Eating Problems Are Associated with Autism Severity in Toddlers with Autism Spectrum Disorder

Thursday, May 14, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)
O. E. Stolar1, D. A. Zachor2, D. Eitan3 and E. Ben Itzchak4, (1)Pediatric, The Autism Center, Assaf Harofeh Medical Center, Ra'anana, Israel, (2)Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel, (3)ALUT the Israeli National Organization for children with ASD, Zerifin, Israel, (4)Ariel University/ Assaf Harofeh Medical Center, Givat Shmuel, Israel

The prevalence of feeding problems in typical toddlers is estimated to be 25% and 46-89% for children with autism spectrum disorder (ASD). Most of the problems in feeding toddlers with ASD are behavioral in nature and includes food selectivity or picky eating. The selective diet which in some cases doesn't meet the nutrition needs for optimal growth may lead to adverse long term medical and developmental outcomes.  There are only few studies on the relationship between eating problems and severity of the ASD core symptoms.

Objectives: The aim of the current study was to explore the frequency and type of eating disorder in toddlers with ASD and to examine the association between selective eating disorder and the severity of autism symptoms. 


The study included 117 toddlers aged 19-39 months (M=29.2; SD=4.3), 93 boys and 24 girls diagnosed with ASD that were enrolled in 8 center-based early intervention programs (EIP) for toddlers with ASD.  The assessment included evaluation of autism severity using the Social Communication Questionnaires (SCQ), filled by the caretakers and the EIP professional team at the entrance to EIP. Information on eating profile was obtained by a questionnaire developed by the researchers. The questionnaire included information on the variety of foods accepted by the participant, the eating habits, dietary intake and selectivity based on colors, textures and shapes. 


Based on the results of the eating profile questionnaire 5 subgroups were defined: 38% had no eating problems, (adequate variety and appropriate for age eating habits);  30% had extreme selectivity in food intake (eating < 16 types of food, not meeting the food pyramid requirements); 16% had mild selectivity in food intake (accept at least 16 types of food including at least 4 types of fruit and vegetables, 3 different types of protein rich food and 3 different types of carbohydrates); not meeting the food pyramid requirements); 4% ate only ground food or formula; 1%  refused food (eating small amount of food, 1-2 times a day, fulfilled the criteria for failure to thrive). To assess the association between selective eaters and autism severity, the group without eating problems (n=40) was compared in autism severity to a group with selective eating consisted of participants from the subgroups 2, 3 and 5 (n=51).  The professional team SCQ scores revealed that the group with selective eating had significantly more severe autism symptoms than the group without eating disorder (p<0.001).  Specifically, higher reciprocal-social interaction and communication domains scores were noted for the selective eating group (p<0.05).


Toddlers with ASD present high prevalence of eating problems specifically extreme selective eating.  The selective eating profile is associated with higher severity of ASD symptoms, specifically in social and communication domains. These findings emphasize the importance of evaluating the eating problems of young children with ASD. Specific intervention for the eating abnormalities to ensure an adequate diet for proper growth and development should be part of the treatment plan. It is suggested that improving core ASD symptoms might reduce the selective eating problems.