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Food Selectivity and Sensory Sensitivity Subtypes in Children with ASD: A Cluster Analysis
Studies examining food selectivity (FS) conclude that children with ASD demonstrate high levels of reluctance to try new food, restricted repertoire of foods and fewer foods intakes within food categories. Factors that parents felt influence selectivity were: texture, appearance, taste, smell, temperature, or food presentation. In addition, it is also possible that the mealtime behavior problems frequently seen in children with ASDs may reflect problems with sensory sensitivity. Thus, it is suggested that food selectivity is not a unique characteristic of autism, but reflect sensory defensiveness. Recent studies primarily relied on categories of over- and under-responsiveness representing distinct categories of sensory processing (SP). Nevertheless, tactile defensiveness and oral defensiveness may be part of a larger problem in modulating sensory input which can take different forms. A behavior topography of mouth stuffing might result from over-responsiveness difficulty with textures, under-responsiveness difficulty of perceiving sensations, and/or seeking behavior for the purposes of oral stimulation. This suggests that sensory under- and over-responsivity may co-exist in children with autism as found by Ben-Sasson et al. (2007) proposing a mixed pattern of SP in ASD indicative of a common etiology underpinning poor sensory modulation.
Objectives:
The aims of the present study were: (a) to examine the patterns of SP and FS difficulties within autism and (b) to examine the relationship between SP and FS patterns with related dietary issues.
Methods:
Fifty children with autism spectrum disorder participated in this study. Diagnostic status was determined based on the DSM-IV, ADI-R, ADOS-G and independently confirmed. Participants were aged 25 to 72 months (mean=50.42, SD=19.22) with 42 (84%) being male. All participants were registered with the Early Intervention Program at the Autism Treatment and Research Centre Una Breccia nel Muro. SP was assessed via the Sort Sensory Profile (SSP, McIntosh et al., 1999), FS via the Brief Assessment of Mealtime Behaviors In Children (Hendy et al., 2012), dietary intake and gastrointestinal problems via a survey adapted from Badalyan & Schwartz (2012) as well as the BMI.
Results:
Preliminary results confirmed that the majority (~80%) of participants exhibited SP dysfunction, particularly in Auditory Filtering, Underresponsive/Seeks Sensation, Taste/Smell Sensitivity domains. Notably, most participants (~62%) demonstrated differences from typical BMI percentiles, restricted dietary intakes (~56%), gastrointestinal problems (~64%) and mealtime behaviors perceived as problematic by parents (~68%). Detailed analysis that is subject to presentation at the congress is addressed via cluster analysis including sensory processing and mealtime behaviors. It is expected that at least 3 distinct SP/SF subtype pattern can be confirmed where food refusal, limited variety, under-and over-responsiveness are not separately represented but topographically coexists. Differences are expected to be better represented by its contextual function, supporting broader subtypes of modulation difficulties. In deep analysis is completed applying regression analysis in order to examine the association of SP/FS patterns with dietary intake, gastrointestinal problems and BMI.
Conclusions:
This study extends previously published work by: evaluating patterns of SP and FS difficulties, mealtime behaviors, gastrointestinal problems and nutritional intake by applying state-of-the-art cluster analysis techniques.