Abstract
Feeding difficulties related to selective intake, or eating a limited variety of foods, are very common in children with autism spectrum disorder (ASD). A systematic search of PubMed, Embase, PsycInfo, and CINAHL identified 29 studies that evaluated eight correlates: age, ASD symptoms and severity, cognitive and adaptive skills, sensory processing and perception, challenging behavior, weight status, gastrointestinal symptoms, and parenting stress. Feeding difficulties related to selective intake are consistently correlated with impaired sensory processing and perception and tend to be positively associated with rigidity and challenging behavior. These feeding difficulties tend to persist with advancing age. Other correlates demonstrated inconsistent findings. A significant limitation of research reviewed is variability in terminology, definitions, and measurement of feeding difficulties.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms & profiles. University of Vermont, Research Center for Children, Youth, and Families.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, and Families.
Adamo, K. B., & Brett, K. E. (2014). Parental perceptions and childhood dietary quality. Maternal and Child Health Journal, 18(4), 978–995. https://doi.org/10.1007/s10995-013-1326-6
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Aponte, C. A., & Romanczyk, R. G. (2016). Assessment of feeding problems in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 21, 61–72. https://doi.org/10.1016/j.rasd.2015.09.007
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., et al. (2018). Prevalence of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1–23. https://doi.org/10.15585/mmwr.ss6706a1
Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., et al. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics, 157(2), 259–264. https://doi.org/10.1016/j.jpeds.2010.02.013
Bandini, L. G., Curtin, C., Phillips, S., Anderson, S. E., Maslin, M., & Must, A. (2017). Changes in food selectivity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(2), 439–446. https://doi.org/10.1007/s10803-016-2963-6
Beighley, J. S., Matson, J. L., Rieske, R. D., & Adams, H. L. (2013). Food selectivity in children with and without an autism spectrum disorder: Investigation of diagnosis and age. Research in Developmental Disabilities, 34(10), 3497–3503. https://doi.org/10.1016/j.ridd.2013.07.026
Berding, K., & Donovan, S. M. (2018). Diet can impact microbiota composition in children with autism spectrum disorder. Frontiers in Neuroscience, 12, 515. https://doi.org/10.3389/fnins.2018.00515
Bitsika, V., & Sharpley, C. F. (2018). An exploration of the association between matrix reasoning and eating disturbance behavior in girls with autism spectrum disorder. Psychology Research and Behavior Management, 11, 259–266. https://doi.org/10.2147/prbm.S166010
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246. https://doi.org/10.1016/j.jada.2009.10.032
Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(2), 583–591. https://doi.org/10.1007/s10803-017-3340-9
Cohen, I. L., & Sudhalter, V. (2005). PDD behavior inventory (PDDBI). Psychological Assessment Resources.
Constantino, J. N. (2012). Social responsiveness scale (2nd ed.). Western Psychological Services.
Curtin, C., Hubbard, K., Anderson, S. E., Mick, E., Must, A., & Bandini, L. G. (2015). Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3308–3315. https://doi.org/10.1007/s10803-015-2490-x
DeMand, A., Johnson, C., & Foldes, E. (2015). Psychometric properties of the brief autism mealtime behaviors inventory. Journal of Autism and Developmental Disorders, 45(9), 2667–2673. https://doi.org/10.1007/s10803-015-2435-4
Duignan, E., Kenna, P., Watson, R., Fitzsimon, S., & Brosnahan, D. (2015). Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: Case reports and a review of the literature. Case Reports in Ophthalmology, 6(1), 24–29. https://doi.org/10.1159/000373921
Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children: An Interdisciplinary Journal of Early Childhood Intervention, 9(4), 23–35.
Dunn, W. (1999). The sensory profile. Psychological Corporation.
