This study is the first study known in the literature that was planned and conducted to determine the relationship between the cooking and food preparation skills of mothers with children diagnosed with autism spectrum disorder and their children's eating behaviors and gastrointestinal symptoms.
It is thought that parents having sufficient knowledge about the nutrition of their children with autism will reduce the symptoms of autism seen in children with autism (Senguzel et al., 2021). In line with the data obtained in this study, approximately half of the mothers stated that they had knowledge about the nutrition of their children with autism. Similarly, Kabasakal et al. (2021) reported that two-thirds of parents with children with autism had sufficient knowledge for their children with autism. In contrast to these results, Zeybek (2023) found that most of the parents did not have sufficient knowledge about the nutrition of their children with autism and that parents wanted to have information about the nutrition of their children with autism. When the results obtained from the literature review are compared, it is thought that one of the reasons why mothers declared that they had nutritional information about their children may be due to the awareness raising in rehabilitation centers and hospitals where they take their children for treatment.
When the mothers were questioned about their cooking at home, it was observed that the majority of them cooked every day and that they learned cooking from their mothers or from the internet as adults. Generally, mothers reported that they spent one to two hours a day in the kitchen preparing meals and that the meals cooked were easy to prepare and required manual labor. In a study conducted on adults, it was found that the majority of individuals cooked every day, learned to cook from their mothers, and generally cooked dishes that required manual labor and were easy to prepare (Keles & Akcil, 2021). Likewise, it was found that the majority of students learned to cook at an early age and from a family member (Colton & Bulbul, 2020). The findings of our study are consistent with the literature, it is thought that mothers tend to cook easier because they take their children to the rehabilitation center on certain days, and they
prefer to cook dishes that require manual labor when they are at home.
In line with the data obtained, it was found that the majority of mothers read the label information on the packaging and the most read information was the production and expiration date. Bulak and Ersu (2023) reported that all of the parents read the labels on the food when purchasing products, and women and men generally looked at the expiration date. Similarly, it was found that when mothers' conscious consumption behaviors increased, they paid attention to the expiration date, content and naturalness of the foods they purchased (Kestane, 2020). In this case, it can be said that individuals who read the label information on the product they buy are conscious consumers.
A meta-analysis showed that the average age at diagnosis of autism in developed countries ranged between 38–120 months, while in less developed countries the age at diagnosis was even later (Fuentes et al., 2021). In this study, according to the statements of the mothers, the average age at diagnosis of autism for children with autism was found to be 30.69 ± 11.51 months. The meta-analysis of 56 studies covering 40 countries on this topic between 2012 and 2019 reported that the mean age at diagnosis of autism in participants aged ≤ 10 years ranged between 30.90 months and 74.70 months. It was also observed that as the age of the participating children increased, the age at diagnosis also increased (van't Hof et al., 2021). It was observed that between 12 months and 55 months elapsed between the time when parents felt that there was a difference in their children and were concerned about autism and when they were diagnosed with autism, and parents could not diagnose their children with autism (Bejarano-Martín et al., 2020). It is thought that parents have a great influence on the age of early diagnosis in children with autism.
Looking at the epidemiology of autism spectrum disorder, it is 4.2 times more common in boys than in girls (CDC, 2023). In this study, the ratio of boys to girls was 5.07. The information obtained overlaps with the literature. One of the strongest known etiologic factors for autism is male gender. The reason for this is that girls have a protective effect from autism compared to boys (Elsabbagh, 2020; Lord et al., 2018). This supports the higher number of boys with autism compared to girls.
Obesity is frequently seen in children with autism due to the nutritional problems they experience and their preference for foods with high refined sugar and fat content in terms of food selectivity. As a result, the risk of obesity in children with autism increases compared to other children with typical development (Leader et al., 2020). The finding obtained from this study is in line with the literature and children with autism are generally in the normal weight or obese group. Similarly, Kaynar and Yılmaz (2020) found that children with autism were obese. It is thought that children with autism are more inclined to ready-made and processed foods containing starch and sweeteners due to food selectivity (Gursoy & Ozturk, 2019). This explains the obesity seen in children with autism.
According to the statements of the mothers, the majority of children with autism eat three main meals and two snacks, and the majority skip meals, especially the morning and midday meals. The main reason for skipping meals was found to be stubbornness and lack of appetite. Similarly, Elshafie (2021) found that children with autism eat less than three meals, are tense during meals and experience loss of appetite, so they skip breakfast and dinner. It is thought that the reason for this is the lack of healthy hunger-fullness perception of individuals with autism, digestive problems they experience or the content of meals, and that children with autism skip meals because mothers do not make appropriate meal and nutrition planning for their children with autism.
