Observation and comparison of mealtime behaviours in a sample of children with avoidant/restrictive food intake disorder and a control sample of children with typical development

The file attached to this record is the author's pre- peer reviewed version. The Publisher's final version can be found by following the DOI link.Objectives: Despite widespread use of behavioural observations to evaluate child feeding behaviours in research and clinical practice, few studies have comprehensively characterised mealtimes or identified features that differentiate children with and without disordered feeding; these were the aims of the current study. Methods: Mealtime observations were conducted for 18 children with Avoidant Restrictive Food Intake Disorder (ARFID) and 21 typically developing children. Observations were coded inductively, and associations between disorder and observed mealtime actions were examined. Results: Most behaviours were observed across both clinical and non-clinical mealtimes, and many did not differ in frequency between children with and without ARFID. However, significant group differences were observed in the frequencies of behaviours relating to food intake, visual and physical engagement with feeding, and movement during mealtimes. Conclusions: The comparability of behaviours across clinical and non-clinical groups suggests that eating behaviours exist on a continuum from ‘normal’ to ‘abnormal’, with group differences relating to frequency rather than type of behaviour. The behavioural differences observed in this study suggest that identification of children with ARFID should focus on child engagement with food and restlessness during mealtimes. Reliance on emotional and escape-maintained behaviours will lead to under-recognition of families in need of clinical support