Received: 20 May 2019 Revised: 4 July 2021 Accepted: 13 July 2021

DOI: 10.1111/cch.12899

RESEARCH ARTICLE

An investigation of the relationship between the eating

behaviours of children with typical development and autism
spectrum disorders and parent attitudes during mealtime
eating behaviours and parent attitudes during mealtime

Sena Öz1 | Pınar Bayhan2

1
Faculty of Health Sciences, Department of
Child Development, Ankara University,
Keçiören, Ankara, Turkey
2
Faculty of Health Sciences, Department of
Child Development, Hacettepe University,

, Ankara, Turkey
Altındag
Correspondence
Sena Öz, MSc, Faculty of Health Sciences,
Department of Child Development, Ankara
University, Fatih Street 197/A, Keçiören,
Ankara. Turkey.
Email: sena.oz@ankara.edu.tr
Abstract
Background: Nutrition has significant importance in the course of growth and
development in early childhood. Selective and fussy eating is prevalent among
children with autism spectrum disorder and can have a profound impact on parents'
mealtime actions.
Aims: The study aimed to investigate the relationship between parental mealtime
actions and the eating behaviours of children aged 3–5 years with typical develop-
ment (TD) and autism spectrum disorder (ASD).
Methods: A total of 180 parents of children between 3 and 5 years in Ankara
participated in the study; 90 were parents of children with TD, and 90 were
parents of children with ASD. We measured the variables using the Brief Assessment
of Mealtime Behaviour in Children (BAMBIC), Children's Eating Behaviour
Questionnaire (CEBQ), and Parent Mealtime Action Scale (PMAS).
Results: The results revealed that food refusal, disruptive behaviours, and limited
variety in TD children were related to parental actions, such as the use of rewards.
We also found a negative correlation between enjoyment of food and the use of
rewards. Children with ASD displayed differences concerning food refusal, and their
parents were found to prepare more special meals for them compared with children
with TD.
Conclusion: Despite differences, the eating behaviours of children with TD and ASD
show similarities in some cases. If a child has a low interest in eating, then their
parents tend to be more insistent, use more rewards, and offer special meals. On the
contrary, a child's high interest in eating harms such parental behaviours. Because an
acknowledgement that a relationship exists between the eating behaviours of
children and parental actions would make intervening to shape parental attitudes
easier, it is recommended that future studies should be carried out to respond to the
eating problems of children by working with parents.

KEYWORDS
autism spectrum disorder, eating behaviours, family mealtime, fussy eating, selective eating

