Unusual eating behaviours may be a diagnostic indicator for autism

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Atypical eating behaviours may be a sign a child should be screened for autism, according to a study from Penn State College of Medicine. Research by Susan Mayes, professor of psychiatry, found that atypical eating behaviours were present in 70% of children with autism, which is 15 times more common than in neurotypical children.

Atypical eating behaviours may include severely limited food preferences, hypersensitivity to food textures or temperatures, and pocketing food without swallowing. According to Mayes, these behaviours are present in many 1-year-olds with autism and could signal to doctors and parents that a child may have autism. “If a primary care provider hears about these behaviours from parents, they should consider referring the child for an autism screening,” Mayes said.

Mayes said that the earlier autism is diagnosed, the sooner the child can begin treatment with a behaviour analyst. Previous studies have shown applied behaviour analysis to be most effective if implemented during the preschool years. Behaviour analysts use a number of interventions, including rewards, to make positive changes in the children’s behaviour and teach a range of needed skills.

Keith Williams, director of the feeding programme at Penn State Childrens Hospital, uses this therapy to help a variety of individuals with unusual eating behaviours. He said that identifying and correcting these behaviours can help ensure children are eating a proper diet.

“I once treated a child who ate nothing but bacon and drank only iced tea,” Williams said. “Unusual diets like these don’t sustain children.”

Williams also noted that there is a distinct difference between worrisome eating behaviours and the typical picky eating habits of young children. He explained that most children without special needs will slowly add foods to their diets during the course of development, but children with autism spectrum disorders, without intervention, will often remain selective eaters.

“We see children who continue to eat baby food or who won’t try different textures,” Williams said. “We even see children who fail to transition from bottle feeding.”

Mayes said that many children with autism eat a narrow diet consisting primarily of grain products, like pasta and bread, and chicken nuggets. She said that because children with autism have sensory hypersensitivities and dislike change, they may not want to try new foods and will be sensitive to certain textures. They often eat only foods of a particular brand, colour or shape.

The research also showed that most children with autism who had atypical eating behaviours had two or more types – almost a quarter had three or more. Yet, none of the children with other developmental disorders who did not have autism had three or more. According to Williams, this is a common, clinical phenomenon – and it has prompted him and his colleagues to recommend some children for further evaluation.

“When we evaluate young children with multiple eating problems, we start to wonder if these children might also have the diagnosis of autism,” Williams said. “In many cases, they eventually do receive this diagnosis.”

The researchers evaluated the eating behaviours described in parent interviews of more than 2,000 children from two studies. They investigated the difference in the frequency of unusual eating behaviours between typical children and those with autism, attention deficit hyperactivity disorder and other disorders.

Williams said the study data shows that atypical eating behaviours may help diagnostically distinguish autism from other disorders. Even though children from both groups have unusual eating habits, they are seven times more common in autism than in other disorders, according to the study data.
“This study provided further evidence that these unusual feeding behaviours are the rule and not the exception for children with autism,” Williams said.

Hana Zickgraf, University of Chicago, also contributed to this research.

The authors received no funding to conduct this study and declare no conflict of interest.

Background: Previous research has not yet examined the prevalence of atypical eating behaviors in children and adolescents with autism compared to those with ADHD, other disorders, and typical development.
Method: The sample comprised 2102 children: 1462 with autism, 327 with other disorders (ADHD, intellectual disability, language disorder, and learning disability), and 313 typical children, 1–18 years of age (mean 7.3). Atypical eating behaviors were assessed with the Checklist for Autism Spectrum Disorder based on a standardized parent interview conducted by licensed psychologists.
Results: Atypical eating behaviors were significantly more common in autism (70.4%) than in children with other disorders (13.1%) and typical children (4.8%). For children with autism who had atypical eating behaviors, the most common behavior was limited food preferences (88%), followed by hypersensitivity to food textures (46%), other peculiar patterns most often eating only one brand of food (27%), pocketing food without swallowing (19%), and pica (12%). Grain products and/or chicken (usually nuggets) were the preferred foods for 92% of children with autism who had limited food preferences. For children with autism who had atypical eating behaviors, 25% had three or more atypical eating behaviors (vs. 0% for children with other disorders or typical development). Only children with autism had pica or pocketed food.
Conclusions: The number and types of atypical eating behaviors found only in children with autism and not in children with other disorders or typical development should alert clinicians to the possibility of autism and the need to evaluate for autism in order to facilitate early identification and access to evidence-based treatment.

Susan Dickerson Mayes, Hana Zickgraf

Penn State material
Research in Autism Spectrum Disorders abstract

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