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Is Using Food As Reward in Children with Autism Associated with Increased Food Responsiveness?
Children with Autism Spectrum Disorder (ASD) are at elevated risk of being overweight and obese (Curtin et al., 2014). Parents use food commonly as a reward for their children’s behavior; however, this is particularly common practice among children with ASD, through approaches such as applied behavior analysis. Research has found a correlation between parents who use food as a reward for their typically developing (TD) children and responsiveness to food and emotional eating (Farrow, 2016). This study seeks to be the first to examine this relationship in children with ASD and whether this relationship is modulated by picky eating status.
Objectives: Determine if parents of children with ASD use food as reward more often than parents of TD children and if food reward usage is correlated with food approach behaviors.
Methods:
Parents of children with ASD (n=153; M age = 8.9; 109 males) and TD children (n=78; M age = 8.3; 36 males) filled out online questionnaires about their children’s eating habits and health. Parent utilization of foods as rewards was assessed using the Child Feeding Questionnaire (Birch et al., 2001) while food approach behavior was assessed using the Child Eating Behavior Questionnaire (CEBQ; Wardle et al., 2001). The CEBQ provides measures of three relevant appetitive traits: food responsiveness, emotional overeating, and enjoyment of food. Picky eating was assessed using an item from the Eating Habits Survey (Wilde et al., 2012).
Results:
Parents of children with ASD reported greater usage of foods as rewards than parents of TD children (t=2.15, p<.05). Food reward utilization was positively correlated with two of the three food approach appetitive traits among all children with ASD: food responsiveness (r=.26, p=.001) and emotional overeating (r=.36, p<.001). However, when splitting the ASD group into picky eaters vs. non-picky eaters, the association with using food as reward and food responsiveness was accentuated in non-picky eaters (n=65; r=.37, p=.003) and disappears among picky eaters (r=.07, p=.54).
Conclusions:
Parents of children with ASD rated themselves as more likely to use food as a reward than parents of TD children, and the frequency of this food reward utilization was positively associated with food approach appetitive traits (i.e., food responsiveness and emotional overeating). Importantly, the link between using food as reward and food responsiveness was not found among picky eaters with ASD suggesting modulatory effects. Given the risks for overweight and obesity in ASD and its health consequences (e.g., cardiovascular health, diabetes, etc.), it is critically important to strive to use non-food-related methods of rewarding children with ASD, so as to try to lower the risk for developing appetitive traits that place children at risk for becoming overweight/obese.