Child Care Health Dev. 2021;1–9. wileyonlinelibrary.com/journal/cch © 2021 John Wiley & Sons Ltd. 1
2 ÖZ AND BAYHAN
1 | I N T RO DU CT I O N
It is widely known that autism spectrum disorder (ASD) often causes
children to struggle with social interactions, show limited and insistent
behaviours, and exhibit divergent sensory responses (American
Psychiatric Association [APA], 2012). Eating disorders can also be
challenges effectuated by ASD, with recent estimates revealing that
they can seriously affect 46%–89% of all children with ASD (Ahearn
et al., 2001; Ledford & Gast, 2006). Numerous problematic eating
behaviours in children with ASD may hinder their overall feeding
practices and potentially disrupt family mealtimes. Any behaviour
considered a feeding challenge may cause the entire family to
experience difficulties in proper food acceptance, the maintenance of
typical routines, dietary intake, and appropriate mealtime interaction
(Ledford & Gast, 2006).
Examples of inappropriate eating behaviours include eating too
fast, insufficient consumption of foods, resistance to swallowing, and,
most commonly, picky eating (Balıkçı & Çiyiltepe, 2017; Meral, 2017).
Picky eating may develop under the influence of several other factors
such as personality traits, pressure to eat, and family habits or feeding
style (including parental supervision and social effects) (Jani Mehta
et al., 2014; Moroshko & Brennan, 2013). It may also develop as a
result of specific factors such as insufficient breastfeeding, premature
intake of complementary foods before 6 months (Shim et al., 2011),
and delays in the introduction of chewable foods to the child's diet
(Northstone et al., 2001).
Eating and mealtime problems manifested by children during
mealtimes may cause troublesome behaviours, inadequate nutrition,
exhaustion among family members, and uncorrectable dietary routines
(DeGrace, 2004; Lukens & Linscheid, 2008; Rogers et al., 2012). Also,
families may seriously be influenced by the eating problems of their
children with ASD (Ausderau & Juarez, 2013); for example, family
mealtimes may be disrupted because the ASD child requires more
supervision and assistance at the table. In some cases, an independent
mealtime may be preferable given the stressful circumstances that
may arise when the child requires too much attention from other
family members (Nadon et al., 2011).
The socio-economic, cultural, and educational characteristics of
the family, parental religious beliefs, and previous experiences may
shape the eating habits of children with TD or ASD (Anderson &
Lock, 2007; Lafraire et al., 2016). Parents of children with ASD are
likely to experience greater stress levels than parents of TD children
(Larson, 2006; Lecavalier et al., 2006).
Ultimately, the primary purpose of the current study was to
identify the relationship between the eating behaviours of TD and
ASD children and their parents' mealtime actions. Specifically, the
study aimed to investigate the differences in eating behaviours
between two groups of children (TD and ASD) and the attitudes and
interventions of their parents at mealtimes. The results of this study
are believed to be useful for the development of family-centred
mealtime interventions for families with young children with TD
and ASD.
Key Messages
• The eating behaviours of children with TD and ASD show
some similarities. Satiety responsiveness and slowness of
eating in children with TD and ASD are related to food
refusal, limited variety, and disruptive behaviours. In
contrast, enjoyment of food and food fussiness are
inversely related.
• While eating problems, except for neophobia, in children
with TD are mostly related to their parents' use of
rewards, a lack of interest in food in children with ASD,
and parental actions, such as providing children with
special meals, affect each other.
• The slowness of eating in children with TD and ASD
corresponds to an insistence on eating.
• Disruptive behaviours of children with ASD are not
related to parent's feeding attitudes during mealtime.
• Using rewards and the enjoyment of foods are negatively
related to each other for children with TD.
2 | METHODOLOGY AND METHODS

an
The present study employed the correlational design (Erdog
et al., 2014; Karasar, 2009), intending to investigate the eating
behaviours of children with TD and ASD aged 3–5 years and the
effects of parental actions (mealtime feeding and other daily
household routines) towards them.
2.1 | Sampling procedures and sample
The research sample included children aged between 3 and 5 years,
as well as their parents. All of the children attended private preschools
or special needs schools in eight districts of Ankara during the
2017–2018 academic year. The participants were chosen using a
random sampling method for each group of schools.
First off, we used multistage and stratified sampling to identify
the school groups. Then, we randomly chose 115 private education-
rehabilitation schools and 41 private preschools. Finally, we reached a
total of 57 (39 special needs schools and 18 private preschools)
voluntary participating schools. While calculating the sample size, we
considered Cohen's d type 1 error margin (α) = 0.05, effect size = 0.5,
and testing power = 0.85, respectively. Consequently, we obtained a
sample size with 180 participants at our intended confidence level.
Therefore, we delivered 392 questionnaires to the two groups of
parents, of which 180 were included in the study. Each parent
participated in the study with one child and was asked to complete a
consent form. Table 1 shows the distribution of the sample by age
and gender.
ÖZ AND BAYHAN 3

T A B L E 1 Distribution of sample by
Typical development Autism spectrum disorder Total
age group and gender
Category Variable n % n % n %
Age Age of 3 23 25.6 14 15.6 37 20.5
Age of 4 28 31.1 32 35.6 60 33.3
Age of 5 39 43.3 44 48.9 83 46.2
Total 90 100 90 100 180 100
Gender Female 38 42.2 25 27.8 63 35.0
Male 52 57.8 65 72.2 117 65.0
Total 90 100 90 100 180 100

