Abstract
Many children with autism spectrum disorders (ASD) have co-occurring feeding problems. However, there is limited knowledge about how these feeding habits are related to other behavioral characteristics ubiqitious in ASD. In a relatively large sample of 256 children with ASD, ages 2–11, we examined the relationships between feeding and mealtime behaviors and social, communication, and cognitive levels as well repetitive and ritualistic behaviors, sensory behaviors, and externalizing and internalizing behaviors. Finally, we examined whether feeding habits were predictive of nutritional adequacy. In this sample, we found strong associations between parent reported feeding habits and (1) repetitive and ritualistic behaviors, (2) sensory features, and (3) externalizing and internalizing behavior. There was a lack of association between feeding behaviors and the social and communication deficits of ASD and cognitive levels. Increases in the degree of problematic feeding behaviors predicted decrements in nutritional adequacy.
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References
Achenbach, T. M. (2002). Child Behavior Checklist 1 1/2–5. Burlington, VT: University of Vermont Department of Psychiatry.
Achenbach, T., & Rescorla, L. (2001). Manual for the Achenbach system of empirically based assessment school-age forms profiles. Burlington, VT: Aseba.
Ahearn, W. H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism and pervasive developmental disorder-not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505–511.
Allik, H., Larsson, J. O., & Smedje, H. (2006). Sleep patterns of school-age children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 36(5), 585–595.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington: American Psychiatric Publication Inc.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Badalyan, V., & Schwartz, R. H. (2011). Feeding problems and GI dysfunction in children with Asperger syndrome or pervasive developmental disorder not otherwise specified; comparison with their siblings. Open Journal of Pediatrics, 1, 51–63.
Baio, J. (2012). Prevalence of autism spectrum disorders: Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention Surveillance Summaries, 61(3).
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. The Journal of Pediatrics, 157(2), 259–264.
Baranek, G. T., Boyd, B. A., Poe, M. D., David, F. J., & Watson, L. R. (2007). Hyperresponsive sensory patterns in young children with autism, developmental delay, and typical development. Journal Information, 112(4), 233–245.
Bennetto, L., Kuschner, E. S., & Hyman, S. L. (2007). Olfaction and taste processing in autism. Biological Psychiatry, 62(9), 1015–1021.
Bennetto, L., Zampella, C. J., Kuschner, E. S., Bender, R. G., & Hyman, S. L. (2012). Food preferences in autism spectrum disorders and their relationship to sensory and behavioral symptoms. Paper presented at the International Meeting for Austim Research, Toronto.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11.
Bodfish, J. W., & Lewis, M. H. (2002). Repetitive behavior in autism. Paper presented at the International Meeting for Autism Research, Orlando, FL.
Boyd, B. A., Baranek, G. T., Sideris, J., Poe, M. D., Watson, L. R., Patten, E., et al. (2010). Sensory features and repetitive behaviors in children with autism and developmental delays. Autism Research, 3(2), 78–87.
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.
Chen, Y.-H., Rodgers, J., & McConachie, H. (2009). Restricted and repetitive behaviours, sensory processing and cognitive style in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(4), 635–642.
Clark, J. H., Rhoden, D. K., & Turner, D. S. (1993). Symptomatic vitamin A and D deficiencies in an eight-year-old with autism. Journal of Parenteral and Enteral Nutrition, 17(3), 284–286.
Coltman, A. E., Keim, K. S., Chapman-Novakofski, K. M., & Taylor, C. A. (2013). Assessing diet quality of a type 2 diabetes sample using the Healthy Eating Index 2005. Topics in Clinical Nutrition, 28(2), 145–153.
Coury, D., Jones, N. E., Klatka, K., Winklosky, B., & Perrin, J. M. (2009). Healthcare for children with autism: The Autism Treatment Network. Current Opinion in Pediatrics, 21(6), 828–832.
Crist, W., & Napier-Phillips, A. (2001). Mealtime behaviors of young children: A comparison of normative and clinical data. Journal of Developmental and Behavioral Pediatrics, 22(5), 279–286.
de Bildt, A., Sytema, S., Kraijer, D., Sparrow, S., & Minderaa, R. (2005). Adaptive functioning and behaviour problems in relation to level of education in children and adolescents with intellectual disability. Journal of Intellect and Disabilities Research, 49, 672–681.
Dominick, K. C., Davis, 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(2), 145–162.