Dunn, W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants and Young Children: An Interdisciplinary Journal of Early Childhood Intervention, 20(2), 84–101. https://doi.org/10.1097/01.iyc.0000264477.05076.5d
Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 29(2), 129–141. https://doi.org/10.1023/a:1023040610384
Esteban-Figuerola, P., Canals, J., Fernandez-Cao, J. C., & Arija Val, V. (2019). Differences in food consumption and nutritional intake between children with autism spectrum disorders and typically developing children: A meta-analysis. Autism, 23(5), 1079–1095. https://doi.org/10.1177/1362361318794179
Evans, E. W., Must, A., Anderson, S. E., Curtin, C., Scampini, R., Maslin, M., et al. (2012). Dietary patterns and body mass index in children with autism and typically developing children. Research in Autism Spectrum Disorders, 6(1), 399–405. https://doi.org/10.1016/j.rasd.2011.06.014
Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. https://doi.org/10.1007/s10803-008-0674-3
Gray, H. L., Sinha, S., Buro, A. W., Robinson, C., Berkman, K., Agazzi, H., et al. (2018). Early history, mealtime environment, and parental views on mealtime and eating behaviors among children with ASD in Florida. Nutrients. https://doi.org/10.3390/nu10121867
Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1), 5–25. https://doi.org/10.1007/s10803-005-0039-0
Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. https://doi.org/10.1007/s10803-012-1604-y
Hill, T. L., Gray, S. A. O., Kamps, J. L., & Enrique Varela, R. (2015). Age and adaptive functioning in children and adolescents with ASD: The effects of intellectual functioning and ASD symptom severity. Journal of Autism and Developmental Disorders, 45(12), 4074–4083. https://doi.org/10.1007/s10803-015-2522-6
Karlsson, L., Råstam, M., & Wentz, E. (2013). The SWedish eating assessment for autism spectrum disorders (SWEAA)-validation of a self-report questionnaire targeting eating disturbances within the autism spectrum. Research in Developmental Disabilities, 34(7), 2224–2233. https://doi.org/10.1016/j.ridd.2013.03.035
Kerzner, B., Milano, K., MacLean, W. C., Jr., Berall, G., Stuart, S., & Chatoor, I. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), 344–353. https://doi.org/10.1542/peds.2014-1630
Kral, T. V., Eriksen, W. T., Souders, M. C., & Pinto-Martin, J. A. (2013). Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: A brief review. Journal of Pediatric Nursing, 28(6), 548–556. https://doi.org/10.1016/j.pedn.2013.01.008
Kral, T. V., Souders, M. C., Tompkins, V. H., Remiker, A. M., Eriksen, W. T., & Pinto-Martin, J. A. (2015). Child eating behaviors and caregiver feeding practices in children with autism spectrum disorders. Public Health Nursing, 32(5), 488–497. https://doi.org/10.1111/phn.12146
Lam, K. S., & Aman, M. G. (2007). The repetitive behavior scale-revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(5), 855–866. https://doi.org/10.1007/s10803-006-0213-z
Lane, A. E., Geraghty, M. E., Young, G. S., & Rostorfer, J. L. (2014). Problem eating behaviors in autism spectrum disorder are associated with suboptimal daily nutrient intake and taste/smell sensitivity. ICAN: Infant, Child, and Adolescent Nutrition, 6(3), 172–180. https://doi.org/10.1177/1941406414523981
Leader, G., O’Reilly, M., Gilroy, S. P., Chen, J. L., Ferrari, C., & Mannion, A. (2020a). Comorbid feeding and gastrointestinal symptoms, challenging behavior, sensory issues, adaptive functioning and quality of life in children and adolescents with autism spectrum disorder. Developmental Neurorehabilitation. https://doi.org/10.1080/17518423.2020.1770354
Leader, G., Tuohy, E., Chen, J. L., Mannion, A., & Gilroy, S. P. (2020b). Feeding problems, gastrointestinal symptoms, challenging behavior and sensory issues in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(4), 1401–1410. https://doi.org/10.1007/s10803-019-04357-7
Leclercq, E., Leeflang, M. M., van Dalen, E. C., & Kremer, L. C. (2013). Validation of search filters for identifying pediatric studies in PubMed. Journal of Pediatrics, 162(3), 629-634.e622. https://doi.org/10.1016/j.jpeds.2012.09.012
Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities, 21(3), 153–166. https://doi.org/10.1177/10883576060210030401
Leiva-Garcia, B., Planells, E., Planells Del Pozo, P., & Molina-Lopez, J. (2019). Association between feeding problems and oral health status in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(12), 4997–5008. https://doi.org/10.1007/s10803-019-04211-w