2.2 | Measures 2.2.2 | Children's Eating Behaviour Questionnaire

The Brief Assessment of Mealtime Behaviour in Children (BAMBIC)
and the Children's Eating Behaviour Questionnaire (CEBQ) were
used to determine the eating behaviours of the participating children,
whereas the Parent Mealtime Action Scale (PMAS) was used to
identify parental feeding actions involving their children.
2.2.1 | Brief Assessment of Mealtime Behaviour in
Children
The BAMBIC scale was developed by Hendy et al. (2013) for use in
clinics and schools by professionals or at homes by parents. It is a tool
designed to provide a preassessment of the eating behaviours of
children. The scale comprises three distinct dimensions with 10 items:
limited variety, food refusal, and disruptive behaviour. Scoring varies
by the groups (the group with ASD, the TD group, and those with
special needs) on these three dimensions (Hendy et al., 2013;
Seiverling et al., 2016).
In Turkey, the researchers attempted to adapt the scale in Turkish
in 2019. For face validity concerns, two certified interpreters performed
its translation and back-translation. Then, the translations were assessed
and confirmed by an expert in the field of Turkish philology. For content
validity, the translated survey was presented to the views of nine
experts. The content validity index was determined to be 0.75. The final
draft obtained at the end of this process was submitted to a mother
with no academic credentials to test its intelligibility. For construct
validity, we performed confirmatory factor analysis (CFA) on the
scale. The CFA results revealed the following fit indices: x /SD = 1.91,
2
GFI = 0.93, NFI = 0.92, CFI = 0.96, RMSEA = 0.078, and SRMR =
0.039. Moreover, limited variety, food refusal, and disruptive behaviour
were validated as the dimensions of the BAMBIC. The factor loadings
(λ) of the three-dimensional model of BAMBIC varied between 0.40 and
0.92 by the standard solutions of error variance. Also, the items had the
intended level (≥0.30) of factor load values (Brown, 2015). Accordingly,
the model was found to have a good fit to the data in terms of both
the factor loading values and the fit indices. Finally, we calculated
Cronbach's α coefficients for reliability concerns and found them to vary
between 0.68 and 0.92 for the subscales (Öz, 2019).
This survey was developed by Wardle et al. (2001) to identify chil-
dren's eating behaviours. The original form of the scale consists of
35 items to be answered by parents. It is a 5-point Likert-type scale
with eight distinct dimensions: food responsiveness (FR), emotional
overeating (EOE), enjoyment of food (EF), desire to drink (DD), satiety
responsiveness (SR), slowness in eating (SE), emotional undereating
(EUE), and food fussiness (FF) (Wardle et al., 2001). In the current
study, we utilized the subscales FR, EOE, EF, SR, SE, EUE, and FF. We
did not include DD because we thought it to remain irrelevant to the
goals of the study. In Turkey, Yılmaz et al. (2011) adapted the scale
into Turkish and found the internal reliability coefficients of the
subscales between 0.61 and 0.84 (Yılmaz et al., 2011). In this study,
we found Cronbach's α to be 0.81 for the total score.
2.2.3 | Parent Mealtime Action Scale
PMAS was developed by Hendy et al. (2009). The scale evaluates the
behaviours of parents while feeding their children during mealtime. It
consists of 31 items with nine distinct dimensions: snack limits (SL),
positive persuasion (PP), daily food-vegetable availability (DFV), use of
rewards (UR), insistence on eating (IE), snack modelling (SMO), special
meals (SM), fat reduction (FRD), and many food choices (MFC) (Hendy
et al., 2009, 2016). Parents are asked to mark only one option on a
5-point Likert-type scale for each question; for example, “During
a typical week in the past month, how often did you show each
mealtime action?” In the current study, we considered only PP, DFV,
UR, IE, and SM because the others seemed irrelevant to the research
context. Arslan (2012) adapted the scale into Turkish and calculated
the internal reliabilities of the subscales to be between 0.41 and 0.75
(Arslan, 2012). In this study, we computed the Cronbach's α to be
0.74 for the total score.
2.3 | Ethical issues and data collection procedures
Prior to data collection, the Hacettepe University Research
Ethics Committee granted the relevant approval for our study
4 ÖZ AND BAYHAN

