Feeding problems and Nutritional Quality in Children with ASD
Dr Shelley Hyman
Approximately 46-89% of children with Autism Spectrum Disorder (ASD) have been reported to display co-occurring feeding problems compared to 25% of typically developing children.
These problems include food selectivity, food refusal and disruptive mealtime behaviours. Studies have shown that children with ASD eat a more narrow range of food than children without ASD.
It may be the behavioural inflexibility that is contributing to the rigid mealtime routines. Johnson et al. (2014) examined the relationship between feeding behaviours and autistic behaviours as well as the relationship between feeding behaviours and nutritional well-being.
A number of different questionnaires were given to parents to fill out for their child with ASD regarding their eating/feeding behaviours, autistic behaviours as well as a cognitive and sensory assessment.
Johnson et al. (2014) found strong associations between parent reported feeding habits and a number of autistic behaviours such as repetitive and ritualistic behaviours, sensory features and externalising (aggression, complaining, tantrums) and internalising (anxiety and depression) behaviours.
In other words children who show repetitive or disruptive behaviours in other situations are also likely to engage in those behaviours at mealtimes.
In terms of internalising behaviours, a child with anxiety may avoid trying new food or may become anxious about social interactions during mealtimes. They also found that an increase in problematic feeding behaviours predicted decrease in nutritional adequacy.
Thus there is a strong association between repetitive behaviours, sensory differences and both externalising and internalising behaviours, and problematic feeding and mealtime behaviours.
It is therefore suggested that children presenting autistic behaviours should be screen for these disruptive feeding and mealtime behaviours as well as lack of nutrition in their diet.
It is also recommended to include the impact of feeding problems and nutritional status as part of a comprehensive assessment and intervention approach for children with Autism Spectrum Disorder.
- Johnson, C. R., Turner, K., Stewart, P. A., Schmidt, B., Shui, A., Macklin, E., Reynolds, A., James, J., Johnson, S. L., Courtney, P. M., & Hyman, S. L. (2014). Relationships between feeding problems, behavioural characteristics and nutritional quality in children with ASD. Journal of Autism Developmental Disorder, 44, 2175–2184.