Journal of Autism and Developmental Disorders

, Volume 43, Issue 9, pp 2159–2173 | Cite as

Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature

  • William G. Sharp
  • Rashelle C. Berry
  • Courtney McCracken
  • Nadrat N. Nuhu
  • Elizabeth Marvel
  • Celine A. Saulnier
  • Ami Klin
  • Warren Jones
  • David L. Jaquess
Original Paper

Abstract

We conducted a comprehensive review and meta-analysis of research regarding feeding problems and nutrient status among children with autism spectrum disorders (ASD). The systematic search yielded 17 prospective studies involving a comparison group. Using rigorous meta-analysis techniques, we calculated the standardized mean difference (SMD) with standard error and corresponding odds ratio (OR) with 95 % confidence intervals (CI). Results indicated children with ASD experienced significantly more feeding problems versus peers, with an overall SMD of 0.89 (0.08) and a corresponding OR of 5.11, 95 % CI 3.74–6.97. Nutrient analyses indicated significantly lower intake of calcium (SMD: −0.65 [0.29]; OR: 0.31, 95 % CI 0.11–0.85) and protein (SMD: −0.58 [0.25]; OR: 0.35, 95 % CI: 0.14–0.56) in ASD. Future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population.

Keywords

Diet Food selectivity Mealtime problems Nutrition Picky eating Pediatric feeding disorders 

