Psychological, Health, and Demographic Correlates of Atypical Eating Behaviors in Children with Autism

  • Hana Zickgraf
  • Susan D. MayesEmail author


Potential psychological, health, and demographic correlates of atypical eating behaviors in children with autism were analyzed in the largest sample with the broadest range of independent variables to date. Eating behaviors were assessed in 1112 children with autism 1–17 years of age using the Checklist for Autism Spectrum Disorder (CASD), a standardized parent interview conducted by licensed psychologists. Independent variables were demographics (age, IQ, sex, race, and parent occupation), 29 CASD autism symptom scores (e.g., distress with change and sensory hypersensitivity), psychotropic medication use, and maternal ratings on the Pediatric Behavior Scale assessing psychopathology (e.g., behavior problems, ADHD, anxiety, and depression), appetite, weight, gastrointestinal problems, and other health problems. Atypical eating behaviors were found in 70.5% of children and were positively related to only four variables: age (most common at ages 1–3), increasing autism severity (total number of autism symptoms present), poor appetite, and constipation. Given the high prevalence of atypical eating behaviors in autism and their presence at a very young age, primary care and early intervention providers should be alert to these problems and if present, consider the possibility of autism and a referral for a diagnostic evaluation so that children with autism can access behavioral intervention shown to be effective in treating autism in toddlers and young preschoolers, as well as in treating the atypical eating behaviors.


Atypical eating behaviors Limited food preferences Autism 


Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was waived by the Institutional Review Board because analyses were conducted retrospectively on existing clinical data.

Conflict of Interest

The authors declare they have no conflicts of interest.


