Annals of International Occupational Therapy

Original Research 

Let's Eat: Development and Reliability of an Eating Behavior Assessment for Children With Autism Spectrum Disorders

Lauren M. Little, PhD, OTR/L; Anna Wallisch, MOT, OTR/L

Abstract

Objective:

Children with autism spectrum disorder (ASD) show unusual eating behaviors that may reflect sensory-motor differences. However, current measures of eating behavior largely focus on mealtime behaviors only. Therefore, we describe the development and reliability testing of Let's Eat, an assessment of sensory-motor contributions to eating behavior among children with ASD.

Methods:

We describe the theoretical underpinnings, development, and refinement of the measure. We used Cronbach's alpha to test the internal consistency of the assessment among 221 caregivers of children with ASD, aged 2 to 16 years. We tested how the Let's Eat subscales differed by child factors (chronological age, gender, gastrointestinal condition).

Results:

Internal consistency of the overall measure was good (α = 0.895); subscale and item results ranged from acceptable to good (α = 0.653–0.844). Child factors were differentially associated with subscale scores.

Conclusion:

Let's Eat is a reliable measure that may be used to assess sensory-motor contributions to eating behavior in ASD. [Annals of International Occupational Therapy. 2018;1(1):24–30.]

Abstract

Objective:

Children with autism spectrum disorder (ASD) show unusual eating behaviors that may reflect sensory-motor differences. However, current measures of eating behavior largely focus on mealtime behaviors only. Therefore, we describe the development and reliability testing of Let's Eat, an assessment of sensory-motor contributions to eating behavior among children with ASD.

Methods:

We describe the theoretical underpinnings, development, and refinement of the measure. We used Cronbach's alpha to test the internal consistency of the assessment among 221 caregivers of children with ASD, aged 2 to 16 years. We tested how the Let's Eat subscales differed by child factors (chronological age, gender, gastrointestinal condition).

Results:

Internal consistency of the overall measure was good (α = 0.895); subscale and item results ranged from acceptable to good (α = 0.653–0.844). Child factors were differentially associated with subscale scores.

Conclusion:

Let's Eat is a reliable measure that may be used to assess sensory-motor contributions to eating behavior in ASD. [Annals of International Occupational Therapy. 2018;1(1):24–30.]

Children with autism spectrum disorder (ASD) show differences in eating behavior, often characterized by aversion to many foods as well as high reward associated with specific foods (Sharp et al., 2013). Differences in eating behavior among children and adolescents with ASD may contribute to higher rates of obesity (Curtin, Anderson, Must, & Bandini, 2010) as well as malnutrition (Adams et al., 2011) in this population. Interventions to address eating behavior in ASD are limited (Williams & Seiverling, 2010), and one reason may be a lack of validated instruments to characterize the distinct eating behaviors of children with ASD. Therefore, this study was conducted to develop and validate an assessment of eating behavior for children with ASD, aged 2 to 16 years.

Although many parent-reported measures capture various behavioral dimensions of mealtime (e.g., Meals in Our Household [Anderson, Must, Curtin, & Bandini, 2012]; Children's Eating Behavior Inventory [Archer, Rosenbaum, & Streiner, 1991]), there are specific aspects of eating behavior in ASD that are not fully assessed by existing measures. Empirical findings and clinical reports point to the effect of sensory processing and motor development on the eating behaviors of children with ASD. Children with ASD may show sensory overresponsiveness to specific and/or novel foods (Cermak, Curtin, & Bandini, 2010; Lane, Geraghty, Young, & Rostorfer, 2014). Oral and gustatory sensitivities are well documented in ASD and are related to decreased intake of a variety of foods (Nadon, Feldman, Dunn, & Gisel, 2011). Conversely, sensory seeking is characterized by extreme interest in specific sensory stimuli and is likely related to high reward associated with specific foods (Cascio et al., 2012). The effects of sensory processing on selective eating and high reward associated with specific foods have not been included in existing measures of eating behavior. Instead, items related to food approach and avoidance are often included in measures of sensory processing that use oral and gustatory processing scales (e.g., Sensory Profile 2 [Dunn, 2014]; Sensory Experiences Questionnaire version 3.0 [Baranek, 2009]). Additionally, parents of children with ASD consistently report that their children show oral motor and fine motor difficulties related to eating and mealtime (Bandini et al., 2010; Kral, Eriksen, Souders, & Pinto-Martin, 2013; Lukens & Linscheid, 2008). Oral motor skills are essential for the development of swallowing, and chewing and fine motor skills are essential for self-feeding; a limited number of studies have addressed the role of oral motor development in the eating behavior of children with ASD (Field, Garland, & Williams, 2003; Kadey, Roane, Diaz, & Merrow, 2013).

