Associations Between Feeding Difficulties, Parental Quality of Life, and Coparenting in Turkish Families of Children With and Without Autism
- Open Access
- 05-03-2026
- Original Article
Abstract
Delen
Autism is a neurodevelopmental condition characterized by deficits in social communication and restricted, repetitive patterns of behavior or interests (American Psychiatric Association, 2013). Regardless of age or cognitive level, feeding and eating difficulties are highly prevalent among individuals with autism (Bandini et al., 2010, 2017). In a study involving 1,462 adolescents, Mayes and Zickgraf (2019) found that atypical eating behaviors—such as limited food preferences and brand-specific choices—were significantly more common in children with autism (70.4%) compared to those with other developmental disorders (13.1%) and the general population (4.8%). These difficulties can negatively affect children’s nutritional balance, hinder healthy development, and are often associated with elevated parental stress and caregiving burden (Matson & Kuhn, 2001).
Common feeding challenges in autism include food selectivity (preference for a narrow range of foods within a food group), food group avoidance, food refusal, pica, overeating, anorexia, regurgitation, allergic reactions, food aversion, and obesity (Al-Khuffash, 2013; Bandini et al., 2010; Matson & Kuhn, 2001). Such problems typically emerge during infancy or early childhood and may persist into adolescence (Al-Khuffash, 2013). Atypical eating patterns are often characterized by strong preferences for or avoidance of specific foods, which may stem from sensory sensitivities related to taste, texture, smell, or temperature (Bandini et al., 2010). These feeding challenges not only affect nutritional outcomes but also are associated with family interactions and parental well-being.
Parents of children with autism face unique challenges in managing mealtimes, including increased food selectivity, food refusal, and disruptive behaviors (Matson & Kuhn, 2001; Al-Khuffash, 2013). Families often adapt by creating individualized meal plans, arranging separate eating environments, and providing verbal prompts and close supervision (Ausderau & Juarez, 2013). In one study, 65% of parents of children with autism reported that their child’s feeding difficulties required substantial attention, dominated family mealtimes, and limited participation of other family members (Marquenie et al., 2011). Such difficulties can diminish shared family mealtime experiences and reduce parental quality of life (Ausderau & Juarez, 2013). However, the impact of these difficulties is not confined to individual parents but may also manifest as stressors within the interparental dynamic, as feeding problems are rarely managed by one caregiver in isolation. Because mealtimes are embedded in daily routines that require coordination (e.g., planning meals, responding to refusals, maintaining consistency), persistent feeding challenges may also spill over into the interparental relationship. Accordingly, examining coparenting—how caregivers collaborate, support, and coordinate around childrearing tasks—offers a family-systems lens for understanding the broader impact of feeding difficulties beyond individual well-being. High-quality coparenting, characterized by effective communication, teamwork, and mutual respect, has been associated with lower levels of parenting stress among both mothers and fathers of children with autism (Ausderau & Juarez, 2013; May et al., 2015). Conversely, poor coparenting—marked by conflict, low emotional well-being, and feelings of parenting inefficacy—has been linked to greater family stress and reduced psychological functioning.
Minuchin’s (1985) family systems theory posits that all family members and subsystems are interconnected and mutually influential. The family comprises interrelated subsystems such as marital, parental, and parent–child dyads, as well as sibling relationships. High marital satisfaction enhances parents’ responsiveness to their children’s needs and promotes positive parent–child interactions. In contrast, marital conflict and dissatisfaction can divert emotional resources toward relationship stress, leading to psychological distress and less effective parenting, ultimately compromising parent–child relationship quality (Osborne & Fincham, 1996). Within this theoretical framework, feeding difficulties can function as a stressor that is associated with the functioning of the entire family system. In families of children with autism, feeding-related challenges often emerge as persistent sources of stress that increase caregiving demands and weaken coparenting dynamics. Therefore, understanding feeding difficulties in autism requires not only a focus on child-specific characteristics but also consideration of their relational and contextual impact on family well-being.