(Number: 16969557-1616, Decision number: GO 17/826-16, and
Date: 24 November 2019). We conducted the study between March
and June 2018.
2.4 | Data analytic strategy
We considered Skewness and Kurtosis values to see whether the data
showed a normal distribution, which led us to run relevant analyses
on the data. We performed correlation analyses to identify if there
were significant correlations between the participants' scores.
Accordingly, we chose the Pearson correlation if the data distributed
normally. When it was not the case, then we calculated Spearman's
correlation coefficient. In addition, t tests and Mann–Whitney U tests
were conducted to reveal whether the groups differed by their scores
on the above-mentioned variables.
3.2 | Results of the scales used to determine
eating behaviours in children
Considering the associations between the subscales of the BAMBIC
and CEBQ, results showed children's food refusal behaviours were
positively related with their satiety responsiveness and slow eating
(rFRL-SR = 0.47, rFRL-SE = 0.44; rFRL-SR = 0.46, rFRL-SE = 0.39, p < 0.05).
Conversely, their enjoyment of food and food fussiness were
found to be negatively correlated (rFRL-EF = 0.42, rFRL-FF = 0.30;
rFRL-EF = 0.44, rFRL-FF = 0.38, p < 0.05). While limited variety of
consumption was positively associated with satiety responsiveness
and slow eating (rSR = 0.54, rLV-SE = 0.25; rLV-SR = 0.61, rLV-SE = 0.24,
p < 0.05), it was negatively correlated with the enjoyment of food
and food fussiness (rLV-EF = 0.56, rLV-FF = 0.69; rLV-EF = 0.59,
rLV-FF = 0.74, p < 0.05). Finally, there was a positive correlation
between disruptive behaviours and slowness in eating (rDB-DD = 0.25,
rDB-EUE = 0.23; rDB-SE = 0.30, p < 0.05).

3 | RESULTS
3.1 | Differences between TD and ASD children by
their scores on the BAMBIC, CEBQ, and PMAS
According to the results, food refusal was higher in children with ASD
than TD children (zFR = 2.65, pFR = 0.01; p < 0.05). We also found
that children with ASD scored higher on the SM subscales than the
TD children (tSM = 3.92, pSM = 0.00; p < 0.05). Moreover, emotional
undereating were more prevalent in TD children than the ASD group
(tEUE = 2.21, pEUE = 0.03; p < 0.05).
3.3 | Relationships between the eating Behaviours
of children and parental feeding attitudes
Table 2 demonstrates the results of the analysis for the BAMBIC and
PMAS. The TD children's food refusal behaviours were positively
related to the use of parental rewards and insistence on eating
(rFRL-UR = 0.35, rFRL-IE = 0.36, p < 0.05). Again, limited consumption
variety for TD children was positively correlated with the use of
rewards (rLV-UR = 0.28, p < 0.05). Furthermore, TD children's disrup-
tive behaviours were also positively associated with the use of

T A B L E 2 Results of the Pearson and Spearman correlation analyses which were conducted to determine the relationship between the points
corresponding to the dimensions of BAMBIC, PMAS scales, and children with TD and ASD

Typical development (N = 90) Autism spectrum disorder (N = 90)

BAMBIC Food Limited Disruptive Food Limited Disruptive

PMAS refusal variety behaviour refusal variety behaviour
PP r 0.20 0.11 0.03 0.04 0.18 0.02
p 0.06 0.30 0.81 0.68 0.09 0.88
DFV r 0.00 0.06 0.06 0.03 0.09 0.02
p 0.97 0.56 0.61 0.81 0.40 0.87
UR r 0.35 0.28 0.23 0.05 0.02 0.17
p 0.00** 0.01* 0.03* 0.62 0.87 0.11
IE r 0.36 0.17 0.22 0.22 0.16 0.19
p 0.00** 0.12 0.03* 0.04* 0.14 0.07
SM r 0.20 0.14 0.01 0.41 0.35 0.07
** **
p 0.06 0.18 0.95 0.00 0.00 0.54
MFC r 0.18 0.16 0.23 0.00 0.07 0.13
p 0.09 0.12 0.03* 0.99 0.52 0.21

Note: r = 0.00–0.30 low, 0.30–0.70 medium, 0.70–1.00 high.

