1 A Comparison of Eating Behaviors between Children with and without Autism

Seediscuss ions,stats,an dauthorpr ofilesforthis publication at: https://www. researchgate .net/publicatio n/8264848 AC o mp ariso no fE atin gBe hav ior sBet wee n Ch ildre nw itha ndW itho ut Autism Article  in  Jou rnalofAut ismand Developm entalDiso rders·Se ptember 2004 DOI:10.1023/B:JAD D.0000037419.78 531.86·Source:P ubMed CITATIONS 285 READS 2,670 3authors , including : Kimberly A.Schreck Pennsylva niaState University 31  PUBLICATIO NS  1,300  CITATION S  SEEPROFILE KeithEW illiams PennStat eHershey Medical Centeran dPen … 48  PUBLICATIO NS  1,556  CITATION S  SEEPROFILE Allconten tfollowing thispage wasuplo adedby  KeithEW illiams on 09Februa ry2015. Theuserhasr equestedenha ncementof thedownload edfile. A Comparison of Eating Behaviors between Children with and without Autism Kimberly A. Schreck, 1,4 Keith Williams, 2 and Angela F. Smith 3 Although clinicians typically assume that feeding problems co-exist with a diagnosis of aut- ism, no previous research has compared the eating behavior of children with autism to typi- cally developing children. This study compared caregiver report of eating problems of children with and without autism on a standardized questionnaire. The questionnaire included items pertaining to food refusal and acceptance patterns as well as food presenta- tion requirements. Caregivers were also asked to complete a food inventory that indicated the number of foods eaten within each food group for both the child and the family. Results indicated children with autism have signiﬁcantly more feeding problems and eat a signiﬁcantly narrower range of foods than children without autism. KEY WORDS: Autism; food refusal; food selectivity; pediatric feeding. INTRODUCTION For new parents some of the most important information related to relative s consists of the weight and height of their new baby. At each well child visit, the child’s pro gress on the growth charts is recorded. It is no wonder that caregivers have viewed feeding as one of their most important responsibilities. For the majority of parents, feeding their children has present ed only transient chal- lenges. However, the prevalence of feeding problems among children with developmental disabilities has ranged from 13% to as high as 80% (Coﬀey & Crawford, 1971; Jones, 1982; Palmer & Horn, 1978; Perske, Clifton, McClean, & Stein, 1977). Within our clinical practice, the overwhelming number of children who present with feeding problems also have developmental disabilities. Among these children with developm ental disabili- ties are a number of childr en with autism spectrum disorders. Anecdotal stories ha ve included children who only eat the ‘‘yellow’’ (i.e., McDonald’s French fries, chicken nuggets, etc.) or ‘‘baby food’’ diets, or who will only eat when food has be en presented in a particular manner (e.g., on a Thomas the tank engine plate with no foods touching and only sitting at his picnic table). Unfortunately, although pa rents have reported these behaviors and even diagnostic sources have assumed that eating problem s have been more serious for children with autism than for typically developing children (American Psychiatric Association, 1994), very little research has described these feeding issues related to the diagnosi s of aut- ism spectrum disorders. The few technical reports on eating pro blems that have been conducted with children with autism have reported selective eati ng based on food presen- tation (e.g., only drinking from bottles) and on food types (Ahearn, Castine, Nault, & Green, 2001; Archer & Szatmari, 1991; DeMyer, Ward, & Lintze- nich, 1968; Kanner, 1943; Kinnell, 1983; Lopr eiato & Wulfsberg, 1992; Minshew & Pay ton, 1988; Rai- ten & Massaro, 1986; Stone, MacLe an, & Hogan, 1 Penn State Harrisburg. 2 Hershey Medical Center. 3 Melmark Inc. 4 Correspondence should be addressed to Kimberly A. Schreck, Ph.D., 777 W. Harrisburg Pike, W157 Olmsted Building, Middle- town, PA 17047-4898; Tel.: +717-948-6048; Fax: +717-948- 6519; e-mail: kas24@psu.edu Journal of Autism and Developmental Disorders, Vol. 34, No. 4, August 2004 ( Ó 2004) 433 0162-3257/04/0800-0433/0 Ó 2004 Plenum Publishing Corporation 1995; Teplin, 1999). The major ity of the studies have reported only individual cases of feeding prob- lems for children with autism. Only a pair of studies has examined groups of ch ildren with autism and found strong preferences and idiosyncratic feedi ng behavior among them (Ahearn et al. , 2001; Archer & Szatmari, 1991; Nagai , 1983). Ahearn et al. (2001) have conducted one of the ﬁrst systematic attempts at discovering the amounts of food s within each food group children wi th autism have typically consumed. Unfortunately, the study was of limit ed generalizability due to the small