Examining Mechanisms of Challenging Eating Behaviors in Children with Autism Using a Biopsychosocial Approach.

PROJECT SUMMARY Up to 83% of children with autism spectrum disorder (ASD) exhibit challenging eating behaviors (CEBs), which lead to clear health risks (e.g., obesity, malnutrition) and up to45-90% present with co-occurring gastrointestinal (GI} symptoms. Parents face significant challenges with these behaviors resulting in increased stress, mealtime accommodations, and family burden. Further, the symptoms of ASD are certainly recognized as heterogeneous and the same is true of CEBs, where different behavioral factors often overlap within the child. Due to this complexity, there is currently no standard of care to treat these behaviors in ASD. Because CEBsare a significant clinical issue there is a need to use dynamic methods that account for intraindividual biobehavioral mechanisms to inform novel personalized treatments. To address such a complicated health issue, we will use the biopsychosocialapproach. One novel area, which assesses both the socia/and biological components of eating, is interpersonal autonomic physiological synchrony (PS). PS occurs when behaviors and physiological arousal are co-regulated between a parent and child. Strong parental sensitivity is linked to greater levels of PS and can buffer a child's response to stressors. Yet, parent stress and anxiety can also override a child's cues. Since parent stress is linked to CEBs the same overriding strategies, while well-intentioned, may occur at mealtime. Biosensors used to assess PS have demonstrated clinical utility in autism but have not been used to uncover how parent-child PS may influence CEBs in ASD. Second, parents often report their child's eating patterns are highly variable, and it is difficult to determine what changes may have predicted this variability. Ecological momentary assessment (EMA} gathers real-time, naturalistic, intraindividual information, thus reducing recall bias from families about psychological states prior to a behavior of interest. Third, given the increase in cooccurring GI symptoms, emerging research in autism is focusing on the gut-brain axis as a biomarker by linking microbiome diversity to the autism phenotype. Understanding the link between biological microbiane mechanisms and how these relate to CEBs is necessary to develop comprehensive treatment approaches. Aims include: Aim 1: Examine dyadic, ambulatory physiological data during naturalistic mealtime observations in the home for children with ASD and TD children. Aim 2: Determine how real-time intraindividual parent, child, and environmental factors predict child dietary intake at mealtime using EMA. Aim 3: Explore the relationship between the microbiome diversity, physiological synchrony, child eating behaviors, and child dietary intake. Training will support development in: 1) PS and arousal data; 2) EMA methodology, 3) microbiane methodology, 4) clinical knowledge focusing on underrepresented populations, and 5) professional development. The long-term goal of this K23 is to inform the development of personalized treatment approaches and potential biomarkers of treatment response. This is critical given the serious health consequences of CEBs in ASD.