Comparing eating and mealtime experiences in families of children with autism, attention deficit hyperactivity disorder and dual diagnosis

Abstract

Shared family meals are associated with family functioning and thought to protect against disordered eating in families with neurotypical children. Limited research, however, has examined the mealtime structure or experience in families with children with autism (Autism spectrum condition) and/or attention deficit hyperactivity disorder, despite eating behaviour differences in these populations. This study sought to compare children’s eating behaviours and caregivers’ mealtime experiences between families with neurotypical children and those with Autism spectrum condition, attention deficit hyperactivity disorder and dual diagnosis (Autism spectrum condition + attention deficit hyperactivity disorder). Think-Aloud methods established validity for the Children’s Eating Behaviour Questionnaire, Meals in our Household and Perceived Stress Scale measures ( N = 9), prior to administering these to caregivers of children aged 3–15 ( N = 351). Neurodevelopmental condition groups (Autism spectrum condition, n = 80; Attention deficit hyperactivity disorder, n = 88; Autism spectrum condition + attention deficit hyperactivity disorder, n = 65) reported higher food fussiness, emotional undereating, problematic child mealtime behaviours, dietary concerns, caregiver and spousal stress, and less conventionally structured mealtimes than neurotypical families ( n = 118). Attention deficit hyperactivity disorder and Autism spectrum condition + attention deficit hyperactivity disorder groups reported higher food responsiveness, problematic behaviour and caregiver stress than the Autism spectrum condition group. Conversely, Autism spectrum condition and Autism spectrum condition + attention deficit hyperactivity disorder groups reported lower food enjoyment and mealtime structure than the attention deficit hyperactivity disorder group. Distinct eating and mealtime patterns in neurodevelopmental condition families may adversely impact family functioning, emphasising the need for bio-psychosocial approaches and transdiagnostic mealtime support. Lay abstract Children with neurodevelopmental conditions like autism and attention deficit hyperactivity disorder may experience eating difficulties and related health issues later in life. Sharing family meals can help prevent these issues developing, but most studies have looked at families with neurotypical children. Our goal was to learn more about how families of children with autism, attention deficit hyperactivity disorder and both conditions (autism + attention deficit hyperactivity disorder) experience mealtimes. We developed an online survey asking caregivers about their child’s eating, mealtime experience and if they experienced stress. We tested it with nine caregivers and made improvements based on their feedback before recruiting 351 caregivers to complete the main survey. We found that families of children with neurodevelopmental conditions experienced greater food fussiness, emotional undereating, ‘problematic’ child mealtime behaviours, dietary concerns, higher stress for caregivers and spouses and less frequent conventionally structured mealtimes compared to those without these conditions. Families of children with attention deficit hyperactivity disorder and autism + attention deficit hyperactivity disorder reported greater appetite, ‘problematic’ mealtime behaviours and increased stress for caregivers and spouses compared to families of children with autism. Meanwhile, families of children with autism and autism + attention deficit hyperactivity disorder reported less enjoyment of food and less structured mealtimes compared to those with attention deficit hyperactivity disorder. Our findings highlight that families of children with neurodevelopmental conditions, particularly those with autism + attention deficit hyperactivity disorder, have different mealtime experiences and eating behaviours compared to those with neurotypical children. These families may benefit from support at mealtimes. Learning why people do or do not participate in shared family meals will be crucial to developing improved mealtime support in the future.