A Comparison of Food Refusal Related to Characteristics of Food in Children with Autism Spectrum Disorder and Typically Developing Children


      Parents of children with autism spectrum disorder (ASD) frequently report child food refusal based on characteristics of food. Our study sought to determine whether parent report of food refusal based on the characteristics of food was greater in children with ASD than in typically developing children, associated with a greater percentage of foods refused of those offered, and associated with fruit and vegetable intake. A modified food frequency questionnaire was used to determine overall food refusal as well as fruit and vegetable intake. Parent-reported food refusal related to characteristics of food (eg, texture/consistency, temperature, brand, color, shape, taste/smell, foods mixed together, or foods touching other foods) was compared between 53 children with ASD and 58 typically developing children aged 3 to 11 years in the Children's Activity and Meal Patterns Study (2007-2008). Children with ASD were significantly more likely to refuse foods based on texture/consistency (77.4% vs 36.2%), taste/smell (49.1% vs 5.2%), mixtures (45.3% vs 25.9%), brand (15.1% vs 1.7%), and shape (11.3% vs 1.7%). No differences between groups were found for food refusal based on temperature, foods touching other foods, or color. Irrespective of ASD status, the percentage of foods refused of those offered was associated with parent reports of food refusal based on all characteristics examined, except temperature. Food refusal based on color was inversely associated with vegetable consumption in both groups. Routine screening for food refusal among children with ASD is warranted to prevent dietary inadequacies that may be associated with selective eating habits. Future research is needed to develop effective and practical feeding approaches for children with ASD.


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      K. L. Hubbard is a research associate, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.


      S. E. Anderson is an associate professor, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus.


      C. Curtin is a research assistant professor, Family Medicine and Community Health, University of Massachusetts Medical School, and co-director, University Center for Excellence in Developmental Disabilities and Leadership Education in Neurodevelopmental Disabilities Programs, Eunice Kennedy Shriver Center, Charlestown, MA.


      A. Must is a professor and chair, Department of Public Health and Community Medicine, and dean, Public Health Professional Degree Programs, Tufts University Medical School, Tufts University, Boston, MA.


      L. G. Bandini is an associate professor, Department of Pediatrics, University of Massachusetts Medical School, and director of nutrition, Leadership Education in Neurodevelopmental Disabilities Program, Eunice Kennedy Shriver Center, Charlestown, MA; and clinical professor, Boston University, Department of Health Sciences, Boston, MA.