Feeding Behavior & Comorbidity Differences for Children with and without ASD

Background:  Highly selective food preferences have been noted in individuals with an autism spectrum disorder (ASD), since such disorders were first described by Kanner (1943).  In many if individuals, these restricted interests and related strong behavioral avoidance result in nutritional deficiencies and disrupted psychosocial development (Ledford & Gast, 2006).  Although they may also suffer long-term health consequences, children without ASD’s tend to present with difficulties related to inadequate oral intake, with less focus on selective food choices (Sharp, Jaquess, Morton & Herzinger, 2010).  No researchers to date have compared initial clinical profiles that included direct behavioral observation of feeding disorder patients with and without comorbid ASD’s.

Objectives:  (a) Describe feeding patterns and medical conditions in children referred to a feeding clinic.  (b) Compare and contrast profiles of children with and without ASD's.

Methods:  Medical charts of 359 children (104 children with parent-reported diagnosis of ASD and 255 children without) who completed interdisciplinary evaluation (nutrition, speech/occupational therapy, behavioral psychology) of feeding difficulties were reviewed for medical history, oral-sensory and oral-motor functioning, and directly observed behavioral performance in mealtime.  Measures were summarized and compared across diagnostic category. 

Results:  Significant differences observed for children with ASD included the following: reason for referral (more selectivity by type, and less food refusal), age (1.7 years older), fewer medical problems, fewer number of surgeries, elevated responding to sensory experiences, more problems with heightened sensitivity to sensory input, more sleep problems, less likely history of tube feedings (and related formula dependence), and fewer problems with overall caloric intake.  No differences emerged in mean body mass index (BMI) z-scores, gestational age at birth, number of oral motor problems, reduced sensitivity to sensory experiences, or total number of prior therapy contacts for feeding.  Both groups showed behavioral preferences for and against some foods, and the related behavioral topographies did not differ significantly under direct observation.  With regard to total number of tolerated foods, however, children with ASD’s did show greater restriction. 

Conclusions:  Children with ASD’s share many similarities with other children who have feeding disorders related to divergent medical backgrounds, although the overall patterns of refusal differ.  Therapists may be able to select intervention techniques primarily based on presenting complaint without regard to whether there is a comorbid ASD diagnoses.  Nutritional impact of food selectivity among individuals with ASD’s may require analysis of micronutrients to detect clinically significant deviations from recommended dietary intake.