Although feeding problems and parental stress in autism have been extensively documented, empirical studies examining how these difficulties simultaneously relate to parental quality of life and coparenting dynamics remain scarce. Moreover, most existing research has been conducted in Western contexts, raising questions about the generalizability of findings to different cultural settings. Consequently, there is a growing need for studies that integrate feeding difficulties within a family systems perspective and examine these associations across diverse sociocultural contexts.
The present study aims to examine the associations among children’s feeding difficulties, parental quality of life, and coparenting in families of children with autism and typically developing (TD) children. Adopting a comparative and systemic approach, this study offers three primary contributions:
(1).
It conceptualizes feeding difficulties not merely as an individual clinical symptom but as a family-level stressor;
(2).
It provides culturally relevant evidence from a Turkish sample, contributing to the limited cross-cultural literature on autism and family functioning;
(3).
It compares autism and TD families within the same sociocultural context using validated measures of feeding behavior, parental quality of life, and coparenting.
Based on prior literature, the following hypotheses were proposed:
(a).
Children with autism would exhibit higher levels of feeding difficulties compared to their typically developing peers;
(b).
Feeding difficulties would be negatively associated with parental quality of life and coparenting quality; and
(c).
These associations would be stronger in the autism group than in the TD group.
To test these hypotheses, the study used an observational, cross-sectional comparative design with parents of children aged 3–9 years living in Ankara, Türkiye (Autism: n = 67; TD: n = 58; total n = 125). Validated instruments were used to assess parental quality of life, coparenting, and children’s feeding difficulties.
Methods
Participants and Procedure
Participants were parents of children aged 3–9 years who were recruited from special education preschools, rehabilitation centers, and inclusive preschools located in Ankara, Türkiye. Recruitment procedures were facilitated by school administrators, who distributed study information and the online questionnaire link to eligible families. Parents who preferred in-person participation were approached by the researcher during scheduled school visits between July and September 2024. This multimodal recruitment strategy was implemented to increase accessibility for parents of children with developmental differences and to enhance overall response rates.
This study followed an observational, cross-sectional comparative design (Cohen et al., 2018; Creswell & Creswell, 2018) to examine parental quality of life, coparenting dynamics, and children’s mealtime behaviors among parents of children with autism and those of typically developing (TD) children. Parents were eligible to participate if they had a child within the target age range and were able to complete the questionnaire independently. All parents who chose to participate completed the questionnaire voluntarily and anonymously.
Before beginning the questionnaire, parents were provided with information regarding the purpose of the study, confidentiality of responses, and the voluntary nature of participation. Written informed consent was obtained from all participants. The questionnaire was administered either online via Google Forms or in person in a quiet classroom environment. To minimize potential method bias, the survey included varied response formats (e.g., Likert-type scales, multiple-choice items, and short-text fields), and demographic questions were distributed across different sections of the survey to create buffers between conceptually similar scales.
The standardized order of administration was as follows: (1) Demographic Form, (2) Quality of Life in Autism Questionnaire, (3) Coparenting Relationship Scale, and (4) Brief Autism Mealtime Behavior Inventory. Completion time ranged from 30 to 40 min. All data were screened for completeness; no cases required removal. The final analytic sample consisted of 125 parents, including 67 parents of children with autism and 58 parents of TD children.
A purposeful sampling strategy was applied to ensure inclusion of participants relevant to the study aims (Sencer, 1989). A priori power analysis using G*Power 3.1 (Faul et al., 2009) for independent-samples t-tests (two-tailed, α = 0.05, power = 0.80, large effect size f = 0.40) suggested a minimum sample of approximately 120 participants. To account for potential data loss, recruitment continued until 125 complete responses were obtained.
Children in the autism group had a prior clinical diagnosis of autism established by licensed child psychiatrists or clinical psychologists according to DSM-5 criteria. For the present study, diagnosis was verified through official documentation (clinic/hospital diagnostic reports or individualized education program records) provided by the family or school. Inclusion required an existing autism diagnosis and age 3–9 years. The TD group included children with no neurodevelopmental or psychiatric diagnoses, no ongoing evaluations, and no special education services, confirmed by parent report and school records. For both groups, exclusion criteria included known genetic syndromes and uncorrected hearing or vision impairments.