Children diagnosed with autism have more than one eating problem. In this study, the most common eating problems were found to be food selectivity by type and food refusal, and the most preferred food textures of children with autism were solid and liquid foods. A comparison of children with autism and typically developing children as a control group showed that children with autism had more food selectivity and mealtime problems compared to the control group (Babinska et al., 2020). Children diagnosed with autism are thought to be picky about food due to gastrointestinal symptoms.
According to the statements of the mothers included in the study, children with autism prefer bread and cereals, meat and meat products more, while they refuse to consume vegetables, milk and dairy products. Similarly, Raspini et al. (2021) reported that children with autism consumed more foods containing high energy and carbohydrates such as rice, biscuits and chocolate, and consumed very little fruits, vegetables, milk and cheese compared to other children; therefore, children with autism may have low calcium and protein levels compared to healthy children. Kaynar and Yılmaz (2020) examined the nutritional records of children with autism aged 7–14 years and found that children with autism had high protein intake, low fiber intake, and inadequate nutrition in terms of B1, B6, calcium, folate and potassium. This is thought to be due to the fact that children with autism consume less vegetables.
An analysis of the relationship between the low and high scores of mothers on the CS and FS scale and the BAMBI and GSRS scores of children with autism showed that children with autism of mothers with low scores on the CS and FS scale exhibited more food refusal and autism-specific behaviors, and experienced more gastrointestinal symptoms such as abdominal pain, reflux, diarrhea and indigestion. In Japan, it was observed that low cooking and food preparation skills of mothers with healthy children were associated with their children consuming fewer vegetables, leading to obesity in children (Tani et al., 2021). Mengi and friends (2023) found that there is a relationship between food preparation and cooking skills of university students and their healthy diets. There is a significant relationship between the quality of dietary practices of individuals with high cooking skills and adults with high cooking skills consume less packaged food (Lavelle et al., 2020). Similarly, it has been reported that as parents' cooking skills increase, consumption of processed food at home decreases (Martins et al., 2020). According to the results obtained; mothers' cooking skills indirectly affect the nutrition of their children with autism. Children included in the study had an age range of 2–18 years. Since children at this age are dependent on their mothers, they consume food cooked by their mothers at home. In short, it is seen that a decrease in mothers' cooking skills leads to an increase in nutritional and gastrointestinal symptoms experienced by children with autism.
When the relationship between mothers' cooking skills and food selectivity of children with autism was examined, it was found that the food selectivity experienced in children with autism decreased with the increase in mothers' cooking skills. Looking at the studies in the literature, when basic cooking skills training was given to the parents of kindergarten children, it was observed that the consumption of vegetables and fruits of the children of the parents who received cooking skills training increased after the training compared to the control group. This was reported to be due to the change in the texture and structure of foods with the application of the correct cooking method (Garcia et al., 2020). Similarly, children's refusal to consume the vegetable group was found to be related to the mother's cooking skills (Confer et al., 2023). In this case, it was observed that children's vegetable consumption would increase with an increase in mothers' cooking skills (Sharkey et al., 2023). According to this information, it is thought that providing training to mothers on food preparation and cooking skills will reduce nutritional problems in children with autism.
The findings of the study revealed that food refusal behaviors and abdominal pain in children with autism increased with decreasing food preparation skills and label reading/consumer awareness of mothers. Since this is the first study on this subject, there is no similar study. It is thought that the finding obtained may be due to the fact that children with autism have sensitive intestines, have difficulty in digesting foods containing casein and gluten, and mothers' poor label reading skills may indirectly cause their children to experience abdominal pain. At the same time, in this study, it was observed that autism-specific behaviors, diarrhea, constipation and indigestion exhibited by children with autism increased with the decrease in mothers' shopping resourcefulness, budgeting, food preparation, label reading/consumer awareness and shopping awareness. Bulak and Ersu (2023) found that parents pay attention to the healthiness of food when buying food for their children. Mothers with children with autism think that their children with autism are not different from children with normal development in terms of nutrition (Sinaga & Pandede, 2021). It was observed that the majority of mothers did not have sufficient knowledge about the nutrition of their children with autism (Anderson et al., 2020). This explains the serious eating problems and gastrointestinal symptoms experienced by children with autism. In Turkish culture, the mother is usually responsible for preparing meals for the individuals in the household (Unver & Demirli, 2022). The type of food cooked by the mother indirectly affects the individuals at home. Children with autism generally have problems in terms of both bowel function and eating behaviors. For this reason, it is thought that they should be fed much more carefully than normal individuals. If mothers are aware of this issue, it is thought that children with autism will have fewer nutritional and behavioral problems.
As a result, mothers' food preparation and cooking skills indirectly affect gastrointestinal symptoms and eating behaviors of children with autism. As a solution to this situation, training programs should be organized to improve the cooking and food preparation skills of mothers and expectant mothers. The mothers who have children with autism should be made especially aware of this issue.