In addition to sensory processing and motor aspects that influence eating in ASD, individual factors, such as age, gender, and the presence of a gastrointestinal condition, also may affect children's eating behavior. Eating differences among children with ASD are present at very young ages (Schreck & Williams, 2006) and often are among the first concerns before a diagnosis is made (Gaspar de Alba & Bodfish, 2011). However, it is unknown whether sensory motor factors persist as individuals with ASD age. Studies of the developmental trajectory of sensory processing in ASD have shown mixed findings. For example, sensory sensitivities may persist throughout adulthood in ASD (Kern et al., 2006), yet sensory seeking behaviors decrease as children age (Little, Dean, Dunn, & Tomchek, 2015). It is unclear whether the sensory correlates of eating behaviors persist throughout childhood into adolescence for those with ASD. One study (Råstam, 2008) suggested that the oral motor issues associated with eating in ASD may persist into adolescence and adulthood.

Girls with ASD are often diagnosed at later ages than boys (Rutherford et al., 2016), and girls often have less pronounced symptoms compared with boys (Lai, Tseng, Hou, & Guo, 2012). Although eating behavior differences present among a high number of children with ASD, studies have not yet investigated potential discrepancies in this symptom by gender. In addition, 8% to 18% of children with ASD show gastrointestinal problems (Kuddo & Nelson, 2003), and the etiology is unknown. It is possible that gastrointestinal problems in those with ASD contribute to food selectivity, although some have suggested that extreme food selectivity may lead to gastrointestinal problems (Ibrahim, Voigt, Katusic, Weaver, & Barbaresi, 2009).

In sum, existing measures do not fully address parent and clinical reports of sensory and motor aspects of eating behaviors among children with ASD. Research has largely focused on mealtime behaviors among young children with ASD, and empirical investigations have addressed child age, gender, and gastrointestinal conditions related to eating behavior. In this study, we report on the design and psychometric testing of Let's Eat, a measure of eating behavior. We addressed the following research questions: (a) What is the reliability of Let's Eat for children with ASD, aged 2 to 16 years? and (b) What is the effect of child factors (i.e., chronological age, gender, gastrointestinal condition) on the subscale scores for Let's Eat?

Methods

Procedures

Participants for this study were recruited through a hospital registry database of caregivers of children with ASD who agreed to be contacted for research purposes as well as online through autism organizations across the United States, including social media groups. All data were collected with online survey software through Research Electronic Data Capture (REDCap; Harris et al., 2009). This study was approved by the university institutional review board.

Item Development

We followed the guidelines for measure development as outlined by DeVellis (2016). To guide item development, we used the Dynamic Distributed Neurobehavioral Vulnerability Model of Eating Behavior in Obesity, developed by Carnell, Gibson, Benson, Ochner, and Geliebter (2012), which described hyperactivity and hypoactivity across cognitive, emotional, reward, sensory, and motor dimensions of eating behavior. We focused on the intersection of reward, sensory, and motor aspects of eating. We also used Dunn's Sensory Processing Framework (Dunn, 2014) to conceptualize how eating behavior may align with either low-threshold responses (i.e., avoidance/sensitivity) or high-threshold responses (i.e., registration/seeking). With the use of these two theories, we initially drafted questions that would theoretically map onto (a) avoidance/sensitivity; (b) sensory seeking/reward; and (c) motor development.