Ethics Approval
The study was approved by *** University Social and Human Sciences Ethics Committee (Approval No: ***, ***). All participants provided written informed consent.
Measures
Demographic Information Form
Developed by the researchers, this form was designed to collect basic information about families of children with autism and TD children. It included questions on the parent’s gender, the child’s gender, age, diagnostic status, marital status, and household composition.
Quality of Life in Autism Questionnaire (QoLA)
The QoLA was developed to assess the quality of life of parents of children diagnosed with pervasive developmental disorders based on DSM-IV-TR criteria.
It consists of two parts:
Part A assesses parents’ perceptions of their own quality of life and includes 28 items rated on a five-point Likert scale (1 = not at all, 5 = very much).
Part B measures how problematic parents perceive their child’s autism-related difficulties across 20 items rated from 1 (very problematic) to 5 (not at all problematic). Higher scores indicate fewer perceived difficulties.
Internal consistency coefficients were α = 0.92 for Part A and α = 0.94 for Part B, and test–retest reliability coefficients were 0.68 and 0.76, respectively (Özgür et al., 2017). In the present study, to assess parental quality of life, the QoLA Part A total score was used. This approach aligns with the scale’s Turkish validation study, which recommends scoring Part A (parental well-being) and Part B (child-related difficulties) separately (Özgür et al., 2017). Part B, which reflects parents’ perceptions of their child’s autism-related difficulties, was not included in the main analyses because our focus was on parents’ own well-being rather than their appraisal of child symptom severity.
Coparenting Relationship Scale (CRS)
The Coparenting Relationship Scale (CRS), developed by Feinberg et al. (2012) and adapted into Turkish by Çetin and Demircan (2022), assesses parental support, cooperation, and undermining behaviors in parenting. The Turkish version includes 12 items rated on a 7-point Likert scale (0 = not at all true of us, 6 = very true of us) and consists of two subdimensions: Support (SUP) and Undermining (UND). For the analyses, the CRS Total Score was calculated by summing all items (after reverse-scoring the ‘Undermining’ items, as per the scale’s guidelines) to represent the overall quality of the coparenting relationship. Confirmatory factor analysis in the Turkish adaptation confirmed a two-factor structure with satisfactory fit indices, and internal consistency coefficients were SUP = 0.83, UND = 0.62, and overall α = 0.83 (Çetin & Demircan, 2022).
Brief Autism Mealtime Behavior Inventory
The BAMBI evaluates problematic mealtime behaviors in children and was developed and psychometrically evaluated in children with autism (Lukens & Linscheid, 2008). The original scale consisted of 18 items across three dimensions and was later refined to a 14-item version in subsequent validation work. Confirmatory factor analysis demonstrated acceptable model fit (χ²/df = 3.6, RMSEA = 0.09, SRMR = 0.07, GFI = 0.89, AGFI = 0.84, IFI = 0.90, CFI = 0.90). Internal consistency was α = 0.79, and test–retest reliability was high (Pearson r = .86; Spearman ρ = 0.83).
In the present study, the Turkish adaptation of the BAMBI was used (Meral & Fidan, 2014), as it has been translated, culturally adapted, and psychometrically validated for use in Türkiye. Although the BAMBI was developed for use in samples of children with autism, it was administered to both diagnostic groups for comparative purposes; findings in the typically developing group should be interpreted cautiously as indicators of general mealtime behavior difficulties rather than diagnostic inference.
Psychometric Evaluation of Instruments
All instruments utilized in this study have demonstrated robust psychometric properties in previous validation research. (Çetin & Demircan, 2022; Lukens & Linscheid, 2008; Meral & Fidan, 2014; Özgür et al., 2017). In the current sample, the high internal consistency observed across all measures—with Cronbach’s alpha coefficients of 0.96 for QoLA Part A, 0.83 for BAMBI, and 0.90 for the Coparenting Relationship Scale—further supports the reliability of the data. Given the well-established nature and cultural validity of these tools in the Turkish context, we relied on the original validated factor structures rather than re-estimating them for this specific sample. Although the QoLA was originally developed for parents of children with autism, Part A focuses on parents’ own quality of life rather than child-specific or autism-related symptom severity. Accordingly, Part A was considered appropriate for use across both autism and typically developing groups in the present study.
