Food Preferences in Autism Spectrum Disorders and Their Relationship to Sensory and Behavioral Symptoms

Background: Difficulties related to eating behavior and food selectivity are a common and significant clinical and family concern when working with individuals with autism spectrum disorders (ASD). Compared to their typically developing peers, children with ASD have been found to be more likely to exhibit food refusal, picky eating, and mealtime behavioral problems. Food preferences have been investigated in relation to sensory functioning, restrictive and/or repetitive patterns of behavior, and nutrition and health; however, the current data remain inconclusive with regard to the causes and nutritional consequences of eating differences in ASD, particularly in older children and adolescents.

Objectives: To examine food preferences and eating behavior in children and adolescents with ASD and their typically developing peers, as well as potential relationships between food selectivity and sensory functioning, behavioral symptoms, and health.

Methods: Children and adolescents with high-functioning ASD (n=57) and typically developing controls (n=73), ages 7 through 19, participated in this study. Groups were well-characterized and matched on age and gender. Exclusion criteria included diagnoses of neurological, genetic, and/or other psychiatric disorders, as well as injuries or medications that could affect taste, smell, or eating behavior. Participants and/or a parent completed written measures assessing medical and feeding-related history, food preferences, food neophobia (anxiety around trying new foods), general sensory functioning, restrictive and repetitive behaviors, and autism symptomatology. They were also given laboratory-based measures of chemosensory functioning (taste and smell abilities). Finally, data on height and weight were collected for each participant.

Results: Children and adolescents with ASD were found to be more selective than their typically developing peers with regard to certain food groups, tastes, textures, and temperatures (p’s ranged from .04 to .001, with distinct patterns of selectivity within each category). Participants with ASD were also found to exhibit higher levels of food refusal (p=.001). Preliminary analyses suggested that selective food preferences in the ASD group were related to patterns of restrictive and repetitive behavior (p<.01) and food neophobia (p<.05), as well as to poorer olfactory functioning (p<.05). Finally, participants in the ASD group were significantly more likely than controls to have a body mass index (BMI) within the obesity or overweight range for their ages (p=.01).

Conclusions: Individuals with ASD display clear differences relative to controls related to eating and food preferences, even as they age beyond childhood. Sensory and behavioral factors both appear to play a role in food selectivity. In our sample, children and adolescents with ASD were also found to be at higher risk for obesity as compared to their typically developing peers, underscoring the importance of investigating food selectivity and eating behavior in this population.