References

  1. Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder—Not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505–511.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed, Text Revision ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. Archer, L. A., Rosenbaum, P. L., & Streiner, D. L. (1991). The children’s eating behavior inventory: Reliability and validity results. Journal of Pediatric Psychology, 16(5), 629–642.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. Barr, S. I., Murphy, S. P., & Poos, M. I. (2002). Interpreting and using the dietary references intake in dietary assessment of individuals and groups. Journal of the American Dietetic Association, 102(6), 780–788.PubMedCrossRefGoogle Scholar
  6. Becker, B. J. (2005). Failsafe N or file-drawer number. In H. P. Rothstein, A. J. Sutton, & M. Borenstein (Eds.), Publication bias in meta-analysis: Prevention, assessment and adjustments (pp. 111–125). Chichester: Wiley.Google Scholar
  7. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis (2nd ed.). Englewood, NJ: Biostat.Google Scholar
  8. Campbell, J. M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single-case research. Research in Developmental Disabilities, 8, 165–178.Google Scholar
  9. Cannell, J. J. (2008). Autism and vitamin D. Medical Hypotheses, 70, 750–759.PubMedCrossRefGoogle Scholar
  10. 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(1), 259–264.Google Scholar
  11. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.Google Scholar
  12. Collins, M. R., Kyle, R., Smith, S., Laverty, A., Roberts, S., & Eaton-Evans, J. (2003). Coping with the usual family diet: Eating behavior and food choices of children with Down’s syndrome, autistic spectrum disorders or cri du chat syndrome and comparison groups of siblings. Journal of Learning Disabilities, 7(2), 137–155.Google Scholar
  13. Cornish, E. (1998). A balanced approach towards healthy eating in autism. Journal of Human Nutrition and Dietetics, 11, 501–509.CrossRefGoogle Scholar
  14. Cumine, V., Leach, J., & Stevenson, G. (2000). Autism in the early years. New York: David Fulton.Google Scholar
  15. Dominick, K. C., David, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28, 145–162.PubMedCrossRefGoogle Scholar
  16. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463.PubMedCrossRefGoogle Scholar
  17. Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple graphical test. BMJ (Clinical Research Ed), 315(7109), 629–634.CrossRefGoogle Scholar
  18. Elder, J. H. (2008). The gluten-free casein-free diet in autism: An overview with clinical implications. Nutrition in Clinical Practice, 23(6), 583–588.PubMedCrossRefGoogle Scholar
  19. Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The gluten-fee, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413–420.PubMedCrossRefGoogle Scholar
  20. Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), 337–342.CrossRefGoogle Scholar
  21. Hediger, M. L., England, L. J., Molly, C. A., Yu, K. F., Manning-Courtney, P., & Mills, J. L. (2007). Reduced bone cortical thickness in boys with autism or autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(5), 848–856.CrossRefGoogle Scholar
  22. Herndon, A. C., DiGuiseppi, C., Johnson, S. L., Leiferman, J., & Reynolds, A. (2009). Does nutritional intake differ between children with autism spectrum disorders and children with typical development? Journal of Autism and Developmental Disorders, 39, 212–222.PubMedCrossRefGoogle Scholar
  23. Herzinger, C. V., & Campbell, J. M. (2007). Comparing functional assessment methodologies: A quantitative synthesis. Journal of Autism and Developmental Disorders, 37, 1430–1445.PubMedCrossRefGoogle Scholar
  24. Horvath, K., Papdimitriou, J. C., Rabsztyn, A., Drachenberg, D., & Tildon, J. T. (1999). Gastrointestinal abnormalities in children with autistic disorder. Pediatrics, 135, 559–563.CrossRefGoogle Scholar
  25. Hunter, J. E., & Schmidt, F. L. (2004). Methods of meta-analysis: Correcting error and bias in research findings (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  26. Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124(2), 680–686.PubMedCrossRefGoogle Scholar
  27. Johnson, C. R., Handon, B. L., Mayer-Costa, M., & Sacco, K. (2008). Eating habits and dietary status on young children with autism. Journal of Autism and Developmental Disorders, 20, 437–448.Google Scholar
  28. Kanner, L. (1943). Autistic disturbances of affective contact. The Nervous Child, 2, 217–250.Google Scholar
  29. Kerwin, M. E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal of Pediatric Psychology, 24, 193–214.PubMedCrossRefGoogle Scholar
  30. Konstantareas, M. M., & Homatidis, S. (1987). Ear infections in autistic and normal children. Journal of Autism and Developmental Disorders, 17(4), 585–594.PubMedCrossRefGoogle Scholar
  31. Laud, R. B., Girolami, P. A., Boscoe, J. H., & Gulotta, C. S. (2009). Treatment outcomes for severe feeding problems in children with autism spectrum disorder. Behavior Modification, 33, 520–536.PubMedCrossRefGoogle Scholar
  32. 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, 153–166.CrossRefGoogle Scholar
  33. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.Google Scholar
  34. Lockner, D. W., Crowe, T. K., & Skipper, B. J. (2008). Dietary intake and parents’ perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children. Journal of the American Dietetic Association, 108, 1360–1363.PubMedCrossRefGoogle Scholar
  35. Lord, C., Rsis, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.PubMedCrossRefGoogle Scholar
  36. 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, 659–685.PubMedCrossRefGoogle Scholar
  37. 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, 342–352.PubMedCrossRefGoogle Scholar
  38. Martins, Y., Young, R. L., & Robson, D. C. (2008). Feeding and eating behaviors in children with autism and typically developing children. Journal of Autism and Developmental Disorders, 38, 1878–1887.PubMedCrossRefGoogle Scholar
  39. Matson, J. L., Fodstad, J. C., & Dempsey, T. (2009). The relationship of children’s feeding problems to core symptoms of autism and PDD-NOS. Research in Developmental Disabilities, 3, 759–766.Google Scholar
  40. Mulloy, A., Lang, R., O’Reilly, M., Sigofoos, J., Lancioni, G., & Rispoli, M. (2010). Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4(3), 328–339.CrossRefGoogle Scholar
  41. Nadon, G., Feldman, D.E., Dunn, W., & Gisel, E. (2011). Mealtime problems in children with autism spectrum disorder and their typically developing siblings: A comparison study. Autism, 15(1), 98–113.PubMedCrossRefGoogle Scholar
  42. Niehus, R., & Lord, C. (2006). Early medical history of children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 27, S120–S127.PubMedCrossRefGoogle Scholar
  43. Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children: comparison with autism spectrum disorder and children with typical development. Physical and Occupational Therapy in Pediatrics, 30(3), 220–233.PubMedCrossRefGoogle Scholar
  44. Raiten, D. J., & Massaro, T. (1986). Perspectives on the nutritional ecology of autistic children. Journal of Autism and Developmental Disorders, 16(2), 133–143.PubMedCrossRefGoogle Scholar
  45. Ritvo, E. M., & Freeman, B. J. (1978). National society for autistic children definition of the syndrome of autism. Journal of Autism and Childhood Schizophrenia, 8, 162–170.CrossRefGoogle Scholar
  46. Rosenthal, R., & Rubin, D. (1986). Meta-analytic procedures for combining studies with multiple effect sizes. Psychological Bulletin, 99(3), 400–406.CrossRefGoogle Scholar
  47. Schmitt, L., Heiss, C. J., & Campdell, E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Topics in Clinical Nutrition, 23(1), 23–31.Google Scholar
  48. Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behavior between children with and without autism. Journal of Autism and Developmental Disorders, 34, 433–438.PubMedCrossRefGoogle Scholar
  49. Seiverling, L., Williams, K., & Sturmey, P. (2010). Assessment of feeding problems in children with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 22, 401–413.CrossRefGoogle Scholar
  50. Sharp, W. G., Jaquess, D. L., Morton, J. S., & Herzinger, C. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13, 348–365.PubMedCrossRefGoogle Scholar
  51. Sharp, W. G., Jaquess, D. L., Morton, J. F., & Miles, A. G. (2011). A retrospective chart review of dietary diversity and feeding behavior of children with autism spectrum disorder before and after admission to a day treatment program. Focus on Autism and Other Developmental Disabilities, 26, 37–48.CrossRefGoogle Scholar
  52. Shearer, T. R., Larson, K., Neuschwander, J., & Gedney, B. (1982). Minerals in the hair and nutrient intake of autistic children. Journal of Developmental and Physical Disabilities, 12(1), 25–34.CrossRefGoogle Scholar
  53. Whiteley, P. (2004). Developmental behavioral and somatic factors in pervasive developmental disorders: Preliminary analysis. Child: Care Health and Development, 30, 5–11.CrossRefGoogle Scholar
  54. WHO Multicentre Growth Reference Study Group. (2006). WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization.Google Scholar
  55. Williams, K. E., Gibbons, B. G., & Schreck, K. A. (2005). Comparing selective eaters with and without developmental disabilities. Journal of Developmental and Physical Disabilities, 17, 299–309.CrossRefGoogle Scholar
  56. Yu, S. M., Kogan, M. D., & Gergen, P. (1997). Vitamin-mineral supplement use among preschool children in the United States. Pediatrics, 100, e4.PubMedCrossRefGoogle Scholar
  57. Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42(4), 549–556.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • William G. Sharp
    • 1
    • 2
  • Rashelle C. Berry
    • 2
  • Courtney McCracken
    • 1
  • Nadrat N. Nuhu
    • 2
  • Elizabeth Marvel
    • 2
  • Celine A. Saulnier
    • 1
    • 2
  • Ami Klin
    • 1
    • 2
  • Warren Jones
    • 1
    • 2
  • David L. Jaquess
    • 1
    • 2
  1. 1.Department of PediatricsEmory University School of MedicineAtlantaUSA
  2. 2.The Marcus Autism CenterAtlantaUSA

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