Food Selectivity and Sensory Sensitivity in Children with Autism Spectrum Disorders


      Autism spectrum disorders comprise a complex set of related developmental disorders that are characterized by impairments in communication, social interaction, and repetitive behaviors. Impairments in sensory processing are also extremely common. The prevalence of autism spectrum disorders is increasing and is currently estimated to affect 1 in 150 children. Autism spectrum disorders are considered to be a major health and educational problem, affecting many areas of daily living, including eating. Children with autism spectrum disorders are often described as picky or selective eaters. This article provides a comprehensive narrative review of the empirical literature over the last 25 years on food selectivity and nutritional adequacy in children with autism spectrum disorders. The possible contributions of sensory factors, such as sensory sensitivity, to food selectivity are discussed. The need for an interdisciplinary approach to managing atypical eating patterns in children with autism spectrum disorders is highlighted.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Legge B.
        Can't Eat, Won't Eat: Dietary Difficulties and Autistic Spectrum Disorders.
        Jessica Kingsley Publishers, London, UK2002
        • Tomchek S.D.
        • Dunn W.
        Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile.
        Am J Occup Ther. 2007; 61: 190-200
        • Twachtman-Reilly J.
        • Amaral S.C.
        • Zebrowski P.P.
        Addressing feeding disorders in children on the autism spectrum in school-based settings: Physiological and behavioral issues.
        Lang Speech Hear Serv Sch. 2008; 39: 261-272
        • Centers for Disease Control
        Mental health in the United States: Parental report of diagnosed autism in children aged 4-17 years in the United States, 2003-2004.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 481-486
        • Bowers L.
        An audit of referrals of children with autistic spectrum disorder to the dietetic service.
        J Hum Nutr Diet. 2002; 15: 141-144
        • Cornish E.
        A balanced approach towards healthy eating in autism.
        J Hum Nutr Diet. 1998; 11: 501-509
        • Dovey T.M.
        • Staples P.A.
        • Gibson E.L.
        • Halford J.C.
        Food neophobia and 'picky/fussy' eating in children: A review.
        Appetite. 2008; 50: 181-193
        • Herndon A.C.
        • DiGuiseppi C.
        • Johnson S.L.
        • Leiferman J.
        • Reynolds A.
        Does nutritional intake differ between children with autism spectrum disorders and children with typical development?.
        J Autism Dev Disord. 2009; 39: 212-222
        • Lockner D.W.
        • Crowe T.K.
        • Skipper B.J.
        Dietary intake and parents' perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children.
        J Am Diet Assoc. 2008; 108: 1360-1363
        • Raiten D.J.
        • Massaro T.
        Perspectives on the nutritional ecology of autistic children.
        J Autism Dev Disord. 1986; 16: 133-143
        • Schmitt L.
        • Heiss C.J.
        • Campbell E.E.
        A comparison of nutrient intake and eating behaviors of boys with and without autism.
        Top Clin Nutr. 2008; 23: 23-31
        • Williams P.G.
        • Dalrymple N.
        • Neal J.
        Eating habits of children with autism.
        Pediatr Nurs. 2000; 26: 259-264
        • Klein U.
        • Nowak A.J.
        Characteristics of patients with autistic disorder (AD) presenting for dental treatment: A survey and chart review.
        Spec Care Dentist. 1999; 19: 200-207
        • Whiteley P.
        • Rodgers J.
        • Shattock P.
        Feeding patterns in autism.
        Autism. 2000; 4: 207-211
        • Schreck K.A.
        • Williams K.
        • Smith A.F.
        A comparison of eating behaviors between children with and without autism.
        J Autism Dev Disord. 2004; 34: 433-438
        • Schreck K.A.
        • Williams K.
        Food preferences and factors influencing food selectivity for children with autism spectrum disorders.
        Res Dev Disabil. 2006; 27: 353-363
        • Field D.
        • Garland M.
        • Williams K.
        Correlates of specific childhood feeding problems.
        J Paediatr Child Health. 2003; 39: 299-304
        • Williams K.E.
