Food Selectivity and Taste/Smell Sensitivity in Children with Autism Spectrum Disorder

Background: Food selectivity is a common feeding problem in children with autism spectrum disorder (ASD) and is associated with increased risk of nutrient deficiencies. Children with ASD exhibit varying degrees of food selectivity, which may reflect differences in sensory processing, specifically taste/smell sensitivity (TSS). Studies on the association between atypical sensory characteristics and food selectivity in children with ASD compared to children without ASD are lacking.

Objectives: We compared the sensory profiles of children with and without ASD. Among children with ASD we further examined the association of TSS and food selectivity, as well as the relationship between TSS and fruit and vegetable repertoire.

Methods: The Children’s Activity and Meal Patterns Study, a cross-sectional study conducted in 2007-2008, enrolled 53 children with ASD and 58 children without ASD, ages 3-11 years.  Children’s TSS scores were determined by parent-report on the Sensory Profile and analyzed as typical/atypical and as a continuous variable. TSS scores were derived from a subset of items from the oral sensitivity score and are equivalent to the TSS subset on the Short Sensory Profile. Food selectivity was operationalized as food refusal and limited food repertoire. Food refusal was assessed using a modified FFQ completed by one parent and expressed as the proportion of indicated foods refused by their child of those offered. Food repertoire, defined as the absolute number of unique foods and beverages the child consumed, was quantified from 3-day food records. Fruit and vegetable repertoire was determined by the number of unique fruits and vegetables consumed on the FFQ, which lists 13 fruits and 20 vegetables.

Results: Compared to children without ASD, children with ASD had significantly lower scores on all nine sensory factors of the Sensory Profile (all p<0.05), indicating atypical sensory characteristics. More children with ASD were classified as atypical on TSS compared to children without ASD (66% vs. 6%, p<0.001). Among children with ASD, TSS scores were significantly correlated with food refusal (r=-0.67, p<0.001), food repertoire (r=0.33, p=0.03), number of unique fruits consumed (r=0.45, p<0.01), and number of unique vegetables consumed (r=0.55, p<0.001).  Compared to children with ASD classified as typical TSS, those atypical for TSS had significantly higher levels of food refusal (52% vs. 25%, p<0.001).  In addition, the number of unique fruits (5.3 vs. 8.2, p<0.01), unique vegetables (4.2 vs. 8.9, p<0.001), and total food repertoire (17.9 vs. 20.7, p=0.08) were lower among children with ASD classified as atypical TSS compared to those typical for TSS.  

Conclusions: More children with ASD present with atypical sensory characteristics compared to children without ASD. Atypical taste/smell sensitivity is associated with higher rates of food refusal and consumption of fewer unique fruits and vegetables. These findings suggest that children with ASD who have elevated taste/smell sensitivity may benefit from interventions to address their sensory challenges in order to increase food variety, to help ensure that they consume a diet that will meet their nutritional needs for growth and development.