sample size. All of the studies examining types of feeding problem s in children with autism have been limit ed by several factors including small sampl e size, lack of knowl- edge of co-morbid medic al conditions that could aﬀect eating, lack of compari son to the feeding behaviors of children wi thout autism, and inade- quate information on the food s typically available within the family environmen t. The goal of this study was to corroborat e and expand on the information provided by previous case studies and clinical reports by answering the following research questions: (a) do children with autism have diﬀerent eating habits from typical chil- dren? if so (b) what types of foods do children with autism typically eat or refuse? and (c) do famili es of children with autism eat a narrower range of foods than families of children without autis m? METHOD Participants Caregivers of children between the ages of 5 and 12 years ( n ¼ 472; actual range ¼ 7–9.5 ye ars) were recruited to complete questionnaires pe rtaining to their family’s an d child’s eating habits. Thi s age range was chosen to avoid the infant and toddler years when children trans ition from formula to solid foods and adolescents when children engage in activities outside of the home (making it harder for caregivers to accurately report their child’s food preferences). Caregivers of the children with autism were recruited through member ship lists for local , state, and national autism societies , schools for children with autism, and from local doctors . A control group was recruited from local school districts. A local school dist rict in central Penns ylvania agreed to participate in this study. For a control group, parents of all children in classrooms within the tar- get age group received a packet containing identi cal materials as the autis m group. To ensure co nﬁdenti- ality, all names and address es were kept secured by the principa l co-investigators after mailing labels were typed by a research assi stant. No identifying information was requir ed on the returned responses for either the autism group or the control group. Caregiver report of an autism diagnosis and the Gilliam Autism Rating Scale (GA RS) (Gilliam, 1995) were used to assist wi th group assignment (a description of this instrument is included below). Two initial groups were developed from this infor - mation: 1. Control ( n ¼ 298): Children were assigned to this group if their GAR S scores were less than 80 (indicating below average to very low probability of autism) and their parents rep orted no previous or current diagnosis of autism or pervasi ve devel- opmental disorder. Questionna ire return rate for this group was a pproximately 25%. 2. Autism ( n ¼ 138): This group was composed of children who had been diagnose d with autism or pervasive developmental disorde r by a profes- sional and had a GARS score P 80. Although the cut-oﬀ score falls within the GARS range of below average probabil ity of autism, the GARS manual indicates that 90% of children with autism fall within scores of 80 and above (Gilliam, 1995). Conse quently, this range was chosen to include the maximum amoun t of chil- dren with autistic behavior. Questionna ire return rate for this group was approxim ately 29%. However, precise return rates for this group would be diﬃcult to obtain because autism soci- eties and schools were given permission to make copies of the packe ts and distribute to addi- tional parents. Children whose caregi vers reported a profes - sional diagnosis of autism or pervasive developmen- tal disorder, but had GARS scores O 80 ð n ¼ 31 Þ and children whose caregivers did not report a pro- fessional diagnosis of autism, but whose GARS scores P 80 ð n ¼ 5 Þ , were excluded from analys is. Demographic information was collected for all participants and included: date of birth, height, weight, gender, presence of developmental disabili- ties, and presence of medical pr oblems. Statistical t -tests were conducted to determine if the control group and autism group diﬀered on age, height, weight, or gender. Signiﬁcant diﬀerences were only 434 Schreck et al. found for gender t (397.32) ¼ ) 9.32, p ¼ .001 (see Table I for basic demographic information by group). Although certain medical prob lems could inﬂu- ence eating and mealtime behavior, no speciﬁc med- ical diagnoses were excluded . Instead, data on medical diagn oses that could pos sibly inﬂuence feeding was collected. Children with autism were found to have signiﬁcan tly higher rates than expected of medic al problems; howeve r, the number of children with these problems wi thin the autism group ( n ¼ 138) was small: seizure disorde r ( n ¼ 7), current lactose intolerance ( n ¼ 8), obsessi ve com- pulsive disorder ( n ¼ 21), an xiety ( n ¼ 14), pulmo- nary problems ( n ¼ 3), current