Feeding difficulties in children with autism. Is it the autism or is he just a picky eater?

A review of: Martins, Y., Young, R.L., Robson, D.C. (2008). Feeding and Eating Behaviors in Children with Autism and Typically Developing Children. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0583-5

In this study the researchers were interested in examining the rates of eating behavior problems among children with autism. Based on a parent-completed questionnaire, the researchers compared 41 children with autism spectrum disorders, 14 non-affected siblings, and 41 non-related typically developing children. These children were matched on communication, socialization, and daily living skills (based on the Vineland Adaptive Behavior Scale).

When compared to typically developing kids, children with ASD had more food avoidance behaviors (e.g. not eating something that has been touched), and food Neophobia (fear of unfamiliar foods). These ASD children were also more likely to control the feeding (feeding revolves around the child’s demands, such as timing, type of food, etc) and consequently less likely to have the parent control the feeding ('child must try the food before it is rejected', etc). Surprisingly, there were no differences in rates of ritualistic feeding behaviors, underscoring the commonly observed phenomena of ritualistic feeding behaviors among typically developing children.

However, when compared to their unaffected siblings, the ASD children continued to display higher rates of food avoidance behaviors and food Neophobia. Yet, both groups had the same level of control over feedings. This suggests that the findings concerning high levels of child control over feedings and low levels of parent control over feedings observed in the ASD group when compared to the typically developing group, could reflect parenting styles (since the parent seems to display the same behaviors towards the unaffected sibling) rather than something unique about the child with autism. It is also possible that the parenting behavior towards the unaffected sibling (such as allowing the child more control over the feeding situation) may simply be a management tool (whether conscious or not) used in order to standardize the feeding process in a household with a child with special needs (such as to not appear unfair to the unaffected sibling).

Two last comments. It is possible that the failure to see significant differences between the children with ASD and the unaffected siblings may be a pure artifact of the limitation of the statistical tools uses. The authors compared 14 matched pairs (N=14 per group) on 7 outcome variables via standard ANOVA. An argument can be made that the statistics used were not appropriate for the nature of the data due to limited power.

Finally, I initially had a concern about the fact that these groups had been matched on several functioning scales. I thought that the results would not be generalizable since the groups were purposely selected to be almost identical on many key factors. But the fact that they found significant problems with food avoidance and neophobia in the ASD group but not the others underscores how prevalent these eating behavior problems may be among children with ASD.

Autism Symptoms and Signs | A review of the DSM-IV criteria of Autism.

As several parents have contacted Translating Autism asking me to discuss the symptoms of autism spectrum disorders, I decided to write this brief post explaining the DSM-IV criteria of Autism.

Autism and related disorders are categorized within the larger concept of “Pervasive Developmental Disorders”. These disorders include: Autistic Disoder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder and Pervasive Developmental Disorder NOS. In this review I will focus only on the symptoms and signs of Autism, and soon I will write additional blog reviews of the diagnostic criteria for the other Pervasive Developmental Disorders.

The diagnosis of autism is made on the basis of symptoms observed or reported within 3 categories. The categories include (information in italics are examples I provide):

1. Qualitative Impairment in social interactions such as: a) impairment in the use of nonverbal behaviors (eye gaze, facial expressions, etc), b) failure to develop age appropriate peer relationships, lack of spontaneous seeking of enjoyment, interests, or achievement with others (does he/she show you something he/she made, does he/she invites you to play with him/her, etc), & c) lack of emotion reciprocity (does he/she get sad when you are sad? Does he/she show worry when you hurt yourself, etc). For diagnosis, at least two of these symptoms must be present.
2. Qualitative Impairment in communication such as: a) delay or lack of development of spoken language, b) lack of ability to initiate and maintain conversation with others, c) stereotype and repetitive language (repeating the last words you said or frequently repeating a phrase he/she heard) or idiosyncratic language (does he/she uses her own language or words for specific objects, etc, above what is expected based on the child’s age), and d) lack of varied, spontaneous make believe or interactive play (does he/she do pretend play? Does he/she engage in cooperative play with peers?). For diagnosis at least one of these symptoms must be present.
3. Restricted repetitive and stereotyped patterns of behaviors, interest, and activities such as: a) preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus (is he/she obsessed with plates? Antennas? Argentina? Red dots? above and beyond what is common in today’s society – thus in most cases obsession with video games doesn’t count), b) inflexible adherence to specific, non-functional routines (do you always need to turn off the light before opening the door? etc), c) stereotyped and repetitive motor mannerisms (hand flapping, twisting, etc), and d) persistent preoccupation with parts of objects (can he/she spend hours staring at the cord of a fan, the tip of a pen, etc?) For diagnosis at least one of these symptoms must be present.

In addition to the symptoms included above, there must be a history of abnormal functioning prior to the age of 3 in at least one of these areas: Social Interaction, language use in social communication, and symbolic or imaginative play.

Also, if a diagnosis of Rett’s disorder or Childhood Disintegrative Disorder is met, such diagnoses supersede the autism diagnosis and no autism diagnosis should be provided.

Finally, note that the issue of mental retardation is not addressed anywhere in the diagnostic criteria. That is because these are two separate diagnoses that are taxonomically unrelated. The diagnosis of mental retardation is provided on the basis of IQ performance on standardize tests. If a child with autism also meets the full diagnostic criteria for metal retardation, that child may also receive a secondary diagnosis of MR, although the practice of providing such co-morbid diagnosis varies, often due to questions about the utility of such secondary diagnosis and the ability of intellectual assessment tests to accurately assess the intellectual abilities of people with Autism.

I hope you find this post useful and feel free to ask any question or request clarifications.

Nestor L. Lopez-Duran PhD
Translating Autism: An Autism Research Blog