  1. 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.CrossRefGoogle Scholar
  2. 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, 439–446.CrossRefGoogle Scholar
  3. 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, 3497–3503.CrossRefGoogle Scholar
  4. Bicer, A. H., & Alsaffar, A. A. (2013). Body mass index, dietary intake and feeding problems of Turkish children with autism spectrum disorder (ASD). Research in Developmental Disabilities, 34, 3978–3987.CrossRefGoogle Scholar
  5. Bixler, E. O., Vgontzas, A. N., Lin, H.-M., Calhoun, S., Vela-Bueno, A., Fedok, F., et al. (2009). Sleep disordered breathing in children in a general population sample: Prevalence and risk factors. Sleep, 32, 731–736.CrossRefGoogle Scholar
  6. Cardona Cano, S., Hoek, H. W., & Bryant-Waugh, R. (2015a). Picky eating: The current state of research. Current Opinion Psychiatry, 28, 448–454.CrossRefGoogle Scholar
  7. Cardona Cano, S., Tiemeier, H., Van Hoken, D. Tharner, A., Jaddoe, V. W., Hoffman, A., et al. (2015b). Trajectories of picky eaters during childhood: A general population study. International Journal of Eating Disorders, 48, 570–579.Google Scholar
  8. Carruth, B. R., Ziegler, P. J., Gordon, A., & Barr, S. I. (2004). Prevalence of picky eaters among infants and toddlers and their caretakers decisions about offering a new food. Journal of the American Dietetic Association, 104, 57–64.CrossRefGoogle Scholar
  9. Castro, K., Faccioli, L. S., Baronio, D., Gottfried, C., Perry, I. S., & Riesgo, R. (2016). Feeding behavior and dietary intake of male children and adolescents with autism spectrum disorder: A case-control study. International Journal of Developmental Neuroscience, 53, 68–74.CrossRefGoogle Scholar
  10. Chang, S. E., Park, K. Y., Kang, S. K., Kang, K. S., Na, S. Y., Yang, H. R., et al. (2013). Prevalence, clinical significance, and management of functional constipation at pediatric gastroenterology clinics. Journal of Korean Medical Science, 28, 1356–1361.CrossRefGoogle Scholar
  11. Conrad, A. L., Richman, L., Lindgren, S., & Nopoulos, P. (2010). Biological and environmental predictors of behavioral sequelae in children born preterm. Pediatrics, 125, 83–89.CrossRefGoogle Scholar
  12. Cortese, S., Castelnau, P., Morcillo, C., Roux, S., & Bonnet-Brilhault, F. (2012). Psychostimulants for ADHD-like symptoms in individuals with autism spectrum disorders. Expert Reviews Neurotherapy, 12, 461–472.CrossRefGoogle Scholar
  13. 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, 3308–3315.CrossRefGoogle Scholar
  14. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125, 17–23.Google Scholar
  15. Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with history of language impairment. Research in Developmental Disabilities, 28, 145–162.CrossRefGoogle Scholar
  16. Dubois, L., Farmer, A., Girard, M., Peterson, K., & Tatone-Tokuda, F. (2007). Problem eating behaviors related to social factors and body weight in preschool children: A longitudinal study. International Journal Behavioral Nutrition and Physical Activity, 4, 9.CrossRefGoogle Scholar
  17. Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126, 337–342.CrossRefGoogle Scholar
  18. Equit, M., Pälmke, M., Becker, N., Moritz, A. M., Becker, S., & von Gontard, A. (2013). Eating problems in young children-a population-based study. Acta Paediatrica, 102, 149–155.CrossRefGoogle Scholar
  19. Farrow, C. V., & Coulthard, H. (2012). Relationships between sensory sensitivity, anxiety, and selective eating in children. Appetite, 58, 842–846.CrossRefGoogle Scholar
  20. Gorrindo, P., Williams, K. C., Lee, E. B., Walker, L. S., McGrew, S. G., & Levitt, P. (2012). Gastrointestinal dysfunction in autism: Parental report, clinical evaluation, and associated factors. Autism Research, 5, 101–108.CrossRefGoogle Scholar
  21. Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four- to six-year follow-up. Journal of Autism and Developmental Disorders, 30, 137–142.CrossRefGoogle Scholar
  22. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.Google Scholar
  23. Kauer, J., Pelchat, M., Rozin, P., & Zickgraf, H. F. (2015). Adult picky eating: Phenomenology, taste sensitivity, and psychological correlates. Appetite, 90, 219–228.CrossRefGoogle Scholar
  24. Kuschner, E. S., Eisenberg, I. W., Orionzi, B., Simmons, W. K., Kenworthy, L., Martin, A., & Wallace, G. L. (2015). A preliminary study of self-reported food selectivity in adolescents and young adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 15-16, 53–59.CrossRefGoogle Scholar
  25. 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
  26. Lindgren, S. D., & Koeppl, G. K. (1987). Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale. In R. J. Prinz (Ed.), Advances inBehavioral assessment of children and families (pp. 57–90). Greenwich, CT: JAI.Google Scholar
