Abstract
Children with ASD often exhibit challenging eating behaviors that lead to later health consequences. We used medical records to examine how behavioral parent concerns and behavioral symptoms are linked to picky eating in ASD. Our findings point to distinct behaviors associated with picky eating.
Primary Author and Speaker: Anna Wallisch
Additional Authors and Speakers: Sallie Nowell, Lauren Little
Children with autism spectrum disorder (ASD) often exhibit challenging eating behaviors, with approximately 67-83% of parents reporting mealtime and eating difficulties (Marí-Bauset et al., 2014). Eating difficulties in early childhood often lead to later health conditions (e.g., malnutrition, obesity) and are cause for significant parental stress (Nadon et al., 2011). Currently, there is no standard of care for treating eating behaviors in children with ASD, and our current treatment approaches are associated with high rates of treatment resistance (Kerzner et al., 2015). Perhaps we have yet to devise effective treatment approaches because we have yet to truly understand the underlying factors implicated in eating behavior in ASD; specifically, behavioral correlates. This is critical information given occupational therapists (OTs) often address challenging eating behaviors in young children. Therefore, the purpose of this study was to: 1) predict picky eating in ASD by examining scores on the Behavior Assessment for Children (BASC), 2) examine differences in behavioral parent concerns between children with and without picky eating, and 3) examine differences in IQ and autism severity between children with and without picky eating.
We performed a secondary analysis with data drawn from a large university diagnostic center. Our sample included 215 children, 12-144 months, diagnosed with ASD; n=131 were picky eaters. Data was drawn from intake paperwork parents completed prior to a diagnostic evaluation and standardized assessments administered at the diagnostic evaluation. First, we used logistic regression with BASC clinical subscales predicting picky eating. Second, we performed chi-square tests of independence to examine the relation between behavior parent concerns and picky eating, as well as an independent sample t-test to examine differences on autism severity (Autism Diagnostic Observation Schedule-2 [ADOS-2] and IQ (Kauffman Brief Intelligence Test [KBIT] or Bayley III) scores.
BASC subscales in the Behavioral Symptoms (x 2(6)=10.256, p<0.01) and Adaptive composite scores (x 2(4)=6.099, p<0.01) predicted picky eating. Specifically, the Withdrawal subscale (Wald x 2(1)= 6.673, p=0.01) and Activities of Daily Living subscale (Wald x 2(1)= 4.457, p<0.05) were significant predictors. Children with ASD who were picky eaters were significantly more likely to have sensory differences, anxiousness, short attention spans, hyperactivity, impulsivity, and obsessive behaviors. Lastly, children with ASD were not significantly different on ADOS-2 (picky M= 7.47, SD= 1.79; not picky M= 7.28, SD= 2.04) and IQ (picky M=86.63, SD= 14.89; not picky M= 88.40, SD= 19.87) scores.
Our results suggest children with ASD who are picky eaters are significantly more likely to have behavioral differences when compared to children with ASD who were not picky eaters. Interestingly, picky eaters were more likely to avoid others (BASC Withdrawal subscale) and have increased difficulties completing everyday tasks (BASC Activities of Daily Living subscale). Children with picky eating also had a high rate of parent reported behavior concerns. Picky eating is prominent in children with ASD and cause for significant parental stress; however, we have yet to determine efficacious interventions, likely due to our lack of knowledge related to the underlying factors of eating behavior. Since OTs often address feeding, we need to understand the behavioral profiles associated with picky eating to devise tailored interventions.
Kerzner, B., Milano, K., MacLean, W. C., Berall, G., Stuart, S., & Chatoor, I. (2015). A Practical Approach to Classifying and Managing Feeding Difficulties. Pediatrics, 135(2), 344–353. doi: 10.1542/PEDS.2014-1630
Marí-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-González, A., & Morales-Suárez-Varela, M. (2014). Food Selectivity in Autism Spectrum Disorders. Journal of Child Neurology, 29(11), 1554–1561. doi: 10.1177/0883073813498821
Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011). Mealtime problems in children with Autism Spectrum Disorder and their typically developing siblings: A comparison study. Autism, 15(1), 98–113. doi: 10.1177/1362361309348943