Onset, Trajectory and Pattern of Feeding Difficulties in Infants Later Diagnosed with ASD

Saturday, May 14, 2016: 11:30 AM-1:30 PM
Hall A (Baltimore Convention Center)
M. B. Steinfeld1, G. S. Young2 and S. Ozonoff1, (1)UC Davis MIND Institute, Sacramento, CA, (2)Psychiatry & Behavioral Sciences, UC Davis MIND Institute, Sacramento, CA

Restrictive, rigid and extremely narrow food preferences, difficulties managing advanced or mixed textures, and negative mealtime behaviors are commonly described in children with Autism Spectrum Disorder (ASD). 


To identify the onset, trajectory and pattern of feeding difficulties in infants later diagnosed with ASD. 


A new autism-specific factor structure (Allen et al 2015) for the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), a validated and commonly used parent report measure of feeding problems (Crist & Napier-Phillips 2001), was applied to prospectively collected BPFAS’s in a sample of 93 infants with an older sibling with ASD -- the high-risk (HR) group -- and 62 infants with no known familial ASD -- the low-risk (LR) group, as part of a larger funded infant sibling study. Infants enrolled at 6 or 9 months and were assessed prospectively at 6, 9, 12, 15, 18, 24 months. At 36 months comprehensive diagnostic assessments were conducted using ADOS, Mullen and observational data. The BPFAS was completed by parents at 15, 18, 24, and 36 months. 

4 outcome groups were formed based on the 36 month clinical assessments: ASD, Atypical (defined as mild-moderate cognitive, language, or social impairment), high-risk typically developing (HR-TD) and low-risk typically developing (LR-TD).


As can be seen in Fig 1, longitudinal trajectories across groups revealed that the ASD group exhibited a significantly increasing number of feeding problems between 15-36 months compared to all other groups. By 36 months, the ASD group exhibited significantly more problems than all other groups. No differences were found between any of the other groups in change over time or at any age point.  

The analysis of the 3 factor score described by Allen et al (2015) revealed a similar pattern for the food acceptance and mealtime behavior domains, with significant age by group interaction effects. The ASD group exhibited greater problems in terms of food acceptance and mealtime behavior domains over time compared to the other groups. The medical/oral-motor domain did not show main effects for either age or group and no significant interaction between age and group.


Children developing ASD showed a rapid increase in parent-identified feeding problems starting between 15-18 months of age, with significantly more feeding problems by 36 months of age compared to the other 3 groups. Food acceptance problems and mealtime behavior problems were significantly more common whereas medical/oral motor problems were not more frequent than in the other groups.