime Behaviors Associated with Body Mass Index in Young Children With Autism Spectrum DisordersWilliam R. Black MA1,2, Cathleen Odar Stough MA1,3, Meredith Dreyer Gillette PhD1,4, & Susana Patton PhD, CDE1,5

1 Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri; 2 University of Missouri – Kansas City, Kansas City, Missouri; 3 University of Kansas, Clinical Child Psychology Program, Lawrence, Kansas; 4 Children’s Mercy Hospitals and Clinics, Kansas City, Missouri;5Department of Pediatrics, The University of Kansas Medical Center

Background• Children diagnosed with Autism Spectrum Disorder (ASD) have been shown to

display greater feeding problems and behavioral difficulties at mealtimes than typically developing peers (Provost et al., 2010)

• Children with ASD also are more likely to consume a more narrow variety of foods (Schreck et al., 2004), and may refuse foods due to preferences for certain textures, tastes, smells, shapes, and colors (Hubbard et al., 2014).

• Additionally, children with ASD may be at greater risk for overweight and obesity than typically developing peers (Zuckerman et al., 2014).

• The current study examines relationships between parent-reported child and parent mealtime behaviors and child Body Mass Index (BMI).

Conclusions• Parents of healthy weight versus overweight/obese children report some

differences in child and parent mealtime behaviors (e.g., child food refusal, parents offering rewards to encourage eating). However, they do not exhibit differences in other behaviors that may be expected (e.g., snack limits, fat reduction)

• For healthy weight children, parents of children on the higher end of the BMI spectrum reported higher ASD related behaviors, and reported having more fruits and vegetables available.

• When providing feeding interventions for children with ASD, parents of healthy weight may require a different focus than parents of overweight and obese children.

MethodsParticipants• 53 children ages 2 through 8 (M = 5.38; SD = 2.02 years; Range = 2.43-8.85)• Healthy Weight (n = 35, 66%), Overweight and Obese (n = 18, 34%)• Participants were 75.8% male and represented a variety of races (56.5% Caucasian,

24.5% African American, 3.8% Latino, 15.1% other).

Measures• Anthropometrics: Child height and weight were measured, and the Baylor College of

Medicine BMI graph calculator was used to calculate BMI percentile and a standardized BMI Z-score (BMIz). Child overweight and obese were categorized as a BMI at or greater than the 85th percentile.

• Brief Autism Mealtime Behavior Inventory (BAMBI): An 8-item scale in which caregivers provide frequency ratings of child mealtime behaviors on a 5-point Likert scale (0 = never to 5 = always).• Subscales scores of Food Refusal, Features of Autism, and Limited Food Variety

• Parent Mealtime Action Scale (PMAS): A 31-item scale in which parents self-rated the frequency (1 = never, 2 = sometimes, 3 = always) that they engage in a variety of mealtime and food related behaviors.• Subscales scores of Snack Limits, use of Positive Persuasion, Daily Fruit and

Vegetable Availability, Insistence on Eating, Snack Modeling, Special Meals, Fat Reduction, and Many Food Choices

ReferencesProvost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of

preschool children: Comparison of children with autism spectrum disorder and children with typical development. Physical and Occupational Therapy in Pediatrics, 30, 220- 233.

Hubbard, K. L., Anderson, S. A., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of the Academy of Nutrition and Dietetics, Epub.

Zuckerman, K. E., Hill, A. P., Guion, K., Voltolina, L., & Fombonne, E. Overweight and obesity: Prevalence and correlates in a large clinical sample of children with autism spectrum disorder. Journal of Autism and Developmental Disabilities, 44, 1708-1719.

Data Analysis• Independent-samples t-tests were performed to evaluate potential differences

between weight groups (e.g., Healthy Weight vs. Overweight/Obese) in parent ratings of child mealtime behavior and parent mealtime behavior.

• Pearson’s correlations were conducted to examine if BMIz was related to child and parent mealtime behaviors within each weight group.

Healthy Weight

Overweight & Obese

(n = 35) (n = 18)

Food Refusal 12.80 (3.59) 10.64 (2.88) 2.212*Features of Autism 11.25 (2.96) 8.83 (2.43) 2.987**Limited Food Variety 26.31 (6.04) 27.48 (15.40) -0.394

Snack Limits 7.91 (1.37) 8.17(1.15) -0.665Positive Persuasion 8.48 (2.21) 8.44 (2.57) 0.047Daily F&V Availability 7.29 (1.60) 7.39 (1.65) -0.22Use of Rewards 7.37 (1.57) 6.44 (1.38) 2.114*Insistence on Eating 4.69 (1.79) 4.39 (1.20) 0.632Snack Modeling 5.11 (1.32) 5.67 (1.46) -1.391Special Meals 6.69 (1.86) 6.67 (1.50) 0.038Fat Reduction 4.94 (1.45) 5.39 (1.38) -1.076Many Food Choices 7.57 (1.54) 7.39 (1.33) 0.427

Parent Mealtime Action Scale

Brief Autism Mealtime Behavior Inventory

Comparison of HW and OB/OW

t

*p < .05, **p < .01 *p < .05, **p < .01

•Parents of healthy weight children reported significantly greater difficulty with food refusal and behaviors associated with autism spectrum disorder during mealtimes.

•Parents of healthy weight children also reported a greater frequency of offering the child rewards to encourage eating.

• Parents of healthy weight children reported that greater features of autism were associated with a higher BMIz, and marginally greater Fruit and Vegetable availability.

• Though insignificant, several moderate correlations were found between BMIz and mealtime behaviors in obese children.

For more information contact: For more information contact: William Black, M.A. – wrbwd5@mail.umkc.edu or Cathy Odar Stough, M.A. - odarcc@gmail.com

Healthy Weight

Overweight & Obese

(R ) (R )

Food Refusal 0.043 0.027

Features of Autism 0.307* 0.384

Limited Food Variety 0.086 -0.266

Snack Limits 0.041 -0.040

Positive Persuasion 0.062 -0.134

Daily F&V Availability .419** 0.234

Use of Rewards -0.185 0.341

Insistence on Eating -0.064 0.390

Snack Modeling -0.057 -0.251

Special Meals -0.139 -0.066

Fat Reduction 0.209 0.370

Many Food Choices 0.226 -0.211

Correlations of BMIz and Mealtime Behaviors Within Weight Groups

Brief Autism Mealtime Behavior Inventory

Parent Mealtime Action Scale