According to the guidelines of DeVellis (2016), we initially developed 37 items. Each author independently categorized the items into different constructs until consensus was reached. We elicited in-depth feedback from 2 parents of children with ASD and from 4 occupational therapists. Feedback indicated that a number of items were not salient for children with ASD (e.g., “Ate many different foods as a baby”) and/or were not phrased in a way in which caregivers could respond accurately (e.g., “Cannot tell the difference between particular tastes”). Therefore, we tested the reliability of 29 items that were formatted on a Likert scale of frequency. We named the subscales as follows: (a) Vigilance (food sensitivity items); (b) Intense until . . . (food sensory seeking/ high reward items); and (c) Development (oral motor items).

Participants

Participants included 221 caregivers of children with ASD (mean age, 8.4 years; SD = 3.69 years) (Table 1). Originally, 293 caregivers responded to the questionnaire. However, we excluded respondents with more than 10% missing data on the questionnaire, those who reported that their child was older than 16 years, and those who reported that they were not the child's primary caregiver (e.g., teacher, therapist). We gathered demographic data, including the respondent's level of education, the child's chronological age, the child's gender, and the child's comorbid gastrointestinal and mental health diagnoses. Participants did not receive an incentive for participation.

Sample Demographics

Table 1:

Sample Demographics

Data Analysis

We used Cronbach's alpha to test the internal consistency of the overall score, the subscales (Vigilance, Intense until . . . , Development), and the item level. We used Pearson correlations to test associations between subscales; correlations greater than .80 indicate that the subscales may not be making unique contributions to the overall scale (Worthington & Whittaker, 2006). We used analysis of variance to test the differences in subscale scores across age groups (0–3 years, 3–6 years, 6–9 years, 9–12 years, and 12–16 years). We used t tests to assess differences on subscale scores according to gender and the presence of a gastrointestinal condition.

Results

Findings of the overall internal consistency of Let's Eat showed α = 0.895. Subscale scores ranged from α = 0.714 to α = 0.842, and item level scores ranged from α = 0.653 to α = 0.844 (Table 2). Correlations between subscales ranged from r = .430 to r = .717, suggesting that each subscale makes a unique contribution to the overall scale (Table 3).

Internal Consistency Results

Table 2:

Internal Consistency Results

Subscale Correlations

Table 3:

Subscale Correlations

Results of analysis of variance showed significant values for the Development subscale only (F[4,219] = 8.272; p < .01). Main effects of age on the Vigilance and Intense until . . . subscales were not significant. Bonferroni follow-up comparisons for the Development subscale showed a significant difference for children 0 to 3 years old compared with those 12 to 16 years old (p < .05). In addition, children 3 to 6 years old showed a significant difference compared with those who were 9 to 12 years old (p < .01) and those who were 12 to 16 years old (p < .05). Development subscale scores decreased as children aged; mean scores (SD) across age groups were: 0 to 3 years = 2.79 (0.75); 3 to 6 years = 2.78 (0.75); 6 to 9 years = 2.45 (0.72); 9 to 12 years = 2.18 (0.75); and 12 to 16 years = 2.10 (0.72). Girls scored significantly lower than boys on the Vigilance subscale only (t[222] = 2.08; p < .05). Approximately 13.8% (n = 31) of children had a gastrointestinal diagnosis, which aligns with the estimated 8% to 18% prevalence ranges for gastrointestinal conditions among children with ASD (Kuddo & Nelson, 2003). Children with a gastrointestinal condition had significantly higher scores on the Development subscale only (t[203] = 2.01; p < .05).

Discussion

In this study, we described the development and reliability testing of Let's Eat, a measure of eating behavior for children with ASD, aged 2 to 16 years. Let's Eat showed overall excellent internal consistency (Portney & Watkins, 2015; Tavakol & Dennick, 2011), with subscales ranging from acceptable (i.e., Development subscale) to good (i.e., Vigilance and Intense until . . . subscales). Findings showed differences in Let's Eat subscale scores by child factors. Vigilance and Intense until . . . subscale scores did not differ for children across ages, which suggests that individuals with ASD show relatively stable patterns of food selectivity and food reward/seeking behaviors as they age. These findings are consistent with sensory processing literature that indicates that responsiveness and reactivity patterns remain consistent longitudinally (Dunn, 2001; McCormick, Hepburn, Young, & Rogers, 2016).

