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Objectives: To develop an operational definition of FS, to compare FS among ADI-R confirmed children with ASDs to an age-matched sample of typically developing children, and to examine the relationship of FS to oral sensory sensitivity and sensory qualities of food.
Methods: We conceptualized FS as comprising 3 domains: food refusal, food repertoire, and high frequency single food intake (HFSFI). Food refusal and HFSFI were measured using a modified food frequency questionnaire (FFQ). Food repertoire was measured with the FFQ and a 3-day food diary. Child food refusal due to sensory characteristics of food was assessed with a diet history parent interview, and oral sensory sensitivity was assessed with Dunn’s Sensory Profile.
Results: Fifty-three children with ASDs (44 males/9 females) and 58 typically developing children (45 males/13 females) ages 3-11 (mean age 6.6 years) participated in the Children’s Activity and Meal Patterns Study (CHAMPS). Thirty-two percent of children with ASDs also had intellectual disabilities. Compared to typically developing children, children with ASDs exhibited more food refusal and a narrower repertoire of foods eaten. Very few children in either group demonstrated HFSFI.
Food Refusal | ASDs Mean (SD) | Typical Mean (SD) |
Number of foods refused (out of 131) | 45.2 (26.1) | 21.0 (18.1) *** |
Percentage of foods refused of those offered (%) | 42 (21) | 19 (16) *** |
Number of vegetables refused (out of 26) | 10.8 (6.4) | 5.6 (5.2) *** |
Percentage of vegetables refused of those offered (%) | 63 (31) | 33 (27)*** |
Limited Food Repertoire |
|
|
Number of unique foods eaten during 3 days | 22.7(6) | 25.0(6.0) ** |
Number of foods eaten at least once per week | 29.8 (10.4) | 40.2 (13.0)*** |
High Frequency Single Food Intake | ||
Number (%) of children eating > 4.5 daily servings of a food | 3 (5.6%) | 1 (1.7%) |
More parents of children with ASDs than of typically developing children reported food refusal based on consistency (77% vs. 36%), temperature (30% vs. 24%), shape (11.3% vs. 1.7%), and brand (15% vs. 1.7%) or when foods were mixed together (45% vs. 26%). Parents of children with ASDs and typically developing children reported similar rates of refusal based on the color of foods and whether foods were touching each other. As expected, food refusal correlated with oral sensitivity (r = -0.65, p<0.0001 in children with ASDs and r= -0.51, p<0.0001 in typical children).
Conclusions: Using our operational definition of FS, food refusal was significantly greater and food repertoire significantly narrower in children with ASDs than in typically developing children. Although HFSFI may be characteristic of some children’s eating behavior, it does not appear to occur frequently among children with ASDs. Food refusal was related to sensory aspects of food and oral sensory sensitivity. Further research is needed to determine how FS impacts nutritional status and health of children with ASDs.
Supported by NICHD-R21HD48989