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

https://doi.org/10.1016/j.jand.2014.04.017Get rights and content

Abstract

Parents of children with autism spectrum disorder (ASD) frequently report child food refusal based on characteristics of food. Our study sought to determine whether parent report of food refusal based on the characteristics of food was greater in children with ASD than in typically developing children, associated with a greater percentage of foods refused of those offered, and associated with fruit and vegetable intake. A modified food frequency questionnaire was used to determine overall food refusal as well as fruit and vegetable intake. Parent-reported food refusal related to characteristics of food (eg, 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 typically developing children aged 3 to 11 years in the Children's Activity and Meal Patterns Study (2007-2008). Children with ASD were significantly more likely to refuse foods based on texture/consistency (77.4% vs 36.2%), taste/smell (49.1% vs 5.2%), mixtures (45.3% vs 25.9%), brand (15.1% vs 1.7%), and shape (11.3% vs 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.

Section snippets

Methods

The Children's Activity and Meal Patterns Study was a cross-sectional study conducted during 2007-2008 that included children with ASD and TD children aged 3 to 11 years. Participants were recruited via public listings on the Internet, outreach to local community programs (eg, schools, YMCAs), existing participant databases at the University of Massachusetts Medical School's Shriver Center, autism support organizations, and the Interactive Autism Network Research Database at the Kennedy Krieger

Results

Table 1 presents participant characteristics. Mean age, race, sex, and parental education status were similar in the two groups. TD children were more likely to be an only child than were children with ASD (26% and 11% respectively; P=0.05). More children with ASD were on a special diet than TD children (11 vs 0; P<0.001).

Consistency/texture was most frequently reported as a reason for food refusal both for ASD and TD children (Table 2), but the prevalence was much higher among children with

Discussion

Parents of children with ASD reported a greater prevalence of food refusals based on the texture of food, mixtures, brand, shape, and taste/smell than did TD children. Contrary to expectations, a similar prevalence of food refusal based on temperature, foods touching other foods, and color was found between children with ASD and TD children. Parents of children with ASD reported more reasons for food refusal, with more than one third of parents reporting refusal based on three or more

Practice Implications

Early identification and treatment of selective eating habits that encompass food variety (limited food repertoire) and food refusal in children with ASD is critical; however, guidelines and tools to assess and effectively treat food selectivity in children with ASD are currently lacking. The potential for inadequate intake may be greater in cases when parents report multiple reasons for food refusal. In such cases, a registered dietitian nutritionist can complete an in-depth assessment of

Conclusions

A consistent approach to screen for food refusal among children with ASD would aid the development of a research base. Our findings suggest the need to investigate food refusal cumulatively across multiple domains, as well as individual analysis regarding specific reasons for refusal. Developing practical and effective feeding approaches for children with ASD may help to maintain nutritional adequacy of a child's diet when food refusal is present. Additional studies are needed to better

Acknowledgements

The authors thank Whitney Evans, PhD, RD, Melissa Maslin, MEd, and Renee Scampini, MS, RD, for helping with data collection, and also thank Sharon Cermak, EdD, OTR/L, for assisting with the development of the measures to characterize food refusal.

K. L. Hubbard is a research associate, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.

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    K. L. Hubbard is a research associate, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.

    S. E. Anderson is an associate professor, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus.

    C. Curtin is a research assistant professor, Family Medicine and Community Health, University of Massachusetts Medical School, and co-director, University Center for Excellence in Developmental Disabilities and Leadership Education in Neurodevelopmental Disabilities Programs, Eunice Kennedy Shriver Center, Charlestown, MA.

    A. Must is a professor and chair, Department of Public Health and Community Medicine, and dean, Public Health Professional Degree Programs, Tufts University Medical School, Tufts University, Boston, MA.

    L. G. Bandini is an associate professor, Department of Pediatrics, University of Massachusetts Medical School, and director of nutrition, Leadership Education in Neurodevelopmental Disabilities Program, Eunice Kennedy Shriver Center, Charlestown, MA; and clinical professor, Boston University, Department of Health Sciences, Boston, MA.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This work was supported by National Institutes of Health grant nos. HD048989 and HD004147-33A2, and the Boston Obesity Nutrition Research Center grant no. DK046200-14.

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