        • Gibbons B.G.
        • Schreck K.A.
        Comparing selective eaters with and without developmental disabilities.
        J Dev Phys Disabil. 2005; 17: 299-309
        • Dominick K.C.
        • Davis N.O.
        • Lainhart J.
        • Tager-Flusberg H.
        • Folstein S.
        Atypical behaviors in children with autism and children with a history of language impairment.
        Res Dev Disabil. 2007; 28: 145-162
        • Ahearn W.H.
        • Castine T.
        • Nault K.
        • Green G.
        An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified.
        J Autism Dev Disord. 2001; 31: 505-511
        • Ho H.H.
        • Eaves L.C.
        Nutrient intake and obesity in children with autism.
        Focus Autism Other Dev Disabl. 1997; 12: 187-193
        • Levy S.E.
        • Souders M.C.
        • Ittenbach R.F.
        • Giarelli E.
        • Mulberg A.E.
        • Pinto-Martin J.A.
        Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders.
        Biol Psychiatry. 2007; 61: 492-497
        • Ayres A.J.
        Tactile functions.
        Am J Occup Ther. 1964; 18: 6-11
        • Ornitz E.M.
        • Ritvo E.R.
        The syndrome of autism: A critical review.
        Am J Psychiatry. 1976; 133: 609-621
        • Attwood T.
        The Complete Guide to Asperger's Syndrome.
        Jessica Kingsley Publishers, London, UK2006
        • Chamak B.
        • Bonniau B.
        • Jaunay E.
        • Cohen D.
        What can we learn about autism from autistic persons?.
        Psychother Psychosom. 2008; 77: 271-279
        • Leekam S.R.
        • Nieto C.
        • Libby S.J.
        • Wing L.
        • Gould J.
        Describing the sensory abnormalities of children and adults with autism.
        J Autism Dev Disord. 2007; 37: 894-910
        • Dunn W.
        • Myles B.S.
        • Orr S.
        Sensory processing issues associated with Asperger syndrome: A preliminary investigation.
        Am J Occup Ther. 2002; 56: 97-102
        • Dunn W.
        Sensory Profile.
        The Psychological Corporation, San Antonio, TX1999
        • Rogers S.J.
        • Hepburn S.
        • Wehner E.
        Parent reports of sensory symptoms in toddlers with autism and those with other developmental disorders.
        J Autism Dev Disord. 2003; 33: 631-642
        • Ben-Sasson A.
        • Cermak S.A.
        • Orsmond G.I.
        • Tager-Flusberg H.
        • Carter A.S.
        • Kadlec M.B.
        • Dunn W.
        Extreme sensory modulation behaviors in toddlers with autism spectrum disorders.
        Am J Occup Ther. 2007; 61: 584-592
        • Baranek G.T.
        • David F.J.
        • Poe M.D.
        • Stone W.L.
        • Watson L.R.
        Sensory Experiences Questionnaire: Discriminating sensory features in young children with autism, developmental delays, and typical development.
        J Child Psychol Psychiatry. 2006; 47: 591-601
        • Ben-Sasson A.
        • Hen L.
        • Fluss R.
        • Cermak S.A.
        • Engel-Yeger B.
        • Gal E.
        A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders.
        J Autism Dev Disord. 2009; 39: 1-11
        • Kern J.K.
        • Trivedi M.H.
        • Grannemann B.D.
        • Garver C.R.
        • Johnson D.G.
        • Andrews A.A.
        • Savla J.S.
        • Mehta J.A.
        • Schroeder J.L.
        Sensory correlations in autism.
        Autism. 2007; 11: 123-134
        • Dunn W.
        The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model.
        Infants Young Child. 1997; 9: 23-35
        • Grandin T.
        Thinking in Pictures: And Other Reports from My Life with Autism.
        Vintage Books, New York, NY1996
        • Kern J.K.
        • Trivedi M.H.
        • Garver C.R.
        • Grannemann B.D.
        • Andrews A.A.