gastro esophageal reﬂux ( n ¼ 5), prev ious gastroesophageal reﬂux ( n ¼ 9), constipation ( n ¼ 11), diarrhea ( n ¼ 6), and current g-tube feedin gs ( n ¼ 2). Since children with medical problems constituted such a smal l propor- tion of the children with autis m and the causal links between these medical prob lems and eating is not clear, the responses for these childr en were not elim- inated from the study. Materials Children’s Eating Behavior Inventory The Children’s Eating Behavior Inventory (CEBI) (Archer, Rosenbaum, & Streiner, 1991), caregiver report for evaluating mealtim e behaviors and eating behavior s, measures the frequen cy of 19 diﬀerent eating beh aviors through the use of a 5- point rating scale. It also asks caregi vers to evaluate whether or not each behavior present s a problem for the family. Reliability for the total eati ng problem score is in the acceptable range ( r ¼ .87), as is construct validity. This inst rument is currently the only measure of eating and mealtim e behaviors in children, and has been used previously with chil- dren with autism (Ar cher & Szatmari, 1991). Food Preference Inventory The Food Preferen ce Inventory is a listing of foods from each of the ﬁve food groups (fruits, vegetables, dairy, protei ns, and starches). Car egivers indicate whether the child will eat an age-appropri- ate portion of a particular food and whether the food is typically oﬀer ed at meals and eaten by the family. Scores for the ﬁve food groups are obtaine d by summing the foods accep ted by children within each food group (e.g., total number of starches typi- cally eaten). Scores are also obt ained for what types of foods are typically eaten by the parents (e.g., total number of starches eaten) . Gilliam Autism Rating Scale The GARS (Gilliam, 1995) is a professional and parent report scale for evaluat ing autism, co n- structed from criteria in the Diagnostic and Statist i- cal Manual of Mental Disorde rs: Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) and from the Autism Society of America’s (1994) deﬁnition of autism. Gilliam reported the scale ’s uses as providi ng supplem ental informatio n for identiﬁcation of autis m, identifying serious behavior problems, evaluating progres s for educational goals, identifying target goals, and as providing a resear ch measurement for autism (Gilliam, 1995). The four domains (stereotyped behavior , communi cation , social interacti on, and developmental disturbances) together yield an Autism Quotient (AQ) to deter- mine probab ility and severi ty of autism (with a mean of 100 an d a SD of 15). The AQ was normed on a sample of children ( n ¼ 1,092) with autism. The manual reports that of children with diagnosed autism, 90% obtain AQ scores P 80. The test man- ual (Gilliam, 1995) repo rted adequate validity and reliability for test domains and for the AQ. Personal History Form The personal history form was used to g ather demographic information (date of birth, weight, height, and gender). The form also listed a number of medical diagnoses for the caregivers to indicate if their child was currently or previously diagnose d with any of the listed medical diagn oses. All of the medic al Table I. Child Characteristics by Group Assignment Characteristic Control ( n = 298) Autism ( n = 138) Sex a Female 47 10 Male 53 88 Height b 52 51 Weight c 71 66 Age d 108 99 a Reported by percentages of group. b Average height reported in inches. c Average weight reported in pounds. d Average age reported in months. 435 Comparison of Eating Behaviors between Children wi th and without Autism diagnoses were chosen because they have been associ- ated with feedin g or eating problems in the literature. A list of developmental disabilities was also provided and the caregivers were asked to indicate if their child was currently or previous ly diagnosed with any of the listed developmental disabilities. Procedures Initial approval for the project was obtained from the Penn State Oﬃce of Regulatory Compli- ance and the Penn State College of Medicine. Per- mission to conduct the research was also obtained from the autism societies, the pediatricians’ oﬃces, and the school district admini strations. Once verbal permission was granted, the packets were distributed to the autism societies and schoo ls by mail, by ha nd delivery from one of the co-investigators, or by fax. The autism societies and schoo l districts then dist rib- uted the packets (with return postage included) to the parents. Patients of participat ing doctors received a packet sent directly to them through the mail. All participants were asked to complete the questionnaires and return them v ia the mail (returned postage was included in all packets ). RESULTS All analyses were computed using the Statist i- cal Package for the Social Sciences (SP SS) (2000). As