A Comparison of Food Refusal Related to Characteristics of Food in Children with Autism Spectrum Disorder and Typically Developing Children

Abstract

Parents of children with autism spectrum disorder (ASD) frequently report child food refusal based on characteristics of food. The present study sought to determine if parent report of food refusal based on the characteristics of food was: (1) greater in children with ASD than typically developing (TD) children; (2) associated with a greater percentage of foods refused of those offered; and (3) associated with fruit and vegetable intake. A modified food frequency questionnaire (FFQ) was used to determine overall food refusal as well as fruit and vegetable intake. Parent-reported food refusal related to characteristics of food (texture/consistency, temperature, brand, color, shape, taste/smell, foods mixed together, or foods touching other foods) was compared between 53 children with ASD and 58 TD children age 3–11 years in the Children’s Activity and Meal Patterns Study (CHAMPS) (2007–2008). Children with ASD were significantly more likely to refuse foods based on texture/consistency (77.4% versus 36.2%), taste/smell (49.1% versus 5.2%), mixtures (45.3% versus 25.9%), brand (15.1% versus 1.7%), and shape (11.3% versus 1.7%). No differences between groups were found for food refusal based on temperature, foods touching other foods, or color. Irrespective of ASD status, the percentage of foods refused of those offered was associated with parent reports of food refusal based on all characteristics examined, except temperature. Food refusal based on color was inversely associated with vegetable consumption in both groups. Routine screening for food refusal among children with ASD is warranted to prevent dietary inadequacies that may be associated with selective eating habits. Future research is needed to develop effective and practical feeding approaches for children with ASD.

The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder

“…41,42 Several studies have documented nutrient inadequacy associated in children with ASD 14,17,43 as well as lower intakes of fruits and vegetables. 15,16,27 Mealtime stress represents an additional potential risk factor for the excess caloric intake associated with poor quality diets. 44 Qualitative studies document high levels of parent stress related to the restricted diet and feeding behaviors of children with ASD.…”

“…Children with ASD often exhibit selective eating, frequently resulting in low intakes of fruits and vegetables with ASD and high intakes of calorically dense foods. [14][15][16][17] As youth age, they are more likely to have access to more energy-dense snacks and less engagement in physical activity compared with the peers without ASD, 18 and their physical activity levels decline with age. 19,20 Parents of children with ASD report using television for its calming effect, 21 which may contribute to high levels of sedentary behavior.…”

Sensory Sensitivity and Food Selectivity in Children with Autism Spectrum Disorder

“…The texture of foods has consistently been identified as a related aspect of food acceptance. (Ahearn et al 2001; Hubbard et al 2014; Postorino et al 2015; Schreck & Williams 2006; Schreck et al 2004; Williams et al 2005). For example, using data from the current study, Hubbard et al (2014) found that texture and consistency of foods are highly correlated with parent report of food refusal in a sample of 53 children with ASD ages 3–11 years.…”

Sensory Differences and Mealtime Behavior in Children With Autism

“…Increasing evidence has shown that children with autism spectrum disorder (ASD) experience challenges in these daily routines and that their sensory differences often interfere with their ability to develop skills in these important daily routines Schaaf, Toth-Cohen, Johnson, Outten, & Benevides, 2011;Stein, Polido, & Cermak, 2012;Stein, Polido, Mailloux, Coleman, & Cermak, 2011). Eating difficulties are a frequent problem for children with autism (Hubbard, Anderson, Curtin, Must, & Bandini, 2014;Kral, Eriksen, Souders, & Pinto-Martin, 2013;Marí-Bauset, Zazpe, Mari-Sanchis, Llopis-González, & Morales-Suárez-Varela, 2014;Nadon, Feldman, Dunn, & Gisel, 2011a, 2011bSchreck & Williams, 2006;Schreck, Williams, & Smith, 2004;Suarez, Nelson, & Curtis, 2014) and may weaken their physical health Lukens & Linscheid, 2008;Sharp et al, 2013), cause difficulty during family mealtimes and milieu (Bagby, Dickie, & Baranek, 2012;Schaaf et al, 2011;Suarez, Atchison, & Lagerwey, 2014), and impede participation in the educational setting (Koenig & Rudney, 2010).…”