Duarte, C. S., Bordin, I. A., de Oliveira, A., & Bird, H. (2003). The CBCL and the identification of children with autism and related conditions in Brazil: Pilot findings. Journal of Autism and Developmental Disorders, 33, 703–707.
Duggan, C. P., Westra, S. J., & Rosenberg, A. E. (2007). Case 23-2007. New England Journal of Medicine, 357(4), 392–400.
Dunn, W. (1999). Sensory profile: User’s manual. San Antonio: The Psychological Corporation.
Elliott, C. (2007). Differential Ability Scales 2nd edition normative data tables manual. San Antonio, TX: Harcourt Assessment.
Erinosho, T. O., Ball, S. C., Hanson, P. P., Vaughn, A. E., & Ward, D. S. (2013). Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005. Journal of the Academy of Nutrition and Dietetics, 113(8), 1084–1089.
Evans, D. W., Canavera, K., Maccubbin, E., & Taga, K. (2005). The fears, phobias and anxieties of children with autism spectrum disorders and down syndrome: Comparisons with developmentally and chronologically age matched children. Child Psychiatry and Human Development, 36(1), 3–26.
Farrow, C. V., & Coulthard, H. (2012). Relationships between sensory sensitivity, anxiety and selective eating in children. Appetite, 58(3), 842–846.
Guenther, P. M., Casavale, K. O., Reedy, J., Kirkpatrick, S. I., Hiza, H. A., Kuczynski, K. J., et al. (2013). Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics, 113(4), 569–580.
Guenther, P. M., Krebs-Smith, S. M., Reedy, J., Britten, P., Juan, W. Y., Lino, M., Basiotis, P. P. (2006). Healthy Eating Index-2005: Center for Nutrition Policy and Promotion. U.S. Department of Agriculture.
Hyman, S. L., Stewart, P. A., Schmidt, B., Cain, U., Lemcke, N., Foley, J. T., et al. (2012). Nutrient intake from food in children with autism. Pediatrics, 130(Suppl 2), S145–S153.
Johnson, S. L., Davies, P., Boles, R., Gavin, W., & Bellows, L. (2013) Parent reports of young children’s sensory characteristics are related to children’s food neophobia. Paper presented at the FASEB Journal.
Kerwin, M. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal of Pediatric Psychology, 24(3), 193–214.
Kerwin, M., Eicher, P. S., & Gelsinger, J. (2005). Parental report of eating problems and gastrointestinal symptoms in children with pervasive developmental disorders. Children’s Health Care, 34(3), 217–234.
Kientz, M. A., & Dunn, W. (1997). A comparison of the performance of children with and without autism on the sensory profile. The American Journal of Occupational Therapy, 51(7), 530–537.
Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117–132.
Lam, K., & Aman, M. (2007). The repetitive behavior scale-revised: Independent validation in individuals with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 37(5), 855–866.
Lane, A. E., Young, R. L., Baker, A. E., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders, 40(1), 112–122.
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(5), 520–536.
Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36(8), 1101–1114.
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.
Lindsay, R. L., Arnold, L. E., Aman, M. G., Vitiello, B., Posey, D. J., McDougle, C. J., et al. (2006). Dietary status and impact of risperidone on nutritional balance in children with autism: A pilot study. Journal of Intellectual and Developmental Disability, 31(4), 204–209.
Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1999). Autism diagnostic observation schedule-WPS edition. Los Angeles, CA: Western Psychological Services.
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.
Manikam, R., & Perman, J. A. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30(1), 34–46.
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(10), 1878–1887.
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(2), 455–461.
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(3), 759–766.
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 other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5(1), 474–485.
McIntosh, D. N., Miller, L. J., & Shyu, V. (1999). Development and validation of the short sensory profile. In W. Dunn (Ed.), Sensory profile manual (pp. 59–73). San Antonio, TX: Psychological Corporation.
Mullen, E. (1995). Mullen scales of early learning (AGS Edition ed.). Circle Pines: American Guidance Service.
Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011a). Association of sensory processing and eating problems in children with autism spectrum disorders. Autism Research and Treatment, 2011, 541926.
Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011b). Mealtime problems in children with autism spectrum disorder and their typically developing siblings: A comparison study. Autism, 15(1), 98–113.
Patton, S. R., Dolan, L. M., Chen, M., & Powers, S. W. (2013). Dietary adherence and mealtime behaviors in young children with type 1 diabetes on intensive insulin therapy. Journal of the Academy of Nutrition and Dietetics, 113(2), 258–262.