Lord, C., Luyster, R. J., Gotham, K., & Guthrie, W. (2012a). Autism diagnostic observation schedule toddler module, second edition [manual]. Western Psychological Services.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012b). Autism diagnostic observation schedule modules 1–4, second edition [manual]. Western Psychological Services.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685. https://doi.org/10.1007/bf02172145
Luisier, A. C., Petitpierre, G., Bérod, A. C., Richoz, A. R., Lao, J., Caldara, R., et al. (2019). Visual and hedonic perception of food stimuli in children with autism spectrum disorders and their relationship to food neophobia. Perception, 48(3), 197–213. https://doi.org/10.1177/0301006619828300
Luisier, A. C., Petitpierre, G., Ferdenzi, C., Clerc Bérod, A., Giboreau, A., Rouby, C., et al. (2015). Odor perception in children with autism spectrum disorder and its relationship to food neophobia. Frontiers in Psychology, 6, 1830. https://doi.org/10.3389/fpsyg.2015.01830
Lukens, C. T., & Linscheid, T. R. (2008). Development and validation of an inventory to assess mealtime behavior problems in children with autism. Journal of Autism and Developmental Disorders, 38(2), 342–352. https://doi.org/10.1007/s10803-007-0401-5
Mari-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-Gonzalez, A., & Morales-Suarez-Varela, M. (2014). Food selectivity in autism spectrum disorders: A systematic review. Journal of Child Neurology, 29(11), 1554–1561. https://doi.org/10.1177/0883073813498821
Matheson, B. E., & Douglas, J. M. (2017). Overweight and obesity in children with autism spectrum disorder (ASD): a Critical review investigating the etiology, development, and maintenance of this relationship. Review Journal of Autism and Developmental Disorders, 4(2), 142–156. https://doi.org/10.1007/s40489-017-0103-7
Matson, J. L., LoVullo, S. V., Rivet, T. T., & Boisjoli, J. A. (2009). Validity of the autism spectrum disorder-comorbid for children (ASD-CC). Research in Autism Spectrum Disorders, 3(2), 345–357. https://doi.org/10.1016/j.rasd.2008.08.002
Mayes, S. D., & Zickgraf, H. (2019). Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders, 64, 76–83. https://doi.org/10.1016/j.rasd.2019.04.002
McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Pediatrics, 133(5), 872–883. https://doi.org/10.1542/peds.2013-3995
McIntosh, D., Miller, L., Shyu, V., & Dunn, W. (1999). Development and validation of the short sensory profile. Sensory Profile Manual, 59–73
Padmanabhan, P. S., & Shroff, H. (2020). The relationship between sensory integration challenges and the dietary intake and nutritional status of children with Autism Spectrum Disorders in Mumbai, India. International Journal of Developmental Disabilities, 66(2), 142–152. https://doi.org/10.1080/20473869.2018.1522816
Patton, S. R., Odar Stough, C., Pan, T. Y., Holcomb, L. O., & Dreyer Gillette, M. L. (2020). Associations between autism symptom severity and mealtime behaviors in young children presented with an unfamiliar food. Research in Developmental Disabilities, 103, 103676. https://doi.org/10.1016/j.ridd.2020.103676
Pham, D., Silver, S., Haq, S., Hashmi, S. S., & Eissa, M. (2020). Obesity and severe obesity in children with autism spectrum disorder: Prevalence and risk factors. Southern Medical Journal, 113(4), 168–175. https://doi.org/10.14423/smj.0000000000001068
Pineles, S. L., Avery, R. A., & Liu, G. T. (2010). Vitamin B12 optic neuropathy in autism. Pediatrics, 126(4), e967-970. https://doi.org/10.1542/peds.2009-2975
Pliner, P. (1994). Development of measures of food neophobia in children. Appetite, 23(2), 147–163. https://doi.org/10.1006/appe.1994.1043
Postorino, V., Sanges, V., Giovagnoli, G., Fatta, L. M., De Peppo, L., Armando, M., et al. (2015). Clinical differences in children with autism spectrum disorder with and without food selectivity. Appetite, 92, 126–132. https://doi.org/10.1016/j.appet.2015.05.016
Prosperi, M., Santocchi, E., Balboni, G., Narzisi, A., Bozza, M., Fulceri, F., et al. (2017). Behavioral phenotype of ASD preschoolers with gastrointestinal symptoms or food selectivity. Journal of Autism and Developmental Disorders, 47(11), 3574–3588. https://doi.org/10.1007/s10803-017-3271-5
Riccio, M. P., Franco, C., Negri, R., Ferrentino, R. I., Maresca, R., D’Alterio, E., et al. (2018). Is food refusal in autistic children related to TAS2R38 genotype? Autism Research, 11(3), 531–538. https://doi.org/10.1002/aur.1912
Rutter, M., Bailey, A., & Lord, C. (2003). Social communication questionnaire. Western Psychological Services.
