Impact of Feeding Disorders in Parental Stress in Children with Autism Spectrum Disorder and with Other Developmental Disabilities

Background:  Feeding difficulties, in particular food selectivity, have been reported in children with autism spectrum disorder (ASD) and eating problems are typically part of the repertoire of symptoms for a child with ASD. There are few comparisons with children with other developmental disabilities (DD) and the impact of such problems in the family dynamics.

Objectives:  To compare feeding disorders in children with ASD vs. those with other DD, and to assess the relationship of feeding problems to parental stress.

Methods:  Cross sectional study with structured interview for 50 children with ASD and 50 children with other DD, matched by age/gender. DDs included intellectual disability/global delay and cerebral palsy. Interview included: Feeding Questionnaire, Aberrant Behavior Checklist (ABC) and Parental Stress Index, Short Form. Statistical analysis included McNemar, chi-square, t test and logistic regression.

Results:  Mean age 8±3 yr; 15% White, 44% Hispanic and 24% African/American. Food selectivity was reported in 74% of the ASD group and 62% of the DD group (p=1). Both groups reported selectivity to textures (ASD=36% vs. DD=32% p=.8) and to color (ASD=20% vs. DD=10% p=.2) but children with ASD were more likely to present smell selectivity (36% vs. 14% p=.02), brand selectivity (30% vs. 6% p=.008), inability to mix the food (36% vs. 8% p=.003) and pica (24% vs. 2% p=.003). Both groups reported food allergies (14% vs. 14% p=1). Children with ASD were more irritable (54% vs. 20% p=.001) and parents reported more stress (46% vs. 22% p=.05). There was no association between irritability or parental stress with overall food selectivity in either group, but in the ASD group children with selectivity to textures were more irritable (83% vs. 35% p=.03) and parents reported more stress (77% vs. 26% p=.001). The association between food selectivity (textures) and parental stress persisted after adjusting for demographics, developmental diagnosis and irritability (OR 2.7 95% CI 1.01-7.5).

Conclusions:  Both children with ASD and other DD presented with different types of food selectivity.  In families of children with ASD, selectivity to textures was associated with parental stress. Feeding programs that ameliorate food selectivity in children with ASD may decrease parental stress.