Abbreviations: DFV, daily food-vegetable availability; EI, insistence on eating; MFC, many food choices; PMAS, parent mealtime action scale; PP, positive
persuasion; UR, use of rewards; SM, special meals.
*
p < 0.05.
**
p < 0.01.
 ÖZ AND BAYHAN

T A B L E 3 Results of the Pearson and Spearman correlation analyses that were carried out to determine the relationship between the points corresponding to the dimensions of CEBQ, PMAS
scales, and children with TD and ASD

CEBQ

FR EOE EF SR SE EUE FF FR EOE EF SR SE EUE FF

PMAS PP r Children with 0.09 0.00 0.19 0.10 0.15 0.09 0.02 Children with 0.03 0.02 0.08 0.18 0.15 0.04 0.02
p typical 0.38 0.97 0.07 0.36 0.17 0.41 0.88 autism 0.76 0.88 0.48 0.09 0.16 0.70 0.85
development spectrum
DFV r 0.11 0.15 0.03 0.04 0.11 0.18 0.11 disorder 0.16 0.11 0.23 0.09 0.02 0.22 0.25
* *
p 0.31 0.17 0.78 0.72 0.31 0.08 0.30 0.14 0.33 0.03 0.38 0.88 0.03 0.02*
UR r 0.00 0.01 0.31 0.20 0.26 0.02 0.13 0.15 0.02 0.01 0.01 0.10 0.08 0.05
** *
p 0.99 0.89 0.00 0.06 0.01 0.84 0.21 0.16 0.84 0.89 0.95 0.34 0.47 0.65
IE r 0.02 0.18 0.19 0.18 0.31 0.01 0.08 0.04 0.04 0.16 0.20 0.22 0.02 0.15
** *
p 0.85 0.09 0.07 0.09 0.00 0.90 0.44 0.69 0.70 0.14 0.06 0.04 0.89 0.16
SM r 0.01 0.01 0.15 0.01 0.02 0.13 0.16 0.19 0.16 0.33 0.26 0.20 0.01 0.41
p 0.95 0.95 0.17 0.93 0.89 0.22 0.14 0.07 0.13 0.00** 0.01* 0.06 0.89 0.00**
MFC r 0.05 0.22 0.12 0.07 0.03 0.04 0.07 0.15 0.12 0.14 0.00 0.01 0.13 0.02
*
p 0.65 0.04 0.25 0.54 0.81 0.70 0.54 0.16 0.25 0.18 0.97 0.91 0.21 0.86

Note: r = 0.00–0.30 low, 0.30–0.70 medium, 0.70–1.00 high.

Abbreviations: CEBQ, Children's Eating Behaviour Questionnaire; DFV, daily food-vegetable availability; EF, enjoyment of food; EI, insistence on eating; EOE, emotional overeating; EUE, emotional undereating;
FF, food fussiness; FR, food responsiveness; MFC, many food choices; PMAS, Parent Mealtime Action Scale; PP, positive persuasion; SE, slowness in eating; SM, special meals; SR, satiety responsiveness; UR,
use of rewards.
*
p < 0.05.
**
p < 0.01.
5
6 ÖZ AND BAYHAN
rewards, insistence on eating, and the availability of food choices
(rDB-UR = 0.23, rDB-IE = 0.22, rDB-MFC = 0.23, p < 0.05). As shown in
Table 2, when it comes to ASD children, food refusal had a positive
correlation with special meals and insistence on eating (rFR-SM = 0.41,
rFR-IE = 0.22, p < 0.05). Finally, there was a positive correlation
between limited food variety and special meals (rLV-SM = 0.35,
p < 0.05).
The results of the analyses for CEBQ and PMAS are shown in
Table 3. TD children's emotional overeating was positively related to
many food choices (rEOE-MFC = 0.22, p < 0.05). Also, TD children's
slow eating was positively correlated with insistence on eating and
the use of rewards (rSE-IE = 0.31, rSE-UR = 0.26, p < 0.05). When it
comes to ASD children, enjoyment of food was negatively correlated
with the use of rewards (rEF-UR = 0.31, p < 0.05). While the
enjoyment of food was positively correlated with daily fruit and
vegetable consumption, it was negatively correlated with special
meals. (rEF-DFV = 0.23, rEF-SM = 0.33, p < 0.05). Moreover, satiety
responsiveness and slow eating were positively associated with
special meals and insistence on eating, respectively (rSR-SM = 0.26,
p < 0.05; rSE-IE = 0.22, p < 0.05). Emotional undereating was also
positively correlated with daily fruit and vegetable consumption
(rEUE-DFV = 0.22, p < 0.05). Finally, we found that while food fussiness
was positively correlated with daily fruit and vegetable consumption,
it was negatively associated with special meals (rFF-DFV = 0.25,
rFF-SM = 0.41, p < 0.05).
4 | DISCUSSION
The findings showed that parents of children with ASD prepare more
special meals for their children. Children with ASD may have different
nutritional and metabolic features compared with children with TD
and also require special diets (Önal & Uçar, 2017; Ünal &