Scahill, L., Jeon, S., Boorin, S. J., McDougle, C. J., Aman, M. G., Dziura, J., et al. (2016). Weight gain and metabolic consequences of risperidone in young children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 55(5), 415–423. https://doi.org/10.1016/j.jaac.2016.02.016
Seiverling, L., Hendy, H. M., & Williams, K. (2011). The screening tool of feeding problems applied to children (STEP-CHILD): Psychometric characteristics and associations with child and parent variables. Research in Developmental Disabilities, 32(3), 1122–1129. https://doi.org/10.1016/j.ridd.2011.01.012
Sharp, W. G., Berry, R. C., Burrell, L., Scahill, L., & McElhanon, B. O. (2020). Scurvy as a sequela of avoidant-restrictive food intake disorder in autism: A systematic review. Journal of Developmental and Behavioral Pediatrics. https://doi.org/10.1097/dbp.0000000000000782
Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., et al. (2013a). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders, 43(9), 2159–2173. https://doi.org/10.1007/s10803-013-1771-5
Sharp, W. G., Jaquess, D. L., & Lukens, C. T. (2013b). Multi-method assessment of feeding problems among children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(1), 56–65. https://doi.org/10.1016/j.rasd.2012.07.001
Sharp, W. G., Postorino, V., McCracken, C. E., Berry, R. C., Criado, K. K., Burrell, T. L., et al. (2018). Dietary intake, nutrient status, and growth parameters in children with autism spectrum disorder and severe food selectivity: An electronic medical record review. Journal of the Academy of Nutrition and Dietetics, 118(10), 1943–1950. https://doi.org/10.1016/j.jand.2018.05.005
Shmaya, Y., Eilat-Adar, S., Leitner, Y., Reif, S., & Gabis, L. V. (2017). Meal time behavior difficulties but not nutritional deficiencies correlate with sensory processing in children with autism spectrum disorder. Research in Developmental Disabilities, 66, 27–33. https://doi.org/10.1016/j.ridd.2017.05.004
Smith, B., Rogers, S. L., Blissett, J., & Ludlow, A. K. (2020). The relationship between sensory sensitivity, food fussiness and food preferences in children with neurodevelopmental disorders. Appetite, 150, 104643. https://doi.org/10.1016/j.appet.2020.104643
Strang, J. F., Anthony, L. G., Yerys, B. E., Hardy, K. K., Wallace, G. L., Armour, A. C., et al. (2017). The flexibility scale: Development and preliminary validation of a cognitive flexibility measure in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47(8), 2502–2518. https://doi.org/10.1007/s10803-017-3152-y
Sturman, N., Deckx, L., & van Driel, M. L. (2017). Methylphenidate for children and adolescents with autism spectrum disorder. Cochrane Database Cochrane Systematische Reviews, 11(11), Cd011144. https://doi.org/10.1002/14651858.CD011144.pub2
Suarez, M. A., Nelson, N. W., & Curtis, A. B. (2014). Longitudinal follow-up of factors associated with food selectivity in children with autism spectrum disorders. Autism, 18(8), 924–932. https://doi.org/10.1177/1362361313499457
Tanner, K., Case-Smith, J., Nahikian-Nelms, M., Ratliff-Schaub, K., Spees, C., & Darragh, A. R. (2015). Behavioral and physiological factors associated with selective eating in children with autism spectrum disorder. American Journal of Occupational Therapy, 69(6), 6906180030–6906180038. https://doi.org/10.5014/ajot.2015.019273
Taylor, C. M., & Emmett, P. M. (2019). Picky eating in children: Causes and consequences. The Proceedings of the Nutrition Society, 78(2), 161–169. https://doi.org/10.1017/s0029665118002586
