Food Selectivity, Weight Status, and Caregiver Feeding Practices in Children with Autism Spectrum Disorders

Background: To date limited research exists which has examined eating behaviors and diet quality among children with developmental abilities, including children with autism spectrum disorders (ASD). A small number of studies suggest that children with ASD are picky eaters and show aversions to certain textures, smells, colors, temperatures, and brand names of foods, all of which can adversely affect their dietary intake. Further, very little is currently known about feeding practices that caregivers of children with ASD may develop to address problematic eating and nutritional difficulties in their children.  

Objectives: The aim of this cross-sectional study is to examine weight status/adiposity, eating behaviors including food neophobia (children’s reluctance to eat and/or avoid novel foods) and caregiver feeding practices in an urban sample of 4- to 6-year-old children with ASD and typically developing children (TDC).

Methods: Caregivers of children with ASD (n = 12) and TDC (n = 20) were asked to complete a series of validated questionnaires, including the Child Eating Behavior Questionnaire, Child Food Neophobia Scale, Child Feeding Questionnaire, and Parental Feeding Style Questionnaire, to assess their children’s eating behaviors as well as their own feeding practices. During an onsite visit to the Center for Autism Research at the Children’s Hospital of Philadelphia and the Center for Weight and Eating Disorders at the University of Pennsylvania children’s height, weight, waist circumference, and skinfold thickness were measured. The study is ongoing and data presented here will be augmented by additional data.

Results: Preliminary findings indicate that 50% of children with ASD and 25% of TDC were considered overweight or obese (BMI-for-age ≥ 85^th percentile; P = 0.15). Further, children with ASD, when compared to TDC, had a greater waist circumference (57.9 ± 8.9 vs. 52.0 ± 4.3 cm; P = 0.02) and BMI z-score (1.1 ± 1.4 vs. 0.2 ± 1.1, P = 0.06). In terms of eating behaviors, children with ASD were reported to be significantly more selective about the range of foods they accepted (4.0 ± 0.2 vs. 2.5 ± 0.1; P < 0.001) and showed overall greater food neophobia (3.5 ± 0.2 vs. 2.6 ± 0.2; P = 0.002) and less enjoyment of food (3.2 ± 0.2 vs. 3.8 ± 0.2; P = 0.057) than TDC. Caregivers of children with ASD reported engaging in significantly more prompting and encouraging their children to eat (3.9 ± 0.2 vs. 3.2 ± 0.2; P = 0.03), instrumental feeding (2.1 ± 0.1 vs. 1.6 ± 0.4; P = 0.03), and emotional feeding (1.9 ± 0.2 vs. 1.3 ± 0.1; P= 0.03) than caregivers of TDC.       

Conclusions: These preliminary results suggest that despite being more selective in their food choices and showing enhanced food neophobia, children with ASD appear to be at an increased risk of excess weight gain. This, in turn, puts them at greater risk of chronic diseases associated with obesity. Future studies are needed that evaluate the effectiveness of strategies that caregivers use to counter nutritional difficulties and promote healthy eating in their children.