lu, 2016). Even special diets are considered individually for
Özenog
each child; parents are only those who decide about diets or meals
for their children (Hyman et al., 2012; Raiten & Massaro, 1986; Uçar &
Samur, 2017). On the other hand, emotional undereating was found
to be higher in TD children than in the ASD group. However,
emotional eating received the least attention even though many
parents were aware that eating behaviours of their children vary by
their mood. Emotional undereating was more salient than emotional
overeating (Wardle et al., 2001).
It is widely accepted that the body mass index is not associated
with emotional undereating (Webber et al., 2009). The results
indicated that children with ASD exhibited more food refusal
behaviours than TD children, which was suggested by the previous
research (Hendy et al., 2013; Meral, 2017; Meral & Fidan, 2014;
Seiverling et al., 2016). Food refusal, such as food expulsion, keeping
the mouth closed, crying, and tantrums, may result in the avoidance of
all feeding situations (De Moor et al., 2007; Hendy et al., 2013;
Seiverling et al., 2016).
One of the novel findings of these results was that food refusal,
limited variety, disruptive behaviours, slowness in eating, and opposite
ways to enjoy food in TD children were linked with the parental use
of rewards. Previous studies reported that parents of children with
disruptive behaviours and food refusal try to encourage them to eat
by offering additional rewards (Hendy & Williams, 2012). When
parents present a new food for their children, they tend to engage in
physical prompting and a rewarding/bargaining process (Blissett
et al., 2012). According to previous research, only 8% of the strategies
used by parents to encourage their children to eat incorporate the use
of rewards as a form of play (Orrell-Valente et al., 2007). However,
using rewards can result in undesirable consequences. For example, if
parents continue to offer favourite foods of children as rewards,
children may lose their interest in those foods over time (Birch
et al., 1980, 1982, 1984; DeCosta et al., 2017; Hendy et al., 2009;
Scaglioni et al., 2011).
Parents often react to food refusal, distributive behaviours, and
slow eating of their TD children with insistence on eating. Similarly,
parents of children with ASD insist on eating when their children
exhibit food refusal and slow eating behaviours. Besides, it is a
widely known fact that many parents often insist their children eat
when they tend to eat too slowly (Kermen & Aktaç, 2018;
Powell et al., 2011; Scaglioni et al., 2011; Ventura & Birch, 2008).
Parents employing insistence try to feed their children even
when they do not want to eat, whereas parents who show positive
persuasion tend to encourage their children to eat through
positive statements (Arslan, 2012; Hendy et al., 2009, 2016;
Williams et al., 2011). However, according to a review study in which
mother–child mealtime behaviours were evaluated through
observation, parental discouragements to eat and negative
statements about food were associated with higher child weight
(Bergmeier et al., 2015).
The results revealed a relation between preparing special foods
for a child with ASD and food refusal, limited variety behaviours, and
satiety responsiveness. Similarly, it was previously concluded that
parents of children who consume a limited variety of food are likely to
prepare special meals for their children (Williams et al., 2011). As is
known, special diet treatments can be used for children with ASD
(Rubenstein et al., 2018; Srivastava, 2019). Furthermore, children with
ASD may eat only mono-coloured food, baby food, or only food
served in a certain way (Schreck et al., 2004; Seiverling et al., 2018). If
the child adopts too limited eating preferences, preparation of special
meals may become inevitable (Zimmer et al., 2012).
As parents of children with ASD who exhibit food enjoyment,
food fussiness, and emotional undereating continue to care about
their children's daily fruit and vegetable consumption, consuming food
specifically prepared for them may be the source of their enjoyment.