Patzold, L., Richdale, A., & Tonge, B. (1998). An investigation into sleep characteristics of children with autism and Asperger’s disorder. Journal of Paediatrics and Child Health, 34(6), 528–533.
Pineles, S. L., Avery, R. A., & Liu, G. T. (2010). Vitamin B12 optic neuropathy in autism. Pediatrics, 126(4), e967–e970.
Polimeni, M. A., Richdale, A. L., & Francis, A. J. (2005). A survey of sleep problems in autism, Asperger’s disorder and typically developing children. Journal of Intellectual Disability Research, 49(Pt 4), 260–268.
Provost, B., Crowe, T. K., Osbourn, P. L., McClain, C., & Skipper, B. J. (2010). Mealtime behaviors of preschool children: Comparison of children with autism spectrum disorder and children with typical development. Physical & Occupational Therapy in Pediatrics, 30(3), 220–233.
Rogers, S. J., Hepburn, S., & Wehner, E. (2003). Parent reports of sensory symptoms in toddlers with autism and those with other developmental disorders. Journal of Autism and Developmental Disorders, 33(6), 631–642.
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(1), 19–33.
Roid, G. H. (2003). Stanford-Binet Intelligence Scales: Examiner’s manual (5th ed.). Itasca, IL: Riverside.
Schakel, S. F. (2001). Maintaining a nutrient database in a changing marketplace: Keeping pace with changing food products—A research perspective. Journal of Food Composition and Analysis, 14(3), 315–322.
Schmitt, 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(1), 23–31.
Schreck, K. A., & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities, 27(4), 353–363.
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(4), 433–438.
Seiverling, L. J., Hendy, H. M., & Williams, K. E. (2011). Child and parent variables associated with texture problems in children’s feeding. Journal of Developmental and Physical Disabilities, 23(4), 303–311.
Sharp, W. G., & Jaquess, D. L. (2009). Bite size and texture assessments to prescribe treatment for severe food selectivity in autism. Behavioral Interventions, 24(3), 157–170.
Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13(4), 348–365.
Sivertsen, B., Posserud, M. B., Gillberg, C., Lundervold, A. J., & Hysing, M. (2012). Sleep problems in children with autism spectrum problems: A longitudinal population-based study. Autism, 16(2), 139–150.
Smith, A. M., Roux, S., Naidoo, N. T., & Venter, D. J. (2005). Food choices of tactile defensive children. Nutrition, 21(1), 14–19.
Suarez, M. A., Nelson, N., & Curtis, A. B. (2012). Associations of physiological factors, age, and sensory over-responsivity with food selectivity in children with autism spectrum disorders. The Open Journal of Occupational Therapy, 1(1).
Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. The American Journal of Occupational Therapy, 61(2), 190–200.
Twachtman-Reilly, J., Amaral, S. C., & Zebrowski, P. P. (2008). Addressing feeding disorders in children on the autism spectrum in school-based settings: Physiological and behavioral issues. Language Speech and Hearing Services in Schools, 39(2), 261–272.
Uyanik, O., Dogangun, B., Kayaalp, L., Korkmaz, B., & Dervent, A. (2006). Food faddism causing vision loss in an autistic child. Child: Care, Health and Development, 32(5), 601–602.
Volkert, V. M., & Vaz, P. C. (2010). Recent studies on feeding problems in children with autism. Journal of Applied Behavior Analysis, 43(1), 155–159.
Wiggins, L. D., Robins, D. L., Bakeman, R., & Adamson, L. B. (2009). Brief report: Sensory abnormalities as distinguishing symptoms of autism spectrum disorders in young children. Journal of Autism and Developmental Disorders, 39(7), 1087–1091.
Williams, P. G., Dalrymple, N., & Neal, J. (2000). Eating habits of children with autism. Pediatric Nursing, 26, 259–264.
Acknowledgments
Funding for this study was through Autism Speaks and cooperative agreement (UA3 MC 11054) from HRSA to the Massachusetts General Hospital. The views expressed in this presentation do not necessarily reflect the views of Autism Speaks or HRSA. Additional support for this study was through UL1 RR 024160 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
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Johnson, C.R., Turner, K., Stewart, P.A. et al. Relationships Between Feeding Problems, Behavioral Characteristics and Nutritional Quality in Children with ASD. J Autism Dev Disord 44, 2175–2184 (2014). https://doi.org/10.1007/s10803-014-2095-9
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DOI: https://doi.org/10.1007/s10803-014-2095-9
Keywords
- Feeding problems
- Mealtime behaviors
- Nutrition