previously stat ed, for purposes of general com- parisons of children with autism characteristics, these results were obtaine d by comparing the eati ng behavior of the c ontrol group ( n ¼ 298) and the autism group ( n ¼ 138). General Eating Habi ts Since no signiﬁcant diﬀerence in age between the groups was found and pr evious research has indicated no age diﬀerence interactions with use of the CEBI (Archer et al. , 1991), age was not used as a separate variable in the analyses. General diﬀerences in the children ’s eating hab- its were compared using the CEBI’s total problem score domain (Archer et al ., 1991). The hypo thesis that caregivers of children with autism report their children have signiﬁcantly more feeding prob lems than caregivers of children without autism was conﬁrmed. A t -test was conducted to determine if the children without autism diﬀered from the chil- dren with autism on the CEBI total pro blem score. The Levene’s Test for Equality of Variances was signiﬁcant indicating une qual variances. Conse - quently, the t -test for unequal variances is rep orted t (226.22) ¼ 7.35, p ¼ .001. The autism group ( M ¼ 47.00; SD ¼ 7.01) scored higher than childr en in the control group ( M ¼ 4 1.97; SD ¼ 5.76). Although these diﬀerences indicated that children with autism experienced more general feedi ng problems com- pared to children with fewer autis m symptoms, it did not indicate what types of feedi ng problems were being exhibited. Types of Fee ding Problem s Further analyses were conducted on the types of feeding problems children with autism exhibited. Parent reports of refusing most food s, requiring speciﬁc utensils, requiring particular food presenta- tion, accepting only pureed or low textured foods, and eating a narrow varie ty of foods were com- pared between the control group and the children with autism. An analysis of expected and observed Chi-square scores for food refus al for each group indicated that children wi th autism had a tendency to refuse more foods than ch ildren in the control groups, v 2 ð 1 ; n ¼ 436 Þ¼ 101 : 13 ; p 000. To accept foods, children with autism more likely required speciﬁc utensils ½ v 2 ð 1 ; n ¼ 436 Þ¼ 35 : 29 ; p 000  and particular food present ations ½ v 2 ð 1 ; n ¼ 436 Þ¼ 80 : 75 ; p 000  than children in the control group. Additionally, children with autism were more likely to only accept foods of low texture, such as pure ´ ed foods, v 2 ð 1 ; n ¼ 436 Þ¼ 8 : 75 ; p 01 : Parents also reported that children of autism, regardless of texture, ate only a narrow variety of presented foods, v 2 ð 1 ; n ¼ 436 Þ¼ 105 : 06 ; p 000. In fact, 72% of the children with autism were reported to eat a narrow variety of foods. Clariﬁca - tion of the types of foods eaten by children with autism was then conducted by compari ng parent responses on the Food Prefer ence Inventory’s (FP I) ﬁve food group domains (fruits, vegetables, dairy, protein, and starch) for the two groups. Types of Foods Eaten Statistical t -tests were conducted to determ ine when the children with autism diﬀered from the con- trol group on numbers of fruits, vegetables, dairy, proteins, and starches eaten. When Lev ene’s Test for 436 Schreck et al. Equality of Variances was signiﬁcant indicating unequal variances, the t -test for unequal variances was reported. Becau se multiple comparisons were performed, a more conserva tive alpha was set at .01, due to the exploratory nature of this investigation. Signiﬁcant diﬀerences in the numb ers of each type of foods eaten were report ed for all of the food groups: fruits: t ð 308 : 48 Þ¼ 10 : 79, p ¼ : 001; dairy: t ð 434 Þ¼ 10 : 63, p ¼ : 001; vegetables: t ð 318 : 5 Þ¼  7 : 76, p ¼ : 001; proteins: t ð 324 : 79 Þ¼ 9 : 65, p ¼ : 001; starches: t ð 337 : 88 Þ¼ 8 : 28, p ¼ : 001. The aut- ism group reportedly ate signiﬁcantly fewer foods within each category (Table II contain s the means and SD of the number of foods eaten by food g roup for each group of children). Although the childr en with autism ate signiﬁ- cantly fewer foods from each of the food groups than children without autism, this ﬁnding did not extend to the families, with no signiﬁcant diﬀerences in number of foods eaten from each food group between families of the children with autism and families of children without autism. DISCUSSION The hypothesis that children with autism exhi- bit more eating and meal-time pro blems than typi- cally developing childr en advanced by previous case reports and studies (Ahe arn et al. , 2001; Arche r & Szatmari, 1991; DeMyer et al. , 1968; Kanner, 1943; Kinnell, 1983; Lopreiato & Wulfsberg, 1992; Min- shew & Payton, 1988; Raiten & Massaro, 1986; Stone et al. , 1995; Teplin, 1999) was supported. Speciﬁcally, the results of this study supported pre- vious research that children with autism’ s eating behavior