Feeding difficulties in children with autism. Is it the autism or is he just a picky eater?
Posted Oct 03 2008 11:31am
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.