Chronological age affected the Development subscale scores; younger children showed more difficulty with motor aspects of eating. Research on the developmental trajectories of oral motor influences on eating behavior of children with ASD is limited (Field et al., 2003; Kadey et al., 2013). However, some research suggests that children with ASD are slower to develop mature eating patterns versus typically developing children, and these include the oral motor skills associated with solid food acceptance and slower eating as well as fine motor skills associated with self-feeding (Emond, Emmett, Steer, & Golding, 2010; Martins, Young, & Robson, 2008). In line with these previous findings, the current results show that developmental difficulties, as measured by Let's Eat, are more salient for younger children, when self-feeding and oral motor skills are maturing.

Girls scored significantly lower than boys on the Vigilance subscale (p < .05), indicating potential gender differences in children's eating behavior. Girls with ASD may portray less noticeable sensitivities compared with boys who have ASD. Interestingly, previous research indicated that girls with ASD may show more subtle behaviors and thus are often identified and diagnosed later than boys (Beeger et al., 2013; Little, Wallisch, Salley, & Jamison, 2016). Because girls with ASD in the current sample did not show the extreme food selectivity characterized by the Vigilance subscale, research is needed to investigate this potential contribution to the female phenotype of ASD.

Finally, children with gastrointestinal conditions showed increased difficulty on the Development subscale. Children with comorbid ASD and gastrointestinal diagnoses often present with abdominal pain and constipation (Mannion, Leader, & Healy, 2013), which may contribute to stressful feeding experiences and disrupt the physical processes of eating (i.e., learning to eat, acceptance of tastes, and oral motor development) (Keen, 2008). When children have adverse experiences with eating because of gastrointestinal conditions, eating may become less desirable and the children may have fewer opportunities to practice the developmental skills needed for chewing and swallowing food (Kadey et al., 2013).

Limitations and Future Directions

This study had several limitations. We relied on parent reports, and direct behavioral assessments may help to further elucidate diagnostic, sensory, and motor contributions to children's eating behavior. Future research with a larger and independent sample should validate subscales with confirmatory factor analysis, examine the concurrent validity with Let's Eat with a validated measure of eating behavior, and investigate the discriminant reliability of the tool between children with ASD versus those with typical development. To facilitate the translation between research and practice, future studies should investigate how practitioners can use the instrument to design and test interventions that target a specific domain of eating behavior (e.g., Vigilance or Development). Because of the variability in eating behavior among children with ASD, Let's Eat may help to measure specific outcomes for different eating behavior interventions.

Conclusion

The current findings suggest that Let's Eat is a reliable measure of sensory-motor contributions to eating behavior in ASD. The three subscales of Let's Eat, which include Vigilance, Intense until . . . , and Development, are differentially related to the child's chronological age, gender, and the presence of a gastrointestinal condition. Occupational therapists may use the instrument to characterize children's eating behavior as well as measure the effectiveness of occupational therapy interventions designed to target sensory-motor aspects of eating behavior.

