Pilot Study of Food Acceptance and EDR to Food in Children With ASD Compared With Typically Developing Children

PURPOSE: This study investigated the differences in laboratory food acceptance between children with autism spectrum disorder (ASD) compared with children who are typically developing (TD). In addition, the association between both ASD severity and sensory processing patterns and food acceptance was examined. Finally, the use of electrodermal response (EDR) to food for children with ASD compared with TD children was explored and differences were described.

BACKGROUND: Mealtime is an important occupation for family health and cohesiveness. Food selectivity has significant negative implications for both the nutritional status of the child and the quality of life of the family. Many studies using parent-report data have documented the increased prevalence of food selectivity in the ASD population, but very few have used direct observation to document eating behavior. In addition, EDR has been used to document differences in autonomic nervous system response to sensory stimuli and provide clarity in differentiation of sensory processing disorders. This measure also has the potential to illuminate internal sympathetic nervous system response to everyday activities such as eating.

DESIGN: This study used laboratory observation of food acceptance and EDR to food for children with ASD compared with TD children.

PARTICIPANTS: Fifty-three participants ages 4–14 yr completed this study. The autism diagnosis was confirmed with the Social Responsiveness Scale (SRS). TD children were included if their parents denied any diagnosis that affected learning or behavior.

METHOD: Caregivers filled out a demographic questionnaire. The SRS was used to evaluate the relationship between autism severity and food selectivity. The Short Sensory Profile (SSP) was used to measure sensory processing skills. A data sheet was used to record food acceptance as “ate the food” (food in mouth and swallowed) or “refused” (did not swallow). Finally, during a baseline phase and food presentation phase EDR was collected using the Biopac system.

ANALYSIS: Descriptive statistics captured sample demographics. Differences in food acceptance and EDR between the groups (ASD and TD) were explored using independent t tests. Correlation was used to examine relationships between autism severity, sensory processing, and food acceptance.

RESULTS: Children in the ASD and TD groups were not significantly different in age, and the diagnosis of autism was confirmed for all the children in the ASD group. Children with ASD ate significantly fewer foods. There was not a significant correlation between autism severity and the number of foods the child accepted. There was a significant relationship between all SSP items and the number of foods accepted for all items except the low energy–weak items. As the number of foods that a child accepted in the lab declined, the severity of sensory processing dysfunction increased. Finally, mean baseline and food EDR were significantly lower for the ASD group.

DISCUSSION: As expected on the basis of the literature, children with ASD ate fewer foods than TD children. Food acceptance was not linked to autism severity but was related to sensory processing. Children with greater sensory processing dysfunction ate fewer foods. Finally, capturing EDR to the food presentation experience was possible, and children with ASD had significantly lower mean response to baseline and food presentation conditions.

IMPACT STATEMENT: Direct observation of food acceptance and EDR in a laboratory setting provides powerful, objective insight into eating behavior. Occupational therapists can use this information to advocate for treatment of food selectivity in children with ASD that includes consideration of sensory processing challenges.