Statistical Analysis
Statistical analyses were conducted using IBM SPSS Statistics 28.0. No missing data were observed; therefore, no cases were removed. Internal consistency was assessed using Cronbach’s alpha coefficients. Sampling adequacy of the scales was not re-evaluated through factor analysis, as all measurement instruments were previously validated in the literature. Relationships between variables were examined using Pearson’s correlation coefficients, or Spearman’s rho when normality assumptions were not met (Tabachnick & Fidell, 2019). The normality of the data was rigorously assessed using the Shapiro-Wilk test. The results indicated significant deviations from normality for the BAMBI total scores (p < .001) and QoLA scores (p = .003). While the Coparenting Relationship Scale scores were closer to a normal distribution (p = .054), non-parametric statistical methods—specifically the Mann-Whitney U test for group comparisons and Spearman’s rank correlation for relational analyses—were primarily employed to maintain statistical robustness across all variables. Given that the key variables of feeding difficulties (BAMBI) and parental quality of life (QoLA) were not normally distributed (see Table 4), Spearman’s rho (ρ) was used for all reported correlations involving these variables.
Results
Descriptive statistics for parent and child age are presented in Table 1. Children’s ages ranged from 3 to 9 years (M = 5.74, SD = 1.35), and parents’ ages ranged from 26 to 53 years (M = 38.77, SD = 5.98), indicating a relatively homogeneous age distribution.
Table 1
Distribution of parents’ and children’s ages
Variable | M | SD | Min | Max |
|---|---|---|---|---|
Child’s Age | 5.74 | 1.35 | 3 | 9 |
Parent’s Age | 38.77 | 5.98 | 26 | 53 |
Socio-demographic characteristics stratified by diagnostic group are presented in Table 2. Chi-square analyses of the categorical variables in Table 2 indicated no significant between-group differences in parent gender, relation to child, marital status, or household composition (ps > 0.10). However, child gender differed between groups, with a higher proportion of boys in the autism group (χ²(1) = 7.10, p = .008). Independent-samples t-tests indicated no statistically significant differences between groups in child age or parental age (ps > 0.05).
Table 2
Socio-demographic variables of parents and children
Socio-demographic variable | Group | Autism (n, %) | TD (n, %) |
|---|---|---|---|
Parent gender | Male | 5 (7.5%) | 10 (17.2%) |
Female | 62 (92.5%) | 48 (82.8%) | |
Relation to child | Mother | 62 (92.5%) | 48 (82.8%) |
Father | 5 (7.5%) | 10 (17.2%) | |
Child gender | Male | 49 (73.1%) | 28 (48.3%) |
Female | 18 (26.9%) | 30 (51.7%) | |
Marital status | Married | 65 (97.0%) | 56 (96.6%) |
Single/Divorced | 2 (3.0%) | 2 (3.4%) | |
Household composition | Nuclear family | 62 (92.5%) | 54 (93.1%) |
Extended family | 5 (7.5%) | 4 (6.9%) |
Table 3 presents the results of the normality assessment based on the Shapiro–Wilk test. The Coparenting Relationship Scale and BAMBI Section A demonstrated normal distributions, whereas BAMBI Total, BAMBI Section B, and the Quality of Life in Autism Questionnaire were non-normally distributed. Accordingly, parametric tests were used for variables meeting normality assumptions, and non-parametric tests were applied for variables that did not.
Table 3
Summary of normality assessment and analysis decision
Scale | p (Shapiro–Wilk) | Normality decision | Analysis type |
|---|---|---|---|
Coparenting Relationship Scale | 0.054 | Normal | Parametric |
BAMBI – Total Score | < 0.001 | Non-normal | Non-parametric |
BAMBI – Section A | 0.170 | Normal | Parametric |
BAMBI – Section B | 0.001 | Non-normal | Non-parametric |
Quality of Life in Autism Questionnaire | 0.003 | Non-normal | Non-parametric |
Correlations among feeding difficulties, parental quality of life, and coparenting are reported in Table 4. In the autism group, feeding difficulties were negatively associated with parental quality of life (ρ = −0.43, p < .001, 95% CI [− 0.61, − 0.21]) and coparenting (ρ = −0.33, p < .01, 95% CI [− 0.53, − 0.10]). In the TD group, feeding difficulties were also negatively associated with parental quality of life (ρ = −0.27, p < .05, 95% CI [− 0.49, − 0.01]), whereas the association with coparenting was small and non-significant (ρ = −0.20, p = .14, 95% CI [− 0.44, 0.06]).
