Mealtime behaviours, diet quality and parental stress in children with autism spectrum disorder: a cross-sectional study from Türkiye.

Abstract

Feeding difficulties in children with Autism Spectrum Disorder (ASD) are prevalent, adversely affecting both the child's nutritional status and the family's psychosocial well-being. This study aimed to examine the interrelationships between mealtime behaviours, diet quality and parental stress in children with ASD. A cross-sectional study was conducted with 111 parents of children diagnosed with ASD (mean age: 6.8±3.5 years) in Antalya, Türkiye. Data were collected via face-to-face interviews using validated tools (Brief Autism Mealtime Behaviour Inventory (BAMBI), parental mealtime strategies, parental stress scale, Quality of Life questionnaire in autism). Diet quality was evaluated using the Healthy Eating Index-2020, derived from 3-day food consumption records. Multivariate linear regression was used to identify independent predictors of diet quality. The prevalence of poor diet quality was alarmingly high (94.5%). Multivariate regression revealed that problematic mealtime behaviours (BAMBI) were a strong independent predictor of lower diet quality (B=-0.370, p<0.001), even after adjusting for sociodemographic factors. While overall proactive parental strategies positively predicted diet quality, specific accommodative practices like preparing special meals correlated negatively. Furthermore, caregivers of girls reported significantly higher stress (p=0.017) and perceived autism-related burden (p=0.003) compared with caregivers of boys. Severe mealtime behavioural dysregulation in ASD intrinsically compromises diet quality and elevates parental psychosocial burden. Clinical management requires a multidisciplinary, family-centred approach integrating behavioural feeding support with caregiver stress management.