A previous study could not find a relationship between ASD children's
sensory difficulties and willingness to maintain routines and food
fussiness (Schreck & Williams, 2006). In a study, in which a home-
centred intervention programme was implemented to mitigate food
fussiness of children with ASD, the researchers observed both
increases in their food acceptance levels and decreases in their
negative behaviours (Seiverling et al., 2012). In another study utilizing
peer modelling and reward based interventions, fruit and vegetable
ÖZ AND BAYHAN
consumption increased among children with ASD (Lowe et al., 2004).
Providing a positive parenting model through daily fruit and vegetable
consumption was found to be more effective than special diets or
special meal preparation (Scaglioni et al., 2008).
Disruptive behaviours and emotional overeating may remain
common among TD children as long as their parents maintain offering
many food choices to them. When children demonstrate emotional
undereating, parents tend to let them eat the meals they like and
replace undesired food with desired meals (Arslan, 2012; Hendy
et al., 2009, 2016; Williams et al., 2011). Emotional overeating
represents a natural response to stress to some extent because most
emotional arousal situations change one's eating activities (Wardle
et al., 2001). Furthermore, existing studies show that emotional
overeating behaviours are directly proportional to weight gains
(Webber et al., 2009). In other words, parents of children with
emotional overeating problems reinforce their such behaviours by
offering them the foods they like, which is likely to result in weight
gain in the children.
5 | C O N CL U S I O N
The present study scrutinized and revealed links between parental
actions during mealtimes and daily and their children's eating
behaviours. Using rewards for TD children was associated with food
refusal, limited variety, disruptive behaviours, and slow eating. In
addition, preparing special meals for children with ASD had a relation
with food refusal, limited variety, and the negative enjoyment of food.
Moreover, there was a relationship between insistence on eating for
both groups and food refusal and slow eating. Overall, the findings
demonstrated the importance of the relationship between parental
actions and children's eating behaviours when developing intervention
programs for parent–child mealtime interactions.
On the other hand, using a larger sample size would provide more
accurate results in future research. It may also be essential to observe
children during mealtimes to identify better their eating behaviours. In
the current study, the eating behaviours of children were assessed
based on their parents' opinions.
ACKNOWLEDGEMEN T
This research was prepared by the authors as a dissertation thesis in
Hacettepe University, Graduate School of Health Sciences, Master of
Child Development and Education.
FUND ING INFORMATION
The authors received no financial support for the research.
CONF LICT OF IN TE RE ST S
The authors declare that they have no conflict of interest.
ETHI CS APPROVAL
This study was conducted according to the guidelines laid down in
the Declaration of Helsinki, and all procedures involving human
participants were approved by the Ethical Committee of Hacettepe
7
University. Written informed consent form was obtained from all
participants.
AUTHOR CONTRIBU TION
All authors have materially participated in the research and the
manuscript preparation.
DATA AVAILABILITY STAT EMEN T
The data set used and analysed during the current study are available
from the corresponding author on reasonable request.
OR CID
Sena Öz https://orcid.org/0000-0003-3034-8481
Pınar Bayhan https://orcid.org/0000-0001-9455-6154
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How to cite this article: Öz, S., & Bayhan, P. (2021). An
investigation of the relationship between the eating
behaviours of children with typical development and autism
spectrum disorders and parent attitudes during mealtime
eating behaviours and parent attitudes during mealtime. Child:
Care, Health and Development, 1–9. https://doi.org/10.1111/
cch.12899