Group comparisons between autism and TD children are presented in Table 5. Children with autism exhibited higher feeding difficulties than TD children (Mann–Whitney U: z = 2.52, p = .012, r = .23; parametric robustness check: t(123) = 2.89, p < .01, d = 0.52). Parents of children with autism reported lower quality of life than parents of TD children (t(118) = − 5.58, p < .001, d = 0.99). Coparenting did not significantly differ between groups (t(118) = − 0.89, p = .38, d = 0.16; Mann–Whitney U = 1748, p = .34). Because CRS total scores approximated normality, independent-samples t-tests were treated as the primary group-comparison analyses for coparenting, with Mann–Whitney U tests reported as robustness checks.
Table 4
Correlations between feeding difficulties, parental quality of life, and coparenting (with 95% CI)
Group | Variables | ρ | p | 95% CI |
|---|---|---|---|---|
Autism | Feeding - parental QoL | −0.43 | < 0.001 | [− 0.61, − 0.21] |
Autism | Feeding - coparenting | −0.33 | < 0.01 | [− 0.53, − 0.10] |
TD | Feeding - parental QoL | −0.27 | < 0.05 | [− 0.49, − 0.01] |
TD | Feeding - coparenting | −0.20 | 0.14 | [− 0.44, 0.06] |
Table 5
Group differences between autism and TD groups on feeding difficulties, parental quality of life, and coparenting
Outcome | Primary test | Statistic | p | Effect size | Robustness check |
|---|---|---|---|---|---|
Feeding Difficulties | Mann–Whitney U | z = 2.52 | 0.012 | r = .23 | t(123) = 2.89, p < .01, d = 0.52 |
Parental QoL | Independent t-test | t(118) = − 5.58 | < 0.001 | d = 0.99 | — |
Coparenting | Independent t-test | t(118) = − 0.89 | 0.38 | d = 0.16 | U = 1748, p = .34 |
Finally, the potential influence of child age on the study variables was examined to address whether feeding challenges intensify as children grow older. Correlations were also examined to determine if child age was associated with the primary variables. Spearman’s rank-order correlation analyses revealed no significant associations between child age and feeding difficulties (ρ = 0.08, p = .37), parental quality of life (ρ = −0.05, p = .58), or coparenting quality (ρ = 0.11, p = .22). These results suggest that feeding challenges and their impact on family dynamics remain relatively consistent across the investigated age range of 3–9 years.
Discussion
The findings of this study indicate that higher levels of feeding difficulties are associated with lower parental quality of life, with this association being particularly pronounced among families of children with autism. These results are consistent with prior research suggesting that feeding challenges such as food selectivity, texture sensitivity, and rigid mealtime routines in children with autism can increase parental stress and disrupt family functioning (Conde et al., 2023; Papadopoulos, 2021). Similarly, previous studies have shown that parents of children with autism report lower quality of life compared to parents of typically developing (TD) children (Vasilopoulou & Nisbet, 2016). Because the present study focused on QoLA Part A, which assesses parents’ own quality of life, and did not include QoLA Part B, inferences regarding the severity of children’s autism-related difficulties were not examined.
