Retrospective Review of Dietary Intake in Children with an Autism Spectrum Disorder

Background: Children meeting Autism Spectrum Disorder (ASD) DSM-IV criteria are characterized by impairments in socialization, language and communication, and restricted behavior repertoires. Many demonstrate restricted and repetitive diets. This may be compounded by specialty diets (i.e. gluten free casein free diet) known to increase risk of dietary deficiency.  Dietary restriction has been noted, though the impact on overall nutrition has not been fully examined.

Objectives: To determine how many children known to have ASD report restricted dietary intake.

Methods: Retrospective chart review was performed on University Le Bonheur Pediatric Specialists, Inc., Pediatric Neurology medical records for children between the ages of 18 months and 18 years known to have an ASD listed as an ICD code in any of the first four diagnostic fields.  Charts were identified and histories extracted for analysis using standardized questions prospectively applied to charts.  Collection included demographic data and presence or absence of self or caretaker reported dietary restrictions, diagnosis of developmental delay, special education, speech, occupational or physical therapy and sleep difficulties.  Data was analyzed for frequency, Wilcoxon rank sum comparisons, and associations, using Fisher’s exact tests, to determine if identifiable characteristics of children were associated with a restricted diet or ‘picky-eaters’.

Results: Two hundred-twenty-four charts were reviewed. Eighty-six (38%) contained information about diet.  Mean age of children was 89.6 months (SD 46.8).  Twenty-four (11%) reported having been on a special diet (6% on the GFCG diet).  Fifty-three (24%) commented on eating habits and noted a limited diet or being a ‘picky-eater’.  Weak negative correlations were identified between age and self-restricted diet (r=-0.14; p=0.21), and between age and therapeutic dietary restriction (r=-0.06; p=0.56), though not statistically significant. No differences in presence or absence of developmental delay, use of speech, occupational or physical therapy, special education or sleep difficulties were noted. No difference in age between those with limited diets or picky eaters versus those not with limited diets or picky eaters were noted (p=0.15).

Conclusions: Thirty-eight percent of charts reviewed noted a dietary history. Though less than half of charts reviewed addressed diet, almost a quarter mentioned a limited diet or a ‘picky-eater’.  This suggests that diet and nutrition are a significant concern in these patients. The weak negative correlation noted between age and restricted diets or selective eaters and therapeutic dietary restriction suggests that these children are more likely to be younger in age, though this would need to be confirmed in a larger sample as the finding did not reach statistical significance.  The impact of nutrition on early brain development has been well established.  How ASD and restricted diets impact development in these children is unknown. Our pilot data suggests that many have restricted diets and that further studies of nutrition in these children may be warranted.