  27. 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 Academy of Nutrition and Dietetics, 108, 1360–1363.Google Scholar
  28. 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.CrossRefGoogle Scholar
  29. Mascola, A. J., Bryson, S. W., & Agras, W. S. (2010). Picky eating during childhood: A longitudinal study to age 11 years. Eating Behaviors, 11, 253–257.CrossRefGoogle Scholar
  30. Matson, J. L., & Fodstad, J. C. (2009). The treatment of food selectivity and other feeding problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 455–461.CrossRefGoogle Scholar
  31. 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 Autism Spectrum Disorders, 3, 759–766.Google Scholar
  32. Mattison, R. E., & Mayes, S. D. (2012). Relationship between learning disability, executive function, and psychopathology in children with ADHD. Journal of Attention Disorders, 16, 138–146.CrossRefGoogle Scholar
  33. Mayes, S. D. (2012). Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger’s Disorder Scale. Wood Dale, IL: Stoelting.Google Scholar
  34. Mayes, S. D., & Calhoun, S. L. (1999). Symptoms of autism in young children and correspondence with the DSM. Infants and Young Children, 12, 90–97.CrossRefGoogle Scholar
  35. Mayes, S. D., & Calhoun, S. L. (2004). Influence of IQ and age in childhood autism: Lack of support for DSM-IV Asperger’s disorder. Journal of Developmental and Physical Disabilities, 16, 257–272.CrossRefGoogle Scholar
  36. Mayes, S. D., & Calhoun, S. L. (2011). Impact of IQ, age, SES, gender, and race on autistic symptoms. Research in Autism Spectrum Disorders, 5, 749–757.CrossRefGoogle Scholar
  37. Mayes, S. D., Calhoun, S. L., Murray, M. J., Morrow, J. D., Yurich, K. K. L., Mahr, F., et al. (2009). Comparison of scores on the checklist for autism Spectrum disorder, childhood autism rating scale (CARS), and Gilliam Asperger’s disorder scale (GADS) for children with low functioning autism, high functioning autism or Asperger’s disorder, ADHD, and typical development. Journal of Autism and Developmental Disorders, 39, 1682–1693.CrossRefGoogle Scholar
  38. Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to children with other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5, 474–485.CrossRefGoogle Scholar
  39. Mayes, S. D., Calhoun, S. L., Mayes, R. D., & Molitoris, S. (2012a). Autism and ADHD: Overlapping and discriminating symptoms. Research in Autism Spectrum Disorders, 6, 277–285.CrossRefGoogle Scholar
  40. Mayes, S. D., Calhoun, S. L., Aggarwal, R., Baker, C., Mathapati, S., Anderson, R., & Petersen, C. (2012b). Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical development. Research in Autism Spectrum Disorders, 6, 1–10.CrossRefGoogle Scholar
  41. Mayes, S. D., Gordon, M., Calhoun, S. L., & Bixler, E. O. (2014). Long-term temporal stability of measured inattention and impulsivity in typical and referred children. Journal of Attention Disorders, 18, 23–30.CrossRefGoogle Scholar
  42. Mayes, S. D., Calhoun, S. L., Waschbusch, D., & Baweja, R. (2016). Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation. Clinical Child Psychology and Psychiatry, 22, 620–631.CrossRefGoogle Scholar
  43. Mayes, S. D., Zickgraf, H., & Baweja, R. (2018). Unusual eating patterns and food preferences in children with autism, ADHD, other disorders, and typical development. (October, 2018). Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Seattle, WA.Google Scholar
  44. McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., A., et al. (2002). Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 347, 314–321.Google Scholar
  45. Moore, M. L., Eichner, S. F., & Jones, J. R. (2004). Treating functional impairment of autism with selective serotonin-reuptake inhibitors. Annals of Pharmacotherapy, 38, 1515–1519.CrossRefGoogle Scholar
  46. Murray, M. J., Mayes, S. D., & Smith, L. A. (2011). Brief report: Excellent agreement between two brief autism scales (Checklist for Autism Spectrum Disorder, Social Responsiveness Scale, and Autism Diagnostic Interview-Revised) completed independently by parents and the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 41, 1586–1590.Google Scholar
  47. Murray, M. L., Hsia, Y., Glaser, K., Simonoff, E., Murphy, D. G. M., Asherson, P. J., et al. (2014). Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care. Psychopharmacology, 231, 1011–1021.Google Scholar
  48. Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011). Association of sensory processing and eating problems in children with autism spectrum disorders. Autism Research and Treatment, 2011, 1–8.Google Scholar