The lower quality of life observed in parents of children with autism may also be interpreted through the lens of normative parenting pressures within the Turkish sociocultural context. In cultures where communal dining practices and social conformity are highly valued, mealtime behaviors often carry symbolic meaning beyond their functional role. Parents may therefore experience heightened social scrutiny when their child’s feeding behaviors deviate from culturally expected norms. Rather than reflecting the impact of the diagnosis alone, such pressures may contribute to diminished parental well-being by amplifying feelings of stigma, parental blame, and emotional labor. Parents are often required not only to manage their child’s sensory-based feeding challenges but also to anticipate and regulate social judgments from extended family members and the broader community. From this perspective, cultural expectations surrounding “good parenting” may partially explain the strong association between feeding difficulties and reduced parental quality of life observed in this study and represent one plausible mechanism through which feeding challenges exert their broader family-level impact. Recent theoretical work further emphasizes that the challenges associated with autism are not solely rooted in individual characteristics, but are substantially shaped by socially constructed norms, expectations, and stigma surrounding “normal” development and behavior. From an intersectional and minority stress perspective, such normative pressures may contribute to emotional burden and reduced well-being among caregivers, beyond the effects of the diagnosis itself (Botha & Gillespie-Lynch, 2022). Further empirical support for this perspective comes from research demonstrating that autism-related stigma and social identity pressures are closely linked to well-being outcomes. For example, Bury et al. (2023) showed that experiences of stigma and normative expectations surrounding autism are reflected in language preferences and are associated with how individuals make sense of their identity within social contexts. Such findings reinforce the view that sociocultural norms and stigma may extend beyond the individual and shape family members’ emotional experiences, including parental well-being.
In addition, a significant negative association was found between feeding difficulties and coparenting relationships within the autism group. This finding is consistent with prior research which has also linked feeding problems to heightened parental stress, disagreement, and reduced cooperation (Meral & Fidan, 2014; Sim et al., 2017). These factors, in turn, have been associated with poorer coparenting quality (Meral & Fidan, 2014; Sim et al., 2017; Thullen & Bonsall, 2017). These findings highlight the importance of family-based interventions that strengthen parental communication and support shared responsibility within the family system. In line with family systems theory, feeding difficulties in autism appear to function as a stressor that is associated with both parental well-being and coparenting, suggesting spillover effects from child-specific challenges to interparental dynamics (Minuchin, 1985).
The results can also be interpreted in light of the cultural characteristics of Turkish family structure. In many Turkish families, traditional gender roles and the maternal responsibility for caregiving continue to prevail. Consequently, the concentration of caregiving and feeding duties on mothers may exacerbate parental stress, contributing to the strong association between feeding difficulties and reduced parental quality of life observed in this study. In contrast, Western samples tend to reflect increasingly egalitarian coparenting dynamics, where fatherhood is gaining greater social and emotional significance (Buchler et al., 2017). Fathers’ involvement has been identified as an important factor contributing to children’s developmental outcomes and overall well-being (Pleck, 2010). Recent studies suggest that men are increasingly sharing household and childcare responsibilities with their partners, and that egalitarian values are associated with more balanced divisions of domestic labor (Churchill & Craig, 2022; Garcia Roman & Cortina, 2016).
Although feeding difficulties among TD children have a milder association with parental quality of life, issues such as food selectivity or overeating can still generate stress and emotional burden for parents (Lydecker et al., 2020; Wilksch, 2023). The absence of a significant association between feeding difficulties and coparenting among TD families may indicate that such problems are more manageable and less disruptive to parental cooperation. Prior research has hypothesized that positive coparenting dynamics can buffer the effects of behavioral challenges and promote healthier eating habits in children (Chen et al., 2024).
Group comparison analyses confirmed that feeding difficulties are more prevalent and severe among children with autism (Råstam et al., 2013; Wentz et al., 2019). This finding underscores the emotional and practical support needs of parents raising children with autism. Consistent with previous research, the results also demonstrated that parents of children with autism reported significantly lower quality of life than parents of TD children, which may be attributed to higher caregiving demands, behavioral challenges, and emotional strain (Eapen & Guan, 2016; Likhitweerawong et al., 2022). The findings further reinforce the need for targeted psychosocial interventions to support families of children with autism (Eapen et al., 2014).
Finally, the absence of a significant difference in coparenting quality between the autism and TD groups suggests that parents of children with autism may maintain comparable levels of cooperation and mutual support despite the challenges they face. Some studies have proposed that the diagnostic process and shared caregiving responsibilities in autism may, in fact, strengthen parental collaboration and enhance coparenting quality (May et al., 2017; Sifuentes & Bosa, 2010).
