Feeding Problems in Children with Autism Spectrum Disorders: Evidence from a Developing Country

Background:

Studies have documented that children with Autism Spectrum Disorders (ASDs) experience a range of eating and feeding difficulties including food selectivity and food refusal and these problems can lead to inadequate nutrition over time. Despite evidence to support feeding problems in children with ASDs, no study has examined eating behaviors of children with ASDs from India.

Objectives:

To examine the eating behaviors of children with ASDs and to compare it with an age and socio-economic matched group of typically developing children.

Methods:

Children with a diagnosis of Autistic Disorder (AD) and Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) aged 4 to 10 years were eligible for the study. The exclusion criteria included any neurological or systemic illness or current use of any drugs known to alter eating behaviors. A total of 63 ASD children (Mean= 6.1 years, SD=1.9) meeting criteria were recruited from the Department of Pediatrics of a tertiary care hospital in North India. The ASD sample included: Boys=90.4%, AD = 86%. An age and socio-economic status matched control group of typically developing children (N=50) was also recruited.  Eating behaviors were evaluated using the Children’s Eating Behavior Inventory (CEBI, Archer, Rosenbaum, & Streiner, 1991). It comprises of 40 items and assesses eating problems and mealtime behaviors. Responses are scored on a five point rating scale (ranging from never to always) to measure the frequency of eating behaviors and whether each behavior presents a problem. A list of common foods, specific to the Indian diet, including  proteins, starches, dairy, fruits, and vegetables was prepared to measure food selectivity.  In addition, height and weight was measured and Body Mass Index (BMI) computed. The study was approved by the ethics committee of the Institute.

Results:

The ASD group had significantly higher total scores on the CESI (t= 3.2, P=.002) and more feeding problems (t =3.7, P=.001) as compared to the control group. Eating problems of the ASD children included not chewing food or feeding self as expected for age, not enjoying eating, taking a long time to eat, eating inadequate amounts of food, and meal times being prolonged and stressful for the family. The height, weight, and the BMI, however, did not differ for the two groups of children. As compared to typical controls, children with ASD ate fewer foods (57.8 vs. 51.0, P=.001), particularly fruits, vegetables, and meat products. Feeding difficulties of the ASD children did not differ by socio-economic status or education of the mother. However, severity of ASD was related to eating problems and children with severe autism, as measured by the Childhood Autism Rating Scale (CARS) had significantly higher total CESI scores (t= 2.2, P=.030).  

Conclusions:

Children with ASD are at a high risk for eating problems and this may be associated with long term nutrient inadequacies. Clinicians should routinely screen ASD children for eating difficulties and initiate appropriate interventions.