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Login Loading Personal Care Body Scales. Particularities of the eating behavior of people with ASD can be better investigated and classified using structured assessment instruments addressing the diversity of potential behaviors. The need to better investigate the eating behaviors of individuals with ASD led some researchers to develop instruments that could be completed by parents or caregivers, in order to identify eating-behavior related information and variables.
This study's objective was to perform a systematic review of the instruments assessing the eating behaviors of individuals with ASD available in the literature. Researchers with extensive experience in the treatment of ASD chose these descriptors. The following criteria were used: 1 papers published in English, Portuguese or Spanish; 2 instruments intended to assess problems related to the eating behavior of individuals with ASD.
Papers written in other languages were excluded. The following information was extracted from eligible papers: 1 age groups; 2 study objective; 3 variables assessed. One of the researchers assessed the titles, abstracts or both. Screening according to these criteria resulted in 52 papers Figure 1 , 40 of which were excluded, either because they did not meet the inclusion criteria or appeared more than once.
Of the 12 papers selected during the title and abstract screening, seven were excluded because they did not address assessment instruments. Three of the five papers included were conducted in the USA, one in Switzerland, and the other one in Canada, including children, youth, and adults with ASD, aged from 3 to 25 years old. One of these papers was excluded because it did not focus on ASD. The characteristics of the studies included in this review are listed in Table 1 and described as follows:.
Table 1 - Click to enlarge. The sample was composed of 68 children with ASD and 40 children with typical development aged between years old.
The BAMBI was based on the literature describing and assessing pediatric interventions directed toward autistic children with eating problems. The inventory initially contained 20 items addressing the behavior of children and was supposed to be completed by the caregivers. Each item contained five options, ranging from "never" to "always," in which the highest scores indicated more severe problems.
The items were: cries or screams during meals; turns the face or body away from food; spits food; presents disruptive behavior during meals; closes the mouth tightly when food is presented; sits at the table until food is finished; is aggressive during meals; presents self-injurious behavior during meals; is flexible in regard to meal routines; refuses to eat foods that require much chewing; expects to try new foods; does not like certain foods and does not eat them; prefers to repeat the same food in all meals; prefers crunchy foods; accepts or prefers varied foods; prefers foods that are served in a certain way; prefers only sweet foods; prefers foods prepared in a particular way.
The preliminary version with the 20 items was submitted to psychometric analysis in a study with 50 participants Lukens, and the analysis revealed a coefficient of 0. Five items related to the third factor, however, could not be interpreted. Thus, after the analysis, some items were removed, and a final version with 18 items remained.
The internal consistency of the final version with 18 items was 0. In the inter-rater reliability assessment, eating behaviors assessed via the BAMBI and observed by teachers and caregivers were strong and positive with an r value 16 of 0. The BAMBI also presented positive correlations among the factors limited variety, food refusal, autism characteristics when assessing internal validity.
Positive correlations were also found regarding convergent validity. Correlations between individual factor scores and measures of external criteria were also calculated to verify concurrent validity, and the positive values suggest that the BAMBI properly explores the characteristics of autism described in the DSM-IV.
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The parents initially completed the 23 items originally contained in the STEP, and each item refers to one eating characteristic. The items of each dimension showed a loading factor of 0. Factor analysis revealed 15 items distributed into six dimensions: "chewing problems," "eating fast," "refusing food," "food selectivity," "vomiting," and "stealing foods. Concurrent validity was assessed checking for correlations with instruments that had already been validated.
The associations found in the subcategories were: "chewing problems," which was significantly correlated with texture-related problems Beta: 0. The subscale "vomiting" was not correlated with any of the factors. The participants, aged between 15 and 22 years old, were randomly selected from a pediatric neuropsychiatric clinic of a hospital in Sweden. One expert assessed each of the participants, confirming the diagnosis and measuring their intelligence quotient IQ. An inclusion criterion was that the participants should have an IQ within normal parameters to be able to complete the questionnaire themselves.
The subscales and corresponding items were developed using factor analysis together with Cronbach's alpha coefficient. To assess temporal stability, the mean time between test-retest was 34 days with a good interclass correlation index 0. Allen et al.
The participants were recruited through a longitudinal study using the following inclusion criteria: 1 recent diagnosis of ASD within 4 months as reported to the "Autism Diagnostic Observation Schedule" - ADOS Lord et al. Exclusion criteria were: 1 cerebral palsy or other neuromotor disorder that may interfere in the study's assessment; 2 known genetic or chromosomal anomaly; and 3 severe visual or auditory impairment. The BPFAS is composed of 35 items: the first 25 items focus on the child's behavior, and the last 10 items provide an index of the parents' attitudes and strategies concerning eating habits, such as mealtime and eating problems.
In regard to the construct's validity, factor analysis of the scale's items revealed that three factors represented In terms of construct validity, after factor analysis, three factors explained To assess external validity, consequences of the construct and convergent validity, various positive correlations were found, with the effect ranging from small to moderate, among variables of interest involving the children, their parents, autistic symptoms verified with the application of other psychometric scales, and the three new factors noted above.
The factor "behavior during meals" presented six positive correlations of moderate effect: the parents who reported higher levels of autistic symptoms, according to SRS and RBS-R e. Thus, children of parents who reported more frequent behavioral problems experienced more eating-related problems. Hence, the parents who reported their children as presenting frequent eating problems also reported their children to present many sleep-related problems and, as a consequence, the parents experienced higher levels of stress.
No significant correlations were found between the child's age at the time the BPFAS was completed and cognitive functioning, assessed by the MPR, in regard to the factor "food acceptance" and "oral motor problems. Adequate feeding during infancy, from birth and during the first years of life, is essential to ensuring a child's normal growth and development. Child growth is generally associated with bone growth that is reflected in height, but each of the organic systems is developing, including the central nervous system. The growth of the body as a whole depends on appropriate nutrition.
Inadequate nutrition and malnutrition in the first and second phase of childhood may negatively affect child development, as overeating leads to obesity Drewett, As a consequence, eating behavior in ASD is an important dimension because, in many cases, it may endanger the health of individuals.
Accurate propaedeutic of the eating behavior of this population allows a more individualized and complex therapeutic approach. This paper presents an important contribution, as it presents a literature review of the instruments available to assess the eating behavior of children with ASD, identifying the limitations of existing instruments and proposing more appropriate and comprehensive alternatives regarding the diagnosis of ASD as it currently exists.
The initiative to develop a specific scale was important and initiated the concept of measures that could discriminate between the problems presented by individuals with autism compared to those presented by children with typical development. This instrument focuses on eating-related behaviors, disregarding sensorial and gastrointestinal problems frequently found in ASD and that can influence one's eating behavior.
The sample used to validate the instrument was composed of only 68 children with ASD, and the method presented some limitations: the participants' diagnoses were not established by a psychiatrist, but rather through a scale of symptoms completed by the caregivers; the investigation of eating problems did not consider the severity of ASD; the scale and remaining instruments used were posted on a webpage without the presence of someone to clarify potential doubts; the instrument was assessed using a convenience sample: the participants were those registered on a specific site, who consented to take part in the study.
This last aspect specifically reveals an important limitation because the individuals who opted not to participate in the study may possibly differ in some ways from those included in the sample. Reliability analysis revealed high internal consistency for the factors "limited variety" and "food refusal"; however, the factor "autism characteristics" presented moderate consistency.
Positive correlations between the BAMBI and a previously validated instrument that measures behavioral problems during meals were found. We offer custom software solutions that can be uploaded to your equipment right in the field, and output strings can be easily modified for a wide range of printers and data collection requirements.
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