Skip to main content
Log in

Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We conducted a comprehensive review and meta-analysis of research regarding feeding problems and nutrient status among children with autism spectrum disorders (ASD). The systematic search yielded 17 prospective studies involving a comparison group. Using rigorous meta-analysis techniques, we calculated the standardized mean difference (SMD) with standard error and corresponding odds ratio (OR) with 95 % confidence intervals (CI). Results indicated children with ASD experienced significantly more feeding problems versus peers, with an overall SMD of 0.89 (0.08) and a corresponding OR of 5.11, 95 % CI 3.74–6.97. Nutrient analyses indicated significantly lower intake of calcium (SMD: −0.65 [0.29]; OR: 0.31, 95 % CI 0.11–0.85) and protein (SMD: −0.58 [0.25]; OR: 0.35, 95 % CI: 0.14–0.56) in ASD. Future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder—Not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505–511.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed, Text Revision ed.). Washington, DC: American Psychiatric Association.

  • Archer, L. A., Rosenbaum, P. L., & Streiner, D. L. (1991). The children’s eating behavior inventory: Reliability and validity results. Journal of Pediatric Psychology, 16(5), 629–642.

    Article  PubMed  Google Scholar 

  • Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., et al. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics, 157(2), 259–264.

    Article  PubMed  Google Scholar 

  • Barr, S. I., Murphy, S. P., & Poos, M. I. (2002). Interpreting and using the dietary references intake in dietary assessment of individuals and groups. Journal of the American Dietetic Association, 102(6), 780–788.

    Article  PubMed  Google Scholar 

  • Becker, B. J. (2005). Failsafe N or file-drawer number. In H. P. Rothstein, A. J. Sutton, & M. Borenstein (Eds.), Publication bias in meta-analysis: Prevention, assessment and adjustments (pp. 111–125). Chichester: Wiley.

    Google Scholar 

  • Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis (2nd ed.). Englewood, NJ: Biostat.

    Google Scholar 

  • Campbell, J. M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single-case research. Research in Developmental Disabilities, 8, 165–178.

    Google Scholar 

  • Cannell, J. J. (2008). Autism and vitamin D. Medical Hypotheses, 70, 750–759.

    Article  PubMed  Google Scholar 

  • Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(1), 259–264.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Collins, M. R., Kyle, R., Smith, S., Laverty, A., Roberts, S., & Eaton-Evans, J. (2003). Coping with the usual family diet: Eating behavior and food choices of children with Down’s syndrome, autistic spectrum disorders or cri du chat syndrome and comparison groups of siblings. Journal of Learning Disabilities, 7(2), 137–155.

    Google Scholar 

  • Cornish, E. (1998). A balanced approach towards healthy eating in autism. Journal of Human Nutrition and Dietetics, 11, 501–509.

    Article  Google Scholar 

  • Cumine, V., Leach, J., & Stevenson, G. (2000). Autism in the early years. New York: David Fulton.

    Google Scholar 

  • Dominick, K. C., David, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28, 145–162.

    Article  PubMed  Google Scholar 

  • Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463.

    Article  PubMed  Google Scholar 

  • Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple graphical test. BMJ (Clinical Research Ed), 315(7109), 629–634.

    Article  Google Scholar 

  • Elder, J. H. (2008). The gluten-free casein-free diet in autism: An overview with clinical implications. Nutrition in Clinical Practice, 23(6), 583–588.

    Article  PubMed  Google Scholar 

  • Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The gluten-fee, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413–420.

    Article  PubMed  Google Scholar 

  • Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), 337–342.

    Article  Google Scholar 

  • Hediger, M. L., England, L. J., Molly, C. A., Yu, K. F., Manning-Courtney, P., & Mills, J. L. (2007). Reduced bone cortical thickness in boys with autism or autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(5), 848–856.

    Article  Google Scholar 

  • Herndon, A. C., DiGuiseppi, C., Johnson, S. L., Leiferman, J., & Reynolds, A. (2009). Does nutritional intake differ between children with autism spectrum disorders and children with typical development? Journal of Autism and Developmental Disorders, 39, 212–222.

    Article  PubMed  Google Scholar 

  • Herzinger, C. V., & Campbell, J. M. (2007). Comparing functional assessment methodologies: A quantitative synthesis. Journal of Autism and Developmental Disorders, 37, 1430–1445.

    Article  PubMed  Google Scholar 

  • Horvath, K., Papdimitriou, J. C., Rabsztyn, A., Drachenberg, D., & Tildon, J. T. (1999). Gastrointestinal abnormalities in children with autistic disorder. Pediatrics, 135, 559–563.

    Article  Google Scholar 

  • Hunter, J. E., & Schmidt, F. L. (2004). Methods of meta-analysis: Correcting error and bias in research findings (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124(2), 680–686.

    Article  PubMed  Google Scholar 

  • Johnson, C. R., Handon, B. L., Mayer-Costa, M., & Sacco, K. (2008). Eating habits and dietary status on young children with autism. Journal of Autism and Developmental Disorders, 20, 437–448.

    Google Scholar 

  • Kanner, L. (1943). Autistic disturbances of affective contact. The Nervous Child, 2, 217–250.

    Google Scholar 

  • Kerwin, M. E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal of Pediatric Psychology, 24, 193–214.