Taylor, C. M., Wernimont, S. M., Northstone, K., & Emmett, P. M. (2015). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite, 95, 349–359. https://doi.org/10.1016/j.appet.2015.07.026
Thullen, M., & Bonsall, A. (2017). Co-parenting quality, parenting stress, and feeding challenges in families with a child diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(3), 878–886. https://doi.org/10.1007/s10803-016-2988-x
Tomova, A., Soltys, K., Kemenyova, P., Karhanek, M., & Babinska, K. (2020). The influence of food intake specificity in children with autism on gut microbiota. International Journal of Molecular Sciences. https://doi.org/10.3390/ijms21082797
Vissoker, R. E., Berger, D., Latzer, Y., & Gal, E. (2018). Food selectivity, gastrointestinal symptoms and urine organic acids in autism spectrum disorder: A pilot study. Current Nutrition and Food Science, 14(2), 171–179. https://doi.org/10.2174/1573401313666170525133604
Vissoker, R. E., Latzer, Y., Stolar, O., Rabenbach, A., & Gal, E. (2019). Eating problems and patterns among toddlers and young boys with and without autism spectrum disorders. Research in Autism Spectrum Disorders, 59, 1–9. https://doi.org/10.1016/j.rasd.2018.12.001
Wardle, J., Guthrie, C. A., Sanderson, S., & Rapoport, L. (2001). Development of the children’s eating behaviour questionnaire. Journal of Child Psychology and Psychiatry, 42(7), 963–970. https://doi.org/10.1111/1469-7610.00792
Wildes, J. E., Zucker, N. L., & Marcus, M. D. (2012). Picky eating in adults: Results of a web-based survey. International Journal of Eating Disorders, 45(4), 575–582. https://doi.org/10.1002/eat.20975
Zachor, D. A., & Ben-Itzchak, E. (2016). Specific medical conditions are associated with unique behavioral profiles in autism spectrum disorders. Frontiers in Neuroscience, 10, 410. https://doi.org/10.3389/fnins.2016.00410
Zaenglein, A., Martin, A., Carlson, L., & Williams, K. E. (2020). Pellagra secondary to selective eating in a child with autism. Pediatric Dermatology. https://doi.org/10.1111/pde.14176
Zickgraf, H. F., Richard, E., Zucker, N. L., & Wallace, G. L. (2020). Rigidity and sensory sensitivity: Independent contributions to selective eating in children, adolescents, and young adults. Journal of Clinical Child and Adolescent Psychology. https://doi.org/10.1080/15374416.2020.1738236
Funding
This review received no external funding and was completed as part of the first author’s PhD training at the University of Pennsylvania School of Nursing. AMC was supported, in part, by the National Institute of Nursing Research of the National Institutes of Health under Award Number K23NR017209.
Author information
Authors and Affiliations
Contributions
SDP conducted the systematic review, supervised by MCS and JPM and critically revised by MCS, TVEK, AMC, and JPM.
Corresponding author
Ethics declarations
Conflict of Interest
AMC reports grants and consulting fees from WW International, Inc., outside the submitted work. The other authors have no relevant financial or non-financial interests to disclose.
Ethical Approval
This systematic review was guided by the PRISMA statement. No ethical approval is required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Page, S.D., Souders, M.C., Kral, T.V.E. et al. Correlates of Feeding Difficulties Among Children with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 52, 255–274 (2022). https://doi.org/10.1007/s10803-021-04947-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-021-04947-4