References

  • Adams, J. B., Audhya, T., McDonough-Means, S., Rubin, R. A., Quig, D., Geis, E. & Lee, W. (2011). Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutrition & Metabolism, 8(1), 34. doi:10.1186/1743-7075-8-34 [CrossRef]
  • Anderson, S. E., Must, A., Curtin, C. & Bandini, L. G. (2012). Meals in Our Household: Reliability and initial validation of a questionnaire to assess child mealtime behaviors and family mealtime environments. Journal of the Academy of Nutrition and Dietetics, 112(2), 276–284. doi:10.1016/j.jada.2011.08.035 [CrossRef]
  • Archer, L. A., Rosenbaum, P. L. & Streiner, D. L. (1991). The children's eating behavior inventory: Reliability and validity results. Journal of Pediatric Psychology, 16(5), 629–642. doi:10.1093/jpepsy/16.5.629 [CrossRef]
  • Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R. & Must, A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics, 157(2), 259–264. doi:10.1016/j.jpeds.2010.02.013 [CrossRef]
  • Baranek, G. (2009). Sensory experiences questionnaire version 3.0. Unpublished manuscript.
  • Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F. & Koot, H. M. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(5), 1151–1156. doi:10.1007/s10803-012-1656-z [CrossRef]
  • Carnell, S., Gibson, C., Benson, L., Ochner, C. N. & Geliebter, A. (2012). Neuroimaging and obesity: Current knowledge and future directions. Obesity Reviews, 13(1), 43–56. doi:10.1111/j.1467-789X.2011.00927.x [CrossRef]
  • Cascio, C. J., Foss-Feig, J. H., Heacock, J. L., Newsom, C. R., Cowan, R. L., Benningfield, M. M. & Cao, A. (2012). Response of neural reward regions to food cues in autism spectrum disorders. Journal of Neurodevelopmental Disorders, 4(1), 9. doi:10.1186/1866-1955-4-9 [CrossRef]
  • 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(2), 238–246. doi:10.1016/j.jada.2009.10.032 [CrossRef]
  • Curtin, C., Anderson, S. E., Must, A. & Bandini, L. (2010). The prevalence of obesity in children with autism: A secondary data analysis using nationally representative data from the National Survey of Children's Health. BioMed Central Pediatrics, 10(1), 11. doi:10.1186/1471-2431-10-11 [CrossRef]
  • DeVellis, R. F. (2016). Scale development: Theory and applications (Vol. 26). Thousand Oaks, CA: SAGE.
  • Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55(6), 608–620. doi:10.5014/ajot.55.6.608 [CrossRef]
  • Dunn, W. (2014). Sensory Profile 2. San Antonio, TX: Pearson.
  • Emond, A., Emmett, P., Steer, C. & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), e337–e342. doi:10.1542/peds.2009-2391 [CrossRef]
  • Field, D., Garland, M. & Williams, K. (2003). Correlates of specific childhood feeding problems. Journal of Paediatrics and Child Health, 39(4), 299–304. doi:10.1046/j.1440-1754.2003.00151.x [CrossRef]
  • Gaspar de Alba, M. J. & Bodfish, J. W. (2011). Addressing parental concerns at the initial diagnosis of an autism spectrum disorder. Research in Autism Spectrum Disorders, 5(1), 633–639. doi:10.1016/j.rasd.2010.07.009 [CrossRef]
  • Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N. & Conde, J. G. (2009). Research electronic data capture (REDCap): A meta-data-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. doi:10.1016/j.jbi.2008.08.010 [CrossRef]
  • Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L. & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124(2), 680–686. doi:10.1542/peds.2008-2933 [CrossRef]
  • Kadey, H. J., Roane, H. S., Diaz, J. C. & Merrow, J. M. (2013). An evaluation of chewing and swallowing for a child diagnosed with autism. Journal of Developmental and Physical Disabilities, 25(3), 343–354. doi:10.1007/s10882-012-9313-1 [CrossRef]
  • Keen, D. V. (2008). Childhood autism, feeding problems and failure to thrive in early infancy: Seven case studies. European Child & Adolescent Psychiatry, 17(4), 209–216. doi:10.1007/s00787-007-0655-7 [CrossRef]
  • Kern, J. K., Trivedi, M. H., Garver, C. R., Grannemann, B. D., Andrews, A. A., Savla, J. S. & Schroeder, J. L. (2006). The pattern of sensory processing abnormalities in autism. Autism, 10(5), 480–494. doi:10.1177/1362361306066564 [CrossRef]
