Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children

doi:10.1016/j.jpeds.2010.02.013

The Journal of Pediatrics

Volume 157, Issue 2, August 2010, Pages 259-264

https://doi.org/10.1016/j.jpeds.2010.02.013 Get rights and content

Objectives

To define food selectivity and compare indices of food selectivity among children with autism spectrum disorders (ASDs) and typically developing children, and to assess the impact of food selectivity on nutrient adequacy.

Study design

Food selectivity was operationalized to include food refusal, limited food repertoire, and high-frequency single food intake using a modified food frequency questionnaire and a 3-day food record. Food selectivity was compared between 53 children with ASDs and 58 typically developing children age 3-11 years. Nutrient adequacy was assessed relative to the dietary reference intakes.

Results

The children with ASDs exhibited more food refusal than typically developing children (41.7% of foods offered vs 18.9% of foods offered; P <.0001). They also had a more limited food repertoire (19.0 foods vs 22.5 foods; P <.001). Only 4 children with ASDs and 1 typically developing child demonstrated high-frequency single food intake. Children with a more limited food repertoire had inadequate intake of a greater number of nutrients.

Conclusions

Our findings suggest that food selectivity is more common in children with ASDs than in typically developing children, and that a limited food repertoire may be associated with nutrient inadequacies.

Section snippets

Methods

Participants in the Children's Activity and Meal Patterns Study (CHAMPS) included children with ASDs and typically developing children age 3-11 years. Participants were recruited via public listings on the Internet, outreach to local community programs (eg, schools, YMCAs), existing participant databases at the University of Massachusetts Medical School's Shriver Center, autism support organizations, and the Interactive Autism Network Research Database at the Kennedy Krieger Institute.

Results

A total of 53 children with ASDs and 58 typically developing children completed the study (Table II). Mothers were the primary respondents, with 4 fathers in each group. Few of the characteristics differed between the 2 groups, except that children with ASDs were more likely to be on a special diet, and typically developing children were more likely to be an only child. Whether or not a child was an only child was not related to any aspect of food selectivity, however.

Discussion

We found that children with ASDs displayed more food refusal and exhibited a more limited food repertoire compared with typically developing children, although food refusal was seen in both groups of children. The commonly held belief that dietary “pickiness” is outgrown with age was not supported by our cross-sectional findings. We found that among typically developing children, levels of food refusal and food repertoire were similar across age, whereas among children with ASDs, food refusal,

