Behavioral assessment of feeding problems of individuals with severe disabilities.

The team watched five adults with severe intellectual disability eat. Each person lived in a state facility and had long-term food refusal.

Staff offered tiny bites of many foods for three days. They recorded if the person swallowed, spit, or turned away. Foods differed in type (fruit, meat, starch) and texture (puree, chopped, regular).

Every adult fit one of four clear patterns. One man ate only smooth puree. One woman accepted any texture but only starches. Two clients refused every meat item no matter the grind.

The last client ate everything. These profiles showed that refusal can sit with food type, texture, or both.

Robertson et al. (2017) later counted how many people with severe ID also have dysphagia. Their big review says swallowing problems are common, so Pierce et al. (1994) may have missed silent aspiration in their texture tests.

Archibald et al. (2024) tested the AQ-10 in kids with ARFID. They looked at autism traits, not just food refusals. Together the papers form a ladder: first find what is refused, then check if autism or dysphagia drives it.

Parvizi et al. (2026) translated a parent scale into Persian. Their tool asks caregivers; D et al. watched real meals. Both methods work, but direct observation catches subtle texture cues that parent reports can miss.

Before you write a feeding plan, run a three-day probe like this team. Offer each food in each texture and tally acceptance. If the client eats smooth peaches but spits chunky peaches, you know texture is the wall, not taste. Match your treatment to that profile and you will start with the right lever.