By: Erin Whitney Evans
Autism spectrum disorders (ASDs) represent a spectrum of related neurological disorders characterized by a triad of symptoms including impairment in social interaction, impairment in verbal and non-verbal communication, and restrictive, repetitive and stereotyped patterns of behaviors, interests and activities (APA, 1994). For years, parents of children with ASDs have anecdotally reported that their children only eat foods of one color or texture, or that they will only eat foods when presented in a certain way (Schreck, 2004). These reports imply that children with ASDs consume a narrow range of food, which may put them at risk for inadequate nutrient intake. Selective or picky eating is often a normal part of development commonly seen in early childhood (Nicholls, 2001). However, few studies have been conducted to determine whether food selectivity is different among children with ASD than typically developing children. In 2004, Schreck and colleagues published the results of a study performed to determine how the eating patterns of children with ASDs differ from typically developing children. Their findings, as well as those of a follow-up paper, shed light on selective eating in children with ASDs and are reviewed here.
In their study, Schreck and colleagues set out to determine if children with ASDs have different eating habits than typical children, what types of foods children with ASDs prefer and whether or not families of children with ASDs eat a more narrow range of food than those of typically developing children. To answer these questions, the researchers recruited caregivers of both children with ASDs and typical children between five and twelve years of age. They used the Gilliam Autism Rating Scale to determine appropriate group assignment. Once assigned to either the control group (n=298) or autism group (n=138), caregivers were asked to complete the Children’s Eating Behavior Inventory (CEBI), as well as the Food Preference Inventory (FPI) (Schreck, 2004). The CEBI is a tool that is used to evaluate meal time and eating behaviors in children, while the FPI is a tool used to determine whether a child will eat an age appropriate portion of particular foods within food groups as well as whether or not thesame foods are offered as part of family meals (Schrek, 2004).
Schreck and colleagues found that caregivers of children with ASDs report their children have significantly more feeding problems than caregivers of typically developing children (p=0.001). Further, they found that children with ASDs refuse more foods (p<0.000), require specific utensils and particular food presentations (p<0.000), and are more likely to accept foods of low texture (p<.01) than the children in the control group (Schreck, 2004). Lastly, Schrek and colleagues found that according to the FPI, children with ASDs eat a narrower range of food than the children in the control group (p<0.000). Considered together, these findings indicate that children with ASDs are likely more selective in their eating habits than typically developing children; however, these findings do not address how food selectivity may affect the nutritional adequacy of their diets.
In a follow-up paper published in 2006, Schreck and colleagues reanalyzed this data set in order to identify the types of foods that children with ASDs prefer, to determine how family diet affects food selectivity in children with ASDs and lastly to determine if there is a correlation between the number of foods a child will eat and the severity of their autism symptoms (Schreck, 2006). In reanalyzing the FPI, they found that within most food groups, children with ASDs ate fewer than half of the listed food items within each food group with the exception of starches. Their results show that more than 50% of children with ASDs eat chicken nuggets, hot dogs and peanut butter in the protein group, cake, cookies, crackers, French fries, macaroni, pizza, potato chips, spaghetti and white bread in the starch group, ice cream in the dairy group, and apples, grapes, apple juice and grape juice in fruits and juices groups (Schreck, 2006). Additionally, Schreck and colleagues found that restrictive family diets, but not severity of autism symptoms, is associated with more restrictive eating behaviors (Schreck, 2006).
These findings indicate that children with ASDs are more selective eaters than typically developing controls, and they suggest that children with ASDs prefer high energy dense foods, or foods with a high calorie to weight ratio. When considered together, the first and second analyses of Schreck’s data suggest that children with ASDs are more selective eaters than typically developing children, and that their food selectivity may be due to restrictive familial diets rather than to the severity of their autism symptoms. Additionally, their findings indicate that children with ASDs eat a more narrow range of foods that includes high-energy dense foods. Eating a narrow range of foods with high energy density may put children with ASDs at increased risk for excessive weight gain and chronic diseases, as high energy dense diets are typically high in fat and low in fiber.
Schreck’s findings are a first step in understanding how the diets of children with ASDs differ from typically developing children. Further research is needed in this population, however, as it is still unclear how food selectivity affects the nutritional adequacy of the diets of children with ASDs, and their overall health and well-being Further research is also needed to develop effective interventions designed to increase food acceptability in children with ASDs who are very restricted in their intake and are at risk for poor nutritional status.
Erin Whitney Evans recently completed her course work for her MS degree in nutrition at Boston University and is beginning her Dietetic Internship at the University of Massachusetts Medical Center.