Changes in Food Selectivity over 6 Years in Children with Autism Spectrum Disorder

Background: Food selectivity is a common problem in children with autism spectrum disorder (ASD) and is of concern because of its impact on nutrient adequacy and family mealtimes. Despite recent research in this area, few studies have addressed whether food selectivity present in early childhood persists into adolescence in children with ASD.  

Objectives: To determine if food selectivity and the characteristics/presentation of foods that affect food selectivity persist in in children with ASD.  

Methods: We re-contacted children who participated in the Children’s Activity and Meal Patterns Study which examined dietary patterns, mealtime behaviors, and food selectivity in typically developing children and children with ASD aged 3-11 years. At the initial time point and on average 6.5 years later, a parent-completed food frequency questionnaire was used to measure food refusal and consumption of fruits, vegetables, snacks, and beverages; a 3-day food diary was used to determine the number of unique foods eaten; a diet interview with parents assessed refusal by the child based on food characteristics and presentation of the food (e.g., texture, foods mixed together). Food refusal was defined as the percentage of foods offered that were not eaten.

Results: Seventeen of the 53 (32%) children in the original study participated in the follow-up study.  Those who participated in the follow-up study did not differ in age or in measures of food selectivity at baseline compared to those who did not participate. The mean (SD) age at baseline was 6.9 (2.4) years; mean (SD) age at follow-up was 13.4 (2.6) years.    Mean (SD) food refusal at baseline was 46.8% (22.4), compared to 32.2% (19.4) at follow-up (p<0.01).  The number of unique foods eaten decreased an average of 2.1 foods between baseline and follow-up (borderline significance, p=0.08).  We found no statistically significant changes in the servings of beverages, fruits and vegetables, or snacks consumed between baseline and follow-up (all p>0.05).  At baseline, 94% of parents indicated that their child currently refused food based on consistency, compared to 41% of parents at follow-up (p<0.01).  We observed no significant change in food refusal based on temperature, whether foods were mixed together, or whether foods were touching each other.

Conclusions: Our examination of the change in food selectivity as children become adolescents found that some aspects of food selectivity improved while others persisted. While food refusal improved overall, we did not observe an increase in food repertoire (number of unique foods eaten). Larger longitudinal studies are required to determine the extent of the persistence of food selectivity and the impact on nutritional status in children with ASD.