The Food Flexibility Challenge Task (FFCT): Developing an Ecologically Valid Measure of Food Flexibility in Children with Autism Spectrum Disorder

Background:  Food selectivity is often a significant concern for children with autism spectrum disorders (ASD). Assessment tools for measuring feeding problems and treatment gains have generally focused on parent report (e.g., food frequency inventories, dietary recall, ratings of mealtime behavior) and food quantity consumed. Few measures, if any, provide an assessment of the functional, daily impact of food selectivity. A measure of real-world food flexibility is needed to characterize what children will eat, and how they cognitively and behaviorally manage novel or non-preferred food.

Objectives: To develop and test the Food Flexibility Challenge Task (FFCT), an ecologically valid measure of food flexibility. The FFCT was based on and adapted from the Executive Function Challenge Task (Anthony et al., 2014). 

Methods: The FFCT was individually administered to 11 males with ASD ages 8-12 years (mean age=9.9; mean FSIQ=109, range 91-132) as part of a small pilot treatment study for food selectivity. 

The FFCT is a 20-minute, interactive assessment comprised of three tasks: 1) the Food Scenario Challenge aasses knowledge of how someone could be flexible in food situations; 2) the Menu Ordering Challenge presents the child with a mock restaurant ordering situation that challenges flexibility (i.e., the child is told his preferred meal choice is unavailble), and 3) the Food Tasting Challengemeasures in vivo willingness to taste foods. Each task has a standardized set of instructions, prompts, and rules for scoring. The FFCT yields three subtest scores and a total score, with higher scores indicating greater food flexibilty.

Scores were compared to parent report measures of flexibility, cognitive set-shifting, insistence on sameness, difficult mealtime behaviors, and anxiety, as well as to age and verbal abilities.

Results: Preiminary pilot data suggest that parent-report of child flexibilty was significantly positively correlated with FFCT total score (r=.70, p<.05) and menu ordering flexibility (r=.70, p<.05). There was also a positive trend for willingness to taste foods (r=.50, p=.12). FFCT performance did not correlate with standardized measures of global cognitive set-shifting, difficult mealtime behaviors, or anxiety. Preliminary findings also sugest no relationship beween FFCT performance and age, but do highlight possible relationships with ASD symptom severity (ADOS Comparison Score r=-.48, p=.17) and with verbal abilities on the more verbally loaded Food Scenario Challenge task (DAS-II Verbal r=.47, p=.15).   

Conclusions: Initial pilot data suggest that the FFCT provides an ecologically valid measure of food flexibility that is sensitive to a child's more global, real-world inflexibility. Although limited by small sample size and reduced power, data offer a promising option for a food flexibility assessment tool that can be used for characterization and treatment outcome measurement. Data collection for this study is ongoing through the pilot treatment study; FFCT sensitivity to treatment effect will be examined at the conclusion of the study in December 2014.