        • Savla J.S.
        • Johnson D.G.
        • Mehta J.A.
        • Schroeder J.L.
        The pattern of sensory processing abnormalities in autism.
        Autism. 2006; 10: 480-494
        • Ayres A.J.
        Sensory Integration and the Child.
        Western Psychological Services, Los Angeles, CA1979
        • Dunn W.
        Living Sensationally: Understanding Your Senses.
        Jessica Kingsley Publishers, London, UK2007
        • Smith A.M.
        • Roux S.
        • Naidoo N.T.
        • Venter D.J.
        Food choice of tactile defensive children.
        Nutrition. 2005; 21: 14-19
        • Shore S.M.
        Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome.
        Autism Asperger Publishing Co, Shawnee Mission, KS2001
        • Epstein T.
        • Saltzman-Benaiah J.
        • O'Hare A.
        • Goll J.C.
        • Tuck S.
        Associated features of Asperger syndrome and their relationship to parenting stress.
        Child Care Health Dev. 2008; 34: 503-511
        • Ernsperger L.
        • Stegen-Hanson T.
        Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges.
        Future Horizons, Arlington, TX2004
        • Groden J.
        • Diller A.
        • Bausman M.
        • Velicer W.
        • Norman G.
        • Cautela J.
        The development of a stress survey schedule for persons with autism and other developmental disabilities.
        J Autism Dev Disord. 2001; 31: 207-217
        • Fiese B.H.
        • Schwartz M.
        Reclaiming the family table: Mealtimes and child health and wellbeing.
        Soc Policy Rep. 2008; Vol 22 (13-20): 3-9
        • Kimball J.
        Sensory integration frame of reference: Postulates regarding change and application to practice.
        in: Kramer P. Hinojosa J. Frames of Reference for Pediatric Occupational Therapy. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA1999: 169-204
        • Wilbarger J.L.
        • Wilbarger P.L.
        Wilbarger approach to treating sensory defensiveness and clinical application of the sensory diet.
        in: Bundy A.C. Lane S. Murray E.A. Fisher A.G. Sensory Integration: Theory and Practice. 2nd ed. F.A. Davis, Philadelphia, PA2002: 335-341
        • Gray C.
        The New Social Story Book: Illustrated Edition.
        2nd ed. Future Horizons, Arlington, TX2000
        • Marr D.
        • Mika H.
        • Miraglia J.
        • Roerig M.
        • Sinnott R.
        The effect of sensory stories on targeted behaviors in preschool children with autism.
        Phys Occup Ther Pediatr. 2007; 27: 63-79
        • Marr D.
        • Nackley V.L.
        Sensory Stories (A Complete Set of 30 Stories).
        Therapro, Framingham, MA2007
        • Tucker M.T.
        • Neifert M.
        Mealtime Stories: A Guide for Feeding Therapists.
        2nd ed. Mealtime Stories, Seattle, WA2008
        • Williams M.S.
        • Shellenberger S.
        How Does Your Engine Run?.
        Revised Edition. TherapyWorks, Inc, Albuquerque, NM1996
        • Paul C.
        • Williams K.E.
        • Riegel K.
        • Gibbons B.
        Combining repeated taste exposure and escape prevention: An intervention for the treatment of extreme food selectivity.
        Appetite. 2007; 49: 708-711


      S. A. Cermak is a professor in the Division of Science and Occupational Therapy, University of Southern California, Los Angeles; at the time of the writing of this article, she was the director of Occupational Therapy Training at the UMMS-Shriver Center Leadership Education in Neurodevelopmental Disabilities (LEND) Program, University of Massachusetts Medical School, Waltham, MA


      C. Curtin is a research assistant professor in Family Medicine and Community Health at the University of Massachusetts Medical School—E. K. Shriver Center, Waltham, MA


      L. G. Bandini is an associate professor of pediatrics, University of Massachusetts Medical School—E. K. Shriver Center, Waltham, MA, and clinical professor, Department of Health Sciences, Boston University, Boston, MA