is restricted by food categor y (Ahearn et al. , 2001), by texture (Ahe arn et al. , 2001; Archer & Szatmari, 1991), and that these children refuse foods more often than typicall y developing childr en (Archer & Szatmari, 1991). Thi s study also presents a new and much needed (Ahearn et al. , 2001) aspect to the study of feeding problems for childr en with autism—a comparison to typicall y developing chil- dren. In this study, parents reported their children with autism exhibited more general feeding prob - lems including refusing food s, requiring speciﬁc pre- sentations of foods and speciﬁc utensils, eating only low texture foods, and eating a narrow variety of foods than children without autism. Results from the analysis of the numbers of speciﬁc foods eaten within each food group supporte d that children with autism eat fewer foods within each food group than typically developing children. However, the families of children with and withou t autism eat similar numbers of foods within the food groups. Consequently, the diﬀerences in foods eaten did not appear to be a direct resul t of fewer opportunities for diﬀerent foods within the families of ch ildren with autism. Although this study supplements the avail able information concerning feeding problems and chil- dren with autism, some methodol ogical pro blems could have partially inﬂuenced the resul ts. For example, the selection process for the famili es of children with autism could have provided skewed results. The number of childr en with autis m within the sample ( n ¼ 138) constituted approxi- mately 32% of the total sample. This was higher than the estimated occurrence of autis m within the popul ation (American Psychiat ric Associat ion, 1994) and also could have indicated a selection bias for children with autism with feeding prob- lems. However, because this study contained greater numbers of participant s with a utism than previous studies, it has provided far greater sup- port to the occurrence of feeding problem s within this population. Because the sampl e of children could also have been restricted due to the chosen target age group , the results of this study are also limited to the feed- ing problems of older children with autism. Conse - quently, the chosen targe t age restrictions can be viewed as a partial limitation to this study. Although feeding problems can be observed in younger children wi th autism than our ch osen tar- get age, the results of this study can nonetheless be used to evaluate enduring feeding problems for these children. Additionally, the use of parenta l report of foods eaten by children may have also created less Table II. Numbers of Foods Eaten by Children for Each Food Group Food types Autism group Control group MS DMS D Fruits 8.09 6.52 15.75 7.62 Dairy 4.32 3.30 8.07 3.48 Vegetables 4.00 5.00 8.23 6.06 Proteins 7.82 5.98 14.24 7.40 Starches 15.82 8.80 24.08 11.38 437 Comparison of Eating Behaviors between Children wi th and without Autism accurate results than method of actual presentation of foods (see Ahearn et al. , 2001). For examp le, parents may limit exposure (not supported by this study), present foods to the child that he will read- ily accept, or inaccurately report what the child eats. However, as noted in Ahearn et al. (2001) artiﬁcial eating environmen ts may also create prob- lems with feeding for c hildren with autism due to diﬃculties in accepting diﬀerences in their environ- ments. Consequently, the use of multiple paren tal report measures of eating behavior, including a standardized eating pro blem questi onnaire (C EBI: Archer et al. , 1991), aﬀor ds more conﬁden ce in the results of this study and may provide a more nor- malized view of children with autism’s typical eat- ing patterns. Although signiﬁcantly more research should be conducted to determ ine the feedi ng prob lems associated with autism, this study provides one of the most comprehensive prelimina ry investigations into the diﬀerences between parental reports of feeding problems for childr en with and without autism. The resul ts in this study indicate that the problems parents of children with autism face dur- ing feeding situati ons continue to be a pro blem, long after well ch ild visits stop con centrating on the growth charts. Because feeding issues do not appear to be as transient for children with autism as children with- out autism, clinicians should continue to address feeding issues in children wi th autism after the well child visits. In fact, one study has shown that if the selective feeding issues of children with autism are not addressed , these children are at higher risk for nutritionally related medical problem s, such as rick- ets (Clark, Rhoden, & Turner, 1993). While the long-term eﬀects of feedin g problems are not clear, it is certainly possible they could lead