Association Between Eating Behavior And Family Food Environment Among Children With Autism Spectrum Disorders

Objective: To investigate the status quo of eating behavior problems and family food environment of children with ASD,to analyze the association between family food environment and eating behavior problems of children with ASD,to investigate the related factors in the formation process of main caregiver’s feeding practices through qualitative interview.Methods: This study was conducted in 6 rehabilitation institutions of children with ASD in Changsha,Hunan Province from October 2020 to October 2021.Quantitative survey was conducted through electronic questionnaire.First is the basic information of children with ASD and their main caregivers.Eating behavior problems of children with ASD were investigated by children’s eating behavior questionnaire and child food neophobia scale.The family food environment of children with ASD consists of dimension of family food social and cultural environment and dimension of family food physical environment.Child feeding questionnaire designed for parents was used to investigate the characteristics of parents’ feeding behavior of children with ASD,and a self-designed questionnaire was designed to investigate other family food environmental factors.At the same time,the height and weight of children with ASD were measured.Qualitative interviews were conducted through semi-structured interview questionnaires.Information was collected through one-on-one interviews with the main caregivers of children with ASD to in-depth tap the relevant factors affecting their feeding behavior.Results:(1)Eating behavior problems of children with ASD have the following characteristics: the levels of food responsiveness and enjoyment of food are low,while the levels of satiety responsiveness,slowness in eating,emotional overeating,emotional undereating,food fussiness and food neophobia are high.(2)Parents of children with ASD often adopt controlled feeding behaviors such as pressure to eat and taking food as rewards.Children’s main caregiver tend to paly an exemplary role and pay attention to creating a healthy family food physical environment.The supply of healthy food at home is adequate.Most of the children have fixed dining places and their own tableware and often eat with their families.(3)The eating behavior of children with ASD is related to their family food environment: Parental pressure to eat(AOR = 0.244,95% CI 0.101 ～0.589),monitoring(AOR = 2.767,95% CI 1.097 ～ 6.978),and low-energy/ high-nutrient-density food accessibility(AOR = 1.876,95% CI 1.109 ～3.173)were related to enjoyment of food of children with ASD.Pressure to eat(AOR= 2.569,95% CI 1.014 ～ 6.509),restriction on children’s use of electronic products during meals(AOR =1.614,95% CI 1.104～2.360),and main caregiver’s avoidance of using electronic products during meals(AOR=0.653,95% CI 0.428 ～ 0.997)were related to children’s food neophobia.(4)Main caregivers of children with ASD do not fully recognize their feeding behavior.Their feeding behavior were influenced by suggestions from important people or groups and mass media information in the process.Their mainly support were from their families.Their major obstacles including the effects of ASD symptoms,lack of caregivers and their own negative emotions.Conclusion: ASD children have low response to external food cues,high response to internal satiety signals,and serious problems of emotional eating and food selectivity.Parents of children with ASD mostly adopt controlled feeding behavior.Main caregivers of children with ASD tend to play an exemplary role and pay attention to shaping a healthy family food physical environment.Parental pressure to eat negatively related to food neophobia of children with ASD;parental monitoring and healthy family food physical environment were positively correlated with food enjoyment of children with ASD;the main caregivers’ restriction on the use of electronic products during meals was positively correlated with food neophobia of children with ASD,while the main caregivers’ own avoidance of electronic products during meals was negatively correlated with food neophobia of children with ASD.The feeding behavior of the main caregivers is affected by many factors,including ASD core symptoms,lack of caregivers and their negative emotions.In view of the particularity of core symptoms and eating behavior problems of children with ASD,we should strengthen the propaganda of healthy eating knowledge of children with ASD,increase policy support for families and rehabilitation institutions of children with ASD,and promote the construction of healthy family food environment for children with ASD from various angles and ways.