    Article  PubMed  Google Scholar 

  • Konstantareas, M. M., & Homatidis, S. (1987). Ear infections in autistic and normal children. Journal of Autism and Developmental Disorders, 17(4), 585–594.

    Article  PubMed  Google Scholar 

  • Laud, R. B., Girolami, P. A., Boscoe, J. H., & Gulotta, C. S. (2009). Treatment outcomes for severe feeding problems in children with autism spectrum disorder. Behavior Modification, 33, 520–536.

    Article  PubMed  Google Scholar 

  • Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities, 21, 153–166.

    Article  Google Scholar 

  • Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Lockner, D. W., Crowe, T. K., & Skipper, B. J. (2008). Dietary intake and parents’ perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children. Journal of the American Dietetic Association, 108, 1360–1363.

    Article  PubMed  Google Scholar 

  • Lord, C., Rsis, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview—Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Lukens, C. T., & Linscheid, T. R. (2008). Development and validation of an inventory to assess mealtime behavior problems in children with autism. Journal of Autism and Developmental Disorders, 38, 342–352.

    Article  PubMed  Google Scholar 

  • Martins, Y., Young, R. L., & Robson, D. C. (2008). Feeding and eating behaviors in children with autism and typically developing children. Journal of Autism and Developmental Disorders, 38, 1878–1887.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Fodstad, J. C., & Dempsey, T. (2009). The relationship of children’s feeding problems to core symptoms of autism and PDD-NOS. Research in Developmental Disabilities, 3, 759–766.

    Google Scholar 

  • Mulloy, A., Lang, R., O’Reilly, M., Sigofoos, J., Lancioni, G., & Rispoli, M. (2010). Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4(3), 328–339.

    Article  Google Scholar 

  • Nadon, G., Feldman, D.E., Dunn, W., & Gisel, E. (2011). Mealtime problems in children with autism spectrum disorder and their typically developing siblings: A comparison study. Autism, 15(1), 98–113.

    Article  PubMed  Google Scholar 

  • Niehus, R., & Lord, C. (2006). Early medical history of children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 27, S120–S127.

    Article  PubMed  Google Scholar 

  • Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children: comparison with autism spectrum disorder and children with typical development. Physical and Occupational Therapy in Pediatrics, 30(3), 220–233.

    Article  PubMed  Google Scholar 

  • Raiten, D. J., & Massaro, T. (1986). Perspectives on the nutritional ecology of autistic children. Journal of Autism and Developmental Disorders, 16(2), 133–143.

    Article  PubMed  Google Scholar 

  • Ritvo, E. M., & Freeman, B. J. (1978). National society for autistic children definition of the syndrome of autism. Journal of Autism and Childhood Schizophrenia, 8, 162–170.

    Article  Google Scholar 

  • Rosenthal, R., & Rubin, D. (1986). Meta-analytic procedures for combining studies with multiple effect sizes. Psychological Bulletin, 99(3), 400–406.

    Article  Google Scholar 

  • Schmitt, L., Heiss, C. J., & Campdell, E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Topics in Clinical Nutrition, 23(1), 23–31.

    Google Scholar 

  • Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behavior between children with and without autism. Journal of Autism and Developmental Disorders, 34, 433–438.

    Article  PubMed  Google Scholar 

  • Seiverling, L., Williams, K., & Sturmey, P. (2010). Assessment of feeding problems in children with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 22, 401–413.

    Article  Google Scholar 

  • Sharp, W. G., Jaquess, D. L., Morton, J. S., & Herzinger, C. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13, 348–365.

    Article  PubMed  Google Scholar 

  • Sharp, W. G., Jaquess, D. L., Morton, J. F., & Miles, A. G. (2011). A retrospective chart review of dietary diversity and feeding behavior of children with autism spectrum disorder before and after admission to a day treatment program. Focus on Autism and Other Developmental Disabilities, 26, 37–48.

    Article  Google Scholar 

  • Shearer, T. R., Larson, K., Neuschwander, J., & Gedney, B. (1982). Minerals in the hair and nutrient intake of autistic children. Journal of Developmental and Physical Disabilities, 12(1), 25–34.

    Article  Google Scholar 

  • Whiteley, P. (2004). Developmental behavioral and somatic factors in pervasive developmental disorders: Preliminary analysis. Child: Care Health and Development, 30, 5–11.

    Article  Google Scholar 

  • WHO Multicentre Growth Reference Study Group. (2006). WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization.

    Google Scholar 

  • Williams, K. E., Gibbons, B. G., & Schreck, K. A. (2005). Comparing selective eaters with and without developmental disabilities. Journal of Developmental and Physical Disabilities, 17, 299–309.

    Article  Google Scholar 

  • Yu, S. M., Kogan, M. D., & Gergen, P. (1997). Vitamin-mineral supplement use among preschool children in the United States. Pediatrics, 100, e4.

    Article  PubMed  Google Scholar 

  • Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42(4), 549–556.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

This was an unfunded study and no member of the research team has a conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to William G. Sharp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sharp, W.G., Berry, R.C., McCracken, C. et al. Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature. J Autism Dev Disord 43, 2159–2173 (2013). https://doi.org/10.1007/s10803-013-1771-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-013-1771-5

Keywords

Navigation