to nutri tional deﬁcits and signiﬁcant medic al issue s. ACKNOWLEDGME NTS This project was partially funded from a grant to K.A. Schreck & K. Williams from the Pennsy lva- nia State University Research Council. Thanks are given to the many families, sup port groups, and schools that participated in our study. Spe cial thanks are given to the Eden school and the South Eastern school district for their cooperation with distribut ing questionnaires to the famili es of their students. REFERENCES Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance or pervasive developmental disorder-not otherwise speciﬁed. Journal of Autism and Developmental Disorders, 31 (5) , 505–511. American Psychiatric Association (1994). Diagnostic and Statisti- cal Manual of MentalDisorders (4th ed.) Washington, DC: American Psychiatric Association. Archer, L. A., Rosenbaum, P. L., & Streiner, D. L. (1991). The children’s eating behavior inventory. Journal of Pediatric Psychology, 16 , 629–642. Archer, L. A., & Szatmari, D. L. (1991). Assessment and treat- ment of food aversion in a four year old boy: A multidimen- sional approach. Canadian Journal of Psychiatry, 35 , 501– 505. Autism Society of America (1994). Deﬁnitio n of autism. The Advocate: Newsletter of the Autism Society of America, 26 (2), Silver Springs, MD: Author. Clark, J. H., Rhoden, D. K., & Turner, D. (1993). Symptomatic vitamin A and D deﬁciencies in an eight-year-old with autism. Journal of Parenteral and Enteral Nutrition, 17 (3) , 284–286. Coﬀey, K., & Crawford, J. (1971). Nutritional problems com- monly encountered in the developmentally handicapped. In M. A. Smith (Ed.), Feeding the handicapped child . Memphis, TN: University of Tennessee Child Development Center. DeMyer, M. K., Ward, S. D., & Lintzenich, J. (1968). Compari- son of macronutrients in the diets of psychotic and normal children. Archives of General Psychiatry, 18 , 584–590. Gilliam, J. E. (1995). Gilliam Autism Rating Scale: Examiner’s Manual . Austin, Texas: Pro-Ed. Jones, T. W. (1982). Treatment of behavior-related eating prob- lems in retarded students: A review of the literature. In J. H. Hollis & C. E. Myers (Eds.), Life threatening behavior: analy- sis and intervention (pp. 3–26). Washington, DC: American Association on Mental Deﬁciency. Kanner, L. (1943). Autistic disturbances of aﬀective contact. Ner- vous Child, 2 , 217–250. Kinnel, H. G. (1983). Feeding diﬃculties in infantile autism. Nursing Times , 52–53. Lopreiato, J. O., & Wulfsberg, E. A. (1992). A complex chromo- some arrangement in a boy with autism. Journal of Develop- mental and Behavioral Pediatrics, 13 (4) , 281–283. Minshew, N. J., & Payton, J. B. (1988). New perspectives in aut- ism. Part 2: The diﬀerential diagnosis and neurobiology of autism. Current Problems in Pediatrics, 18 , 619–694. Nagai, Y. (1983). The characteristics and mechanism of food preference in infantile autism . Japanese Journal of Child and Adolescent Psychiatry, 24 , 260–278. Palmer, S., & Horn, S. (1978). Feeding problems in children. In S. Palmer & S. Ekvalt (Eds.), Pediatric nutrition in develop- mental disorders , (ch. 13, pp. 107–129). Springﬁeld, IL: Charles S. Thomas. Perske, R., Clifton, A., McClean, B. M., & Stein, J. I. (Eds.) (1977). Mealtimes for severely and profoundly mentally-handi- capped persons: New concepts and attitudes . Baltimore, MD: University Park Press. Raiten, D. J., & Massaro, T. (1986). Perspectives on the nutri- tional ecology of autistic children. Journal of Autism and Developmental Disorders , 16 (2) , 133–143. Statistical Package for the Social Sciences (2000) Release 10.0 [Computer software]. SPSS, Inc. Stone, W., MacLean, W. E., & Hogan, K. L. (1995). Autism and mental retardation. In A. C. Roberts (Ed.), Handbook of pediatric psychology (pp. 655–675) New York: Guilford. Teplin, S. (1999). Autism and related disorders. In M. Levine, W. Carey, & A. Crocker (Eds.), Developmental and behavioral pediatrics (pp. 589–605) Philadelphia: Saunders. 438 Schreck et al. View publication stats View publication stats

1 A Comparison of Eating Behaviors between Children with and without Autism

ESTÁCIO

Nutrição

Continue navegando

Materiais relacionados

Perguntas relacionadas

What is the relationship between restricted, repetitive, stereotyped behaviors and interests and abnormal sensory response in children with autism ...

What are the definitions of eating disorders? Eating disorders are a group of mental disorders characterized by disordered eating behaviors aimed ...

What is the purpose of Embargos de Divergência and what are the requirements for its use? The purpose is to unify jurisprudence in higher courts, a...

Which of the following references is related to the topic 'neurobiological aspects of autism'? A reference to a study on visual recognition of bio...

Outros materiais