  • Kral, T. V. E., Eriksen, W. T., Souders, M. C. & Pinto-Martin, J. A. (2013). Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: A brief review. Journal of Pediatric Nursing, 28(6), 548–556. doi:10.1016/j.pedn.2013.01.008 [CrossRef]
  • Kuddo, T. & Nelson, K. B. (2003). How common are gastrointestinal disorders in children with autism?Current Opinion in Pediatrics, 15(3), 339–343. doi:10.1097/00008480-200306000-00020 [CrossRef]
  • Lai, D. C., Tseng, Y. C., Hou, Y. M. & Guo, H. R. (2012). Gender and geographic differences in the prevalence of autism spectrum disorders in children: Analysis of data from the National Disability Registry of Taiwan. Research in Developmental Disabilities, 33(3), 909–915. doi:10.1016/j.ridd.2011.12.015 [CrossRef]
  • Lane, A. E., Geraghty, M. E., Young, G. S. & Rostorfer, J. L. (2014). Problem eating behaviors in autism spectrum disorder are associated with suboptimal daily nutrient intake and taste/smell sensitivity. ICAN: Infant, Child, & Adolescent Nutrition, 6(3), 172–180. doi:10.1177/1941406414523981 [CrossRef]
  • Little, L., Dean, E., Dunn, W. & Tomchek, S. (2015). Developmental stability of sensory seeking. American Journal of Occupational Therapy, 69(Suppl. 1), 6911500096p1. doi:10.5014/ajot.2015.69S1-PO4051 [CrossRef]
  • Little, L. M., Wallisch, A., Salley, B. & Jamison, R. (2016). Do early caregiver concerns differ for girls with autism spectrum disorders?Autism, 21(6), 728–732. doi:10.1177/1362361316664188 [CrossRef]
  • Lukens, C. T. & Linscheid, T. R. (2008). Development and validation of an inventory to assess mealtime behavior problems in children with autism. Journal of Autism and Developmental Disorders, 38(2), 342–352. doi:10.1007/s10803-007-0401-5 [CrossRef]
  • Mannion, A., Leader, G. & Healy, O. (2013). An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(1), 35–42. doi:10.1016/j.rasd.2012.05.002 [CrossRef]
  • Martins, Y., Young, R. L. & Robson, D. C. (2008). Feeding and eating behaviors in children with autism and typically developing children. Journal of Autism and Developmental Disorders, 38(10), 1878–1887. doi:10.1007/s10803-008-0583-5 [CrossRef]
  • McCormick, C., Hepburn, S., Young, G. S. & Rogers, S. J. (2016). Sensory symptoms in children with autism spectrum disorder, other developmental disorders and typical development: A longitudinal study. Autism, 20(5), 572–579. doi:10.1177/1362361315599755 [CrossRef]
  • Nadon, G., Feldman, D. E., Dunn, W. & Gisel, E. (2011). Association of sensory processing and eating problems in children with autism spectrum disorders. Autism Research and Treatment, 2011, 541926. doi:10.1155/2011/541926 [CrossRef]
  • Portney, L. G. & Watkins, M. P. (2015). Foundations of clinical research: Applications to practice (3rd ed.). Philadelphia, PA: F. A. Davis.
  • Råstam, M. (2008). Eating disturbances in autism spectrum disorders with focus on adolescent and adult years. Clinical Neuropsychiatry, 5(1), 31–42.
  • Rutherford, M., McKenzie, K., Johnson, T., Catchpole, C., O'Hare, A., McClure, I. & Murray, A. (2016). Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. Autism, 20(5), 628–634. doi:10.1177/1362361315617879 [CrossRef]
  • Schreck, K. A. & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities, 27(4), 353–363. doi:10.1016/j.ridd.2005.03.005 [CrossRef]
  • Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A. & Jaquess, D. L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders, 43(9), 2159–2173. doi:10.1007/s10803-013-1771-5 [CrossRef]
  • Tavakol, M. & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53–55. doi:10.5116/ijme.4dfb.8dfd [CrossRef]
  • Williams, K. E. & Seiverling, L. (2010). Eating problems in children with autism spectrum disorders. Topics in Clinical Nutrition, 25(1), 27–37. doi:10.1097/TIN.0b013e3181d10958 [CrossRef]
  • Worthington, R. L. & Whittaker, T. A. (2006). Scale development research: A content analysis and recommendations for best practices. Counseling Psychologist, 34(6), 806–838. doi:10.1177/0011000006288127 [CrossRef]