  49. Nagaraj, R., Singhi, P., & Malhi, P. (2006). Risperidone in children with autism: Randomized, placebo-controlled, double-blind study. Journal of Child Neurology, 21, 450–455.CrossRefGoogle Scholar
  50. Nichols, S., Mahoney, E. M., Sirois, P. A., Bordeaux, J. D., Stehbens, J. A., Loveland, K. A., et al. (2000). HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: Results from the hemophilia growth and development study. Journal of Pediatric Psychology, 25, 545–556.CrossRefGoogle Scholar
  51. Oswald, D. P., & Sonenklar, N. A. (2007). Medication use among children with autism-spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 17, 348–355.CrossRefGoogle Scholar
  52. Pandina, G. J., Bossie, C. A., Youssef, E., Zhu, Y., & Dunbar, F. (2007). Risperidone improves behavioral symptoms in children with autism in a randomized, double-blind, placebo-controlled trial. Journal of Autism and Developmental Disorders, 37, 367–373.CrossRefGoogle Scholar
  53. 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.CrossRefGoogle Scholar
  54. Rogers, L. G., Magill-Evans, J., & Rempel, G. R. (2012). Mothers’ challenges in feeding their children with autism spectrum disorder – Managing more than just picky eating. Journal of Developmental and Physical Disabilities, 24, 19–33.CrossRefGoogle Scholar
  55. Schmidt, L., Heiss, C. J., & Campbell, E. E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Topics in Clinical Nutrition, 23, 23–31.CrossRefGoogle Scholar
  56. Schreck, K. A., & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities, 27, 353–363.CrossRefGoogle Scholar
  57. Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34, 433–438.CrossRefGoogle Scholar
  58. Suarez, M. A., & Nelson, N. W. (2012). Associations of physiological factors, age, and sensory over-responsivity with food selectivity in children with autism spectrum disorders. Open Journal of Occupational Therapy, 1, 1–20.CrossRefGoogle Scholar
  59. 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: The International Journal of Research and Practice, 18, 924–932.CrossRefGoogle Scholar
  60. Tharner, A., Jansen, P. W., Kiefte-de Jong, J. C., Moll, H. A., Hofman, A., Jaddoe, V. W., et al. (2015). Bidirectional associations between fussy eating and functional constipation in preschool children. Journal of Pediatrics, 166, 91–96.CrossRefGoogle Scholar
  61. Tierney, C., Mayes, S. D., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How valid is the Checklist for Autism Spectrum Disorder when a child has apraxia of speech? Journal of Developmental and Behavioral Pediatrics, 36, 569–574.Google Scholar
  62. Valicenti-McDermott, M., McVicar, K., Rapin, I., Wershil, B., Cohen, H., & Shinnar, S. (2006). Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease. Journal of Developmental and Behavioral Pediatrics, 27, S128–S136.CrossRefGoogle Scholar
  63. van der Horst, K., Deming, D. M., Lesniauskas, R., & Carr, B. T. (2016). Picky eating: Associations with child eating characteristics and food intake. Appetite, 103, 286–293.CrossRefGoogle Scholar
  64. West, L., Brunssen, S. H., & Waldrop, J. (2009). Review of the evidence for treatment of children with autism with selective serotonin reuptake inhibitors. Journal for Specialists in Pediatric Nursing, 14, 183–191.CrossRefGoogle Scholar
  65. 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, 575–582.CrossRefGoogle Scholar
  66. Williams, P. G., Dalrymple, N., & Neal, J. (2000). Eating habits of children with autism. Nursing (London), 26, 259–264.Google Scholar
  67. Wolraich, M. L., Lindgren, S. D., Stumbo, P. J., Stegink, L. D., Appelbaum, M. I., & Kiritsy, M. C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330, 301–307.CrossRefGoogle Scholar
  68. Wright, C. M., Parkinson, K. N., Shipton, D., & Drewett, R. F. (2007). How do toddler eating problems relate to their eating behavior, food preferences, and growth? Pediatrics, 120, 1069–1075.CrossRefGoogle Scholar
  69. Zickgraf, H. F., & Elkins, A. R. (2018). Sensory sensitivity mediates the relationship between anxiety and picky eating in children/adolescents ages 8-17 and in college undergraduates: A replication and age-upward extension. Appetite, 128, 333–339.CrossRefGoogle Scholar
  70. Zickgraf, H. F., Franklin, M. E., & Rozin, P. (2016). Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: Comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms. Journal of Eating Disorders, 4, 26–36.CrossRefGoogle Scholar
  71. Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42, 549–556.CrossRefGoogle Scholar
  72. Zucker, N., Copeland, W., Franz, L., Carpenter, K., Keeling, L., Angold, A., et al. (2015). Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics, 136, 1–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry H073Penn State College of MedicineHersheyUSA

Personalised recommendations