Incidence and Effects of Feeding Problems in Children with Symptoms of Autism Spectrum Disorder

Background: Sensory processing dysfunction (SPD) is a known feature of Autism Spectrum Disorder (ASD).  In children with ASD, SPD often manifests itself in extremely limited variety of dietary intake and increased dependence upon processed carbohydrate sources as their main energy source. 

Objectives: This research project sought to describe the incidence and characteristics of feeding problems in a cohort of children being evaluated for possible ASD at an on-campus diagnostic clinic at a large public university. 

Methods: Subjects, aged two to six years of age, were recruited from a university-based ASD Clinic.  As part of the evaluation, parents completed the following measures to provide general information about their child’s symptoms, feeding and dietary habits, parent’s total stress level, and their child’s sensory responses: history form, 24 hour diet recall, Sensory Profile (Dunn, 1999), Behavioral Pediatric Feeding Assessment Scale (BPFAS) (Crist & Napier-Phillip, 2001), Parenting Stress Index- Short Form (3^rd Edition) (PSI-SF) (Abidin, 1995), and the Childhood Autism Rating Scale (2^nd Edition) (CARS^TM-2) (Schopler & Van Bourgondien, 2010).  Additionally, if subjects could be conditioned height and weight measures were collected from standardized methods.   

 Results: In a sample of 29 children aged two to six years of age referred for evaluation of ASD, 48% (n=14/29) received a diagnosis of ASD and 35% (n=10/29) had significantly higher total frequency scores of problematic feeding behavior on the BPFAS.  Forty percent of subjects with anthropometric data were classified as obese (n= 8/20) and of those subjects classified as obese, there was a significant positive correlation with higher scores on the BPFAS and increased consumption of processed foods.  Analysis of 24-hour dietary recall information revealed a mean of 9.3 different foods consumed per day.  Average intake of fresh fruit, vegetables, and minimally processed protein sources was just 2.25 foods in a 24-hour period, or just 24% of average number of foods consumed per day.  Thirty-eight percent of subjects consumed no whole food sources in a 24-hour period.  Average intake of processed and packaged foods, including foods consumed from fast food establishments, was found to be 7.39 foods per day, or more than 75% of the number of foods consumed per day.  Thirty five percent of subjects received the majority of their daily intake of processed foods from carbohydrate sources, such as bread, potato chips, and French fries. 

 Conclusions: Data from this project reveal alarming trends with regard to incidence of obesity, reliance on processed food sources for majority of daily food intake, and minimal consumption of whole foods.  These results suggest an immediate need for increased parent support and possible therapeutic intervention to reduce the number of problematic mealtime behaviors, reduce the percentage of obesity in this cohort, and increase the variety of food sources consumed.