Overall, the findings suggest that feeding difficulties are associated with a significant burden on parental well-being, whereas coparenting processes appear to remain relatively resilient to these challenges. These results emphasize the importance of holistic, family-centered support programs that address both children’s feeding difficulties and parental adjustment.
Limitations and Future Directions
The present study has several limitations. First, the sample was limited to families residing in Ankara, the capital city of Türkiye, which may restrict the generalizability of the findings. Second, the study relied exclusively on parent-report measures, which may be influenced by subjective perceptions or social desirability bias. Although self-report instruments are widely used in family research, future studies would benefit from incorporating objective and observational assessments to strengthen validity. For example, standardized mealtime observation protocols could be used to code child behaviors during meals (e.g., food refusal, bite acceptance, latency to begin eating) as well as parental strategies (e.g., prompts, pressure, responsiveness). In addition, video-based behavioral coding of naturalistic mealtime interactions may provide richer insight into parent–child dynamics that are not fully captured by questionnaire-based assessments.
In addition, the study design involved informing participants about the general purpose of the research as part of the ethical informed consent procedure. Although this information was provided at a broad level and specific hypotheses were not disclosed, it is possible that participants’ awareness of the study context may have influenced their responses through demand characteristics. To mitigate this risk, data were collected anonymously, and the questionnaire emphasized general experiences rather than evaluative judgments or expected outcomes. Nevertheless, future research may further strengthen internal validity by incorporating multi-informant reports or observational methodologies that are less susceptible to self-report bias.
Moreover, the cultural context in which this study was conducted reflects a family structure characterized by traditional gender roles. This may contribute to mothers assuming greater caregiving responsibilities and experiencing parental stress differently. Future research should explore in greater depth how such cultural factors are associated with parental quality of life and coparenting relationships.
From an applied perspective, family-centered interventions that integrate parental stress management, feeding therapy, and coparenting support could holistically enhance the well-being of both children and parents.
Conclusion
This study examined the relationships and differences in feeding difficulties, parental quality of life, and coparenting relationships between parents of children with autism and those of typically developing (TD) children. The findings underscore that feeding challenges in autism are not merely isolated behavioral issues but are deeply intertwined with broader family well-being and interparental dynamics. While feeding is often viewed primarily as a nutritional or behavioral concern, our results suggest it acts as a significant stressor that spills over into the interparental relationship.
The findings indicate that feeding difficulties among children with autism are negatively associated with both parental quality of life and coparenting relationships, suggesting that feeding problems are not solely child-specific but also associated with broader family dynamics. In families of typically developing children, feeding issues showed a mild association with parental quality of life, but were not significantly associated with coparenting quality. This suggests that such difficulties may be linked to less relational strain compared to families of children with autism.
Parents of children with autism reported higher levels of feeding difficulties and lower quality of life compared to parents of TD children; however, coparenting quality did not differ significantly between the two groups. These results suggest that feeding difficulties may be associated with a more specific burden on parental well-being rather than on parental cooperation.
Taken together, the present findings highlight that feeding difficulties in autism may warrant consideration not only in terms of nutritional risk, but also as potential indicators of family stress and parental well-being. Although this study does not evaluate intervention effectiveness, the observed associations suggest that feeding-related challenges are embedded within broader family processes. From this perspective, future research may benefit from examining child-focused feeding interventions that incorporate caregiver support components, particularly for families experiencing elevated stress. In addition, given the associations observed between feeding difficulties and coparenting quality in families of children with autism, future intervention-based studies may consider how parental coordination and shared caregiving responsibilities are addressed during the management of feeding challenges. Finally, within the Turkish sociocultural context—where caregiving responsibilities are often disproportionately assumed by mothers—greater paternal involvement represents a potentially important area for future investigation. These considerations should be interpreted cautiously and warrant further examination through longitudinal and intervention-based research designs.
Acknowledgements
We extend our sincerest gratitude to all the participating families who dedicated their time and shared their experiences for this study.
Declarations
Conflict of Interest
The authors declare no conflict of interest.
Ethical approval
Ethical approval was received from the Hacettepe University Social and Human Sciences Research Ethics Committee (Approval No: E-68552689-302.08-00003702949; August 20, 2024).
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