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A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age = 5.8 ± 2.2 years; range 2–10). Parents rated child mealtime behavior on the Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on the Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS.
Of 103 children, 45.6% (n = 47) were classified as FS; 54.4% (n = 56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, P < .001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, P = .020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified.
Food selectivity (FS) in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.
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This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.
A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4–6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.
The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.
Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.
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Eating behavior, which includes eating habits and preferences, frequency of eating, and other features related to diet, is a major characteristic not only of a person's nutritional status, but also of health in general. In recent years, the prevalence of eating disorders in children has tended to increase; they also require cross-system approaches in diagnosis by a variety of specialists and correction requires appropriate selection of optimal methods. Maladaptive eating attitudes formed at an early age can contribute to the formation of eating disorders, which can lead to or worsen various neuropsychiatric diseases, digestive diseases, and other related conditions. In children with autism spectrum disorder (ASD), eating disorders often appear earlier than other major symptoms of the condition. However, the clinical manifestations of eating disorders in children with ASD are varied and differ in severity and duration, whereas these disorders in neurotypical children might present as short-lived and may not lead to serious consequences. Nevertheless, cases of progressive eating disorders accompanied by a child presenting as under- or overweight and/or with macronutrient and micronutrient deficiencies cannot be excluded. Given the high prevalence of eating disorders in children, many researchers have highlighted the lack of a valid and universally accepted instruments to assess atypical eating behaviors in this population. Therefore, in this review, we wanted to highlight the problems and causes of eating disorders in children, and also to analyze the existing approaches to the validation of these problems, taking into account the existing behavioral features in children with ASD.
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The participants were parents/caregivers of children aged 3–6 years. The ASD-MBQ and a demographic data sheet were mailed to parents/caregivers who consented to participate in this study. Descriptive statistics were used to characterize ASD and non-autistic groups. Group differences were calculated using the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity, specificity, and area under the curve (AUC).
The sample comprised 128 children with ASD and 128 non-autistic children (3–6 years). The mean total and all subdomain scores of the ASD-MBQ obtained from children with ASD were significantly higher than the scores of those non-autistic children (P < 0.001). The total mean score of the ASD-MBQ differentiated children with ASD from non-autistic children with an excellent ROC-AUC of 0.885 (95% CI 0.845–0.942). A total mean score of 2.04, calculated using the Youden score showed the best sensitivity (0.648) and specificity (0.953).
These results indicate that the ASD-MBQ is a promising tool for identifying problematic mealtime behavior in 3–6 year old children with ASD, in Japan.
Father engagement in Syrian Asylum-Seeker families with children on the autistic spectrum
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Asylum-seeking has aspects that encourage and discourage father engagement. The additional care burden of a child on the autistic spectrum is combined with the psychological and economic effects of asylum-seeking for families.
We aimed to contribute to understanding asylum-seeker fathers' experiences and to illuminate father engagement more comprehensively in the upbringing of children on the autistic spectrum.
As part of the research, fourteen Syrian asylum-seeker parents with children on the autistic spectrum were interviewed individually. The researchers used a inductive thematic analysis method.
We identified two themes. The first theme related to the barriers to fathers' engagement. Barriers included economic problems, double stigmatization, belonging problems, Covid-19-related barriers, and gender role norms. The second theme related to the factors that motivate father engagement. These factors were the number of children, the mother's mental health problems, lack of social support, and belief in God (Allah).
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Autism spectrum disorders (ASDs) are associated with specific dietary habits, including limited food selection and gastrointestinal problems, resulting in an altered gut microbiota. Autistic patients have an elevated abundance of certain gut bacteria associated with increased oxidative stress in the gastrointestinal tract. Probiotic supplementation has been shown to decrease oxidative stress in a simulated gut model, but the antioxidant effects of probiotics on the oxidative stress of the gut in autistic patients have not been directly studied. However, it is speculated that probiotic supplementation may help decrease oxidative stress in the gastrointestinal tract of autistic patients due to their specific dietary habits altering the microbiota. PubMed, Scopus and Web of Science databases and Google Scholar were searched up to May 2023. This systematic-narrative review aims to present the latest evidence regarding the changes in eating habits of autistic children which may further increase the gut microbiota induced oxidative stress. Additionally, this review will assess the available literature on the effects of probiotic supplementation on oxidative stress parameters.

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: Supported by National Institutes of Health Grants R21 HD048989, 2P30HD004147-33A2, and 5P30DK046200-14. The authors declare no conflicts of interest.

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Original ArticleFood Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children

Objectives

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Am Diet Assoc

Res Dev Disabil

J Am Acad Child Adolesc Psychiatry

J Am Diet Assoc

Appetite

J Am Acad Child Adolesc Psychiatry

J Am Diet Assoc

Prev Med

J Am Diet Assoc

Perspectives on the nutritional ecology of autistic children

J Autism Dev Disord

A comparison of eating behaviors between children with and without autism

J Autism Dev Disord

A balanced approach towards healthy eating in autism

J Hum Nutr Diet

Feeding patterns in autism

Autism

Eating habits of children with autism

Pediatr Nurs

The phenomenon of “picky eater”: a behavioral marker in eating patterns of toddlers

J Am Coll Nutr

Revisiting the picky eater phenomenon: neophobic behaviors of young children

J Am Coll Nutr

Original Article
Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children