Parent Self-Reported and Observed Mealtime Behaviors Related to Healthier Eating
Teresa Y. Pan MA1,2, Meredith Dreyer Gillette PhD1,3, Susana R. Patton PhD, CDE1,4
1 Center
for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri; 2 University of Kansas, Clinical Psychology Program, Lawrence, Kansas;
3Children’s Mercy Kansas City, Kansas City, Missouri; 4Department of Pediatrics, The University of Kansas Medical Center
Background
• Children with Autism Spectrum Disorder (ASD) exhibit more problems with mealtime
behavior and specific food preferences than typically developing peers (Provost et al.,
2010).
•
Correlations of DINE Parenting Behaviors and HEI-2010
Pearson correlations were used to evaluate the association between HEI-2010 scores,
PMAS dimensions, and DINE parent behaviors.
DINE Parenting Behaviors
• Food selectivity can relate to poor nutrition in children with ASD. As such, diet quality and
food variety are common reasons for referral for nutritional services (Bowers, 2002;
Cornish, 1998; Herndon, 2009).
• Prior research has used parent-reported mealtime behaviors; however, direct observation
of parent behavior during mealtimes could better inform future feeding interventions.
Results
Data Analysis
r
Results
HEI-2010 Score
r
• This study evaluated whether self-reported and observed parent mealtime behaviors are
associated with an index of healthy eating.
.407*
Coaxing
.266
Physical Prompts
.194
Reinforcement
.354*
Positive Persuasion
-.165
Total Commands
.365*
Daily Fruit & Veg Availability
.428*
Participants
• 35 children with ASD (Mage= 5.77) and their parents.
• Children were 71.4% male and 54.3% White.
Insistence on Eating
.080
Snack Modeling
-.164
Measures
• Healthy Eating Index (HEI-2010): A measure of diet quality based on the U.S. Dietary
Guidelines for Americans. The total HEI-2010 score is based on a sum of the component
scores data taken from a three day diet record that parents were asked to complete.
HEI-2010 scores have a maximum of 100 points.
• Component scores include Total Fruit, Whole Fruit, Total Vegetables, Greens and
Beans, Whole Grains, Dairy, Total Protein Foods, Seafood and Plant Proteins, Fatty
Acids, Refined Grains, Sodium, and Empty Calories.
Special Meals
-.118
Fat Reduction
.195
Many Food Choices
.095
• Dyadic Interaction Nomenclature for Eating (DINE): A behavioral coding system for
mealtime behaviors, including child eating behaviors, child behaviors, and parent
behaviors (Stark et al, 1995).
• Parent mealtime behaviors were recorded and included :
Parent Alpha Commands: Parent orders/suggestions to eat
Beta Commands: Parent orders/suggestions to eat with no opportunity for
compliance (interrupted commands)
Coaxing: Offers of food, evaluation of food, coaching
Physical Prompts: Physical action by parent to assist or indicate to child to eat/drink
Reinforcement: Positive verbal or physical behavior by parent following child’s
eating/drinking
Beta Commands
.117
.011
• Parent Mealtime Action Scale (PMAS): A 31-item self-rating scale in which parents rated
frequency that they engage in a variety of mealtime and food related behaviors.
• Subscales scores include Snack Limits, use of Positive Persuasion, Daily Fruit and
Vegetable Availability, Insistence on Eating, Snack Modeling, Special Meals, Fat
Reduction, and Many Food Choices.
.176
Snack Limits
Use of Rewards
Methods
Alpha Commands
Correlations of Parent Self-Reported Mealtime Behaviors and HEI-2010
Parent Mealtime Action
Scale Subscales
Objective
HEI-2010 Score
*p < .05
•
Several DINE parent behaviors were associated with greater HEI-2010 score:
• Beta (interrupted) commands (r=.407, p=.015)
• Reinforcement (r=.354, p=.037)
• Total commands (r=.365, p=.031).
Discussion
• In children with ASD, parent self-reported behaviors of providing availability of fruits to
the child, and parent eating of fruits and vegetables are related to healthier eating.
Additionally, observed parent behaviors of greater number of total and interrupted
commands and reinforcement during a meal are related to healthier eating.
*p < .05
• PMAS dimension of Daily Fruit and Vegetable Availability was associated with greater
HEI-2010 score (r=.428, p=.010).
• This relationship held with each item within the subscale, such that greater HEI2010 score was associated with:
• “You gave the child fruit each day” (r=.383, p=.023)
• “You ate fruit each day” (r=.335, p=.049)
• “You ate vegetables each day” (p=.357, p=.035)
References
Bowers L. An audit of referrals of children with autistic spectrum disorder to the dietetic service. J Hum Nutr Diet. 2002;15:141144.
Cornish E. A balanced approach towards healthy eating in autism. J Hum Nutr Diet. 1998;11:501–509.
Herndon AC, DiGuiseppi C, Johnson SL, Leiferman J, Reynolds A. Does nutritional intake differ between children with autism
spectrum disorders and children with typical development? J Autism Dev Disord. 2009;39:212–222.
Ingersoll, B., Lewis, E., & Kroman, E. (2007). Teaching the imitation and spontaneous use of descriptive gestures in young
children with autism using a naturalistic behavioral intervention. Journal of Autism and Developmental Disorders, 37(8),
1446-1456.
Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children:
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Therapy in Pediatrics, 30, 220- 233.
Stark, L. J., Jelalian, E., Mulvihill, M. M., Powers, S. W., Bowen, A. M., Spieth, L. E., . . . Hovell, M. F. (1995). Eating in preschool
children with cystic fibrosis and health peers: Behavioral analysis. Pediatrics, 95, 210-215.
Stone, W. L., Ousley, O. Y., & Littleford, C. D. (1997). Motor imitation in young children with autism: What's the object?. Journal
of abnormal child psychology, 25(6), 475-485.
• Treatments should focus on improving eating habits of the whole family and increasing
interaction between parent and child during mealtimes. Some specific strategies that
may be effective could include positive reinforcement when a child takes bites of new
foods and increasing the availability of fruits and vegetables.
• Consistent with existing research showing that children with ASD can benefit from
parent modeling (Ingersoll, Lewis, & Kroman, 2007; Stone, Ousley & Littleford, 1997),
behavioral interventions should instruct parents on how to model eating new foods and
eating fruits and vegetables and how to encourage child imitation of these behaviors in
order to help children with ASD eat more healthfully.
Acknowledgments
The authors wish to thank the parents and children who participated in our study and
contributed the data for the current analyses. We would like to also like to acknowledge
funding from the National Institutes of Health R21 HD076116 (to S.R.P.).
For more information contact: Teresa Y Pan, M.A.; University of Kansas, Department of
Psychology, 1415 Jayhawk Blvd, Lawrence, KS 66045; typan@ku.edu