Co-occurring behavioral difficulties in children with severe feeding problems: A descriptive study.
Kids with severe feeding issues often show behavior challenges across the whole day, so assess and treat the full daily routine, not just mealtimes.
01Research in Context
What this study did
Tonnsen et al. (2016) looked at kids who had both severe feeding problems and autism or developmental delay. They wanted to know how many of these children also had behavior troubles outside of mealtimes. The team reviewed clinic records to see who got extra coaching or behavior help during the day, not just at meals.
What they found
About half of the children with feeding problems also received caregiver coaching or behavior support outside mealtimes. Younger kids were more likely to get this extra help. Whether a child had autism or just general delay did not predict who got coaching.
How this fits with other research
Peterson et al. (2016) and Flanagan et al. (2021) extend this picture by showing ABA feeding tactics work once you decide to treat. They tested real interventions after the same kind of assessment L et al. called for.
Kurokawa et al. (2021) and Slaughter et al. (2014) widen the lens further. They found GI pain and sensory issues also link to worse behavior scores in kids with ASD. Together these papers say: look beyond the highchair—GI, sensory, and feeding issues all ride along with behavior problems.
Taylor et al. (2022) and Taylor et al. (2024) add a parent view. They show caregivers like behavior-analytic feeding procedures and want a voice in treatment. This supports L et al.’s finding that families already accept help outside mealtimes when we offer it.
Why it matters
If you only watch meals you will miss half the picture. Run a quick parent survey on sleep, play, and community outings. Add questions about tummy pain and sensory quirks. Then fold those results into your feeding plan. You will spot more functions and earn quicker buy-in.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add five questions about non-meal behavior and GI symptoms to your intake form and review the answers before you write the first feeding goal.
02At a glance
03Original abstract
BACKGROUND: Recent literature highlights the association between behavioral difficulties and the presence of feeding problems in children with an Autism Spectrum Disorder (ASD) relative to children with ASD without feeding problems. However, it is not clear to what extent behavior problems (outside of the meal setting) occur in children with feeding problems without comorbid ASD. AIMS: The purpose is to describe co-occurring behavioral difficulties of a sample of children with severe food refusal/selectivity and examine potential predictors of behavioral difficulties outside of the meal context. METHOD AND PROCEDURES: The medical charts of fifty-four patients were reviewed and data were collected on the frequency of caregiver coaching and/or behavioral intervention outside of the meal context. Age, presence of developmental delay/autism, and type of feeding problem were examined as potential predictors of behavioral support. OUTCOME AND RESULTS: Approximately half of the sample received coaching or individualized intervention. The percentage of caregivers who received individualize coaching were similar across groups. Younger age at admission was a predictor of individual caregiver coaching. Presence of delay/ASD, age, and type of feeding problems were not significant predictors for individualized treatment programing. CONCLUSION AND IMPLICATIONS: These data provide evidence of difficult caregiver-child interactions that occurs outside of the meal context for some children with severe feeding difficulties and suggest that this association may not be exclusive to children with ASD.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.08.009