Food and Feeding Questionnaire

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Hi! My name is Macie Moore, and I am a clinical intern at The Johnson Center for Child Health and Development in Austin, Texas. I am a Senior at The University of Texas at Austin conducting an independent inquiry project on food, feeding, and dietary intervention in children with ASD. Each response is completely anonymous. If you could please fill out this questionnaire to help me in gathering information for my project, I would greatly appreciate it! Thank you!

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ARI Newsletter

The Johnson Center for Child Health and Development

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Please select the option that most accurately describes your child's eating issues.

Picky/Selective Eater: Highly selective in food choice with restrictive food repertoires, eating 30 or fewer foods

Problem Eater: Highly selective, complete food refusal, vomiting/gagging/choking when trying new foods, refusal of former favorite foods, phobic to new foods, poor growth status, eating fewer than 20 foods

Resistant Eater: Severe food aversions, excluding one or more food groups anxiety and trantrums with new foods, refusal of former favorite foods, minimal food consumption, selective self-feeding, mouth stuffing/choking, eating less than 15 foods

None of these

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