Sample Demographics

Demographic variable n (%)
Child age, months
  0–36 13 (5.9)
  37–72 66 (29.9)
  73–108 54 (24.4)
  109–144 50 (22.6)
  145–192 38 (17.2)
Child gender
  Male 182 (82.4)
  Female 39 (17.6)
Respondent education
  Less than high school 8 (3.6)
  High school 57 (25.8)
  Associate's degree 47 (21.3)
  Bachelor's degree 65 (29.4)
  Master's degree 43 (19.5)
  Unknown 1 (0.4)
Respondent
  Mother 206 (93.2)
  Father 4 (1.8)
  Grandmother 6 (2.7)
  Other primary 5 (2.3)

Internal Consistency Results

Item M (SD) α if item deleted Scale α
Vigilance subscale 0.842
  Can smell certain things before other people can 2.96 (1.42) 0.835
  Will avoid certain restaurants or other rooms in the house because of certain smells 2.18 (1.44) 0.827
  Prefers to have foods in specific shapes 2.17 (1.31) 0.837
  Prefers to have foods with a specific smell 2.17 (1.33) 0.826
  Prefers to have foods with a specific texture 3.59 (1.41) 0.827
  Will only eat food if it is a specific temperature 2.37 (1.37) 0.831
  Has to be distracted while eating 2.25 (1.43) 0.844
  Refuses to eat foods that have touched other food on the plate 2.32 (1.42) 0.821
  Has to eat meals that are different from others in the family 3.42 (1.52) 0.828
  Will gag or vomit if a new food is presented on the plate 1.97 (1.37) 0.836
  Reacts strongly to new foods 3.61 (1.43) 0.819
  Immediately notices if there is a change in one ingredient in their preferred food 3.29 (1.54) 0.821
Intense until . . . subscale 0.771
  Will crave a specific food for a short period, then gives it up completely 2.50 (1.40) 0.740
  Will crave a food for a short period, give it up for a while, and then I have to reintroduce it 3.04 (1.47) 0.731
  Has specific foods that are highly rewarding and would eat them all the time 4.38 (1.05) 0.771
  Asks and/or indicates for specific foods 4.13 (1.14) 0.751
  Has highly preferred foods to the extent that it interferes with other foods/a balanced diet 3.82 (1.46) 0.722
  Will become overfocused on a specific food 2.89 (1.45) 0.736
  Is fascinated with certain tastes 2.32 (1.40) 0.769
  Strongly prefers specific brands of foods 3.15 (1.62) 0.746
Development subscale 0.714
  Has difficulty holding/using utensils 2.69 (1.40) 0.703
  Has difficulty chewing 1.86 (1.21) 0.685
  Keeps food in the mouth for a long time before swallowing 2.20 (1.34) 0.653
  Lets food melt in the mouth before swallowing 1.78 (1.14) 0.679
  Frequently spits out new foods 3.23 (1.49) 0.699
  Stuffs food in cheeks 2.25 (1.52) 0.692
  Prefers drinks that are a certain consistency 2.81 (1.59) 0.705
  Frequently gags when eating 2.03 (1.24) 0.663
  Prefers to walk around when eating 2.97 (1.50) 0.718

Subscale Correlations

Subscale Subscale
Vigilance Intense until . . . Development
Vigilance 1.000
Intense until . . . .717* 1.000
Development .513* .430* 1.000
Authors

Dr. Little is Assistant Professor, Department of Occupational Therapy, Rush University, Chicago, Illinois. Ms. Wallisch is Research Assistant, Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas.

The authors have no relevant financial relationships to disclose.

Address correspondence to Lauren M. Little, PhD, OTR/L, Assistant Professor, Department of Occupational Therapy, Rush University, 600 S. Pauline St. 1009A AAC, Chicago, IL 60612; e-mail: Lauren_little@rush.edu.

Received: October 11, 2017
Accepted: December 11, 2017

10.3928/24761222-20180212-03

Sign up to receive

Journal E-contents