Autism spectrum disorders (ASDs) 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 ASDs is increasing and is currently estimated to affect 1 in 150 children. ASDs are considered to be a major health and educational problem, affecting many areas of daily living, including eating. Children with ASDs are often described as picky or selective eaters.
Early childhood is a period when children experience new foods, tastes, and textures. Parents of toddlers and young children often describe their children as “picky eaters”, refusing to try or eat a variety of foods. Although picky eating is not uncommon among young children who are typically developing, pickiness in children with autism spectrum disorders (ASDs) may be even more restrictive and may extend beyond the early childhood period (1–3).
Autism spectrum disorders are life-long neurodevelopmental disorders characterized by impairments in three domains of functioning: social behavior, communication abilities, and restricted, repetitive or stereotyped patterns of behavior. ASD currently affects one in 150 children in the US (4), a prevalence that has quadrupled in the last 20 years. The implications of this rise in prevalence is on the scale of an epidemic, but as yet no definitive cause has been determined, and the efficacy of specific interventions are not yet clear. Parents of children with ASDs report many challenges with children’s daily activities, behavior, and communication. Parents also frequently express concern related to mealtimes.
Parents of children with ASDs often report that their children are highly selective eaters, with very restricted repertoires of food acceptance that may be limited to as few as five foods. Management of food selectivity and concerns about dietary adequacy have been found to be a major reason for referral of children for nutrition services (5). Picky eating, also referred to as food selectivity, is a significant problem because it may be associated with inadequate nutrition as a result of the restricted diet (6–12).
Despite considerable anecdotal evidence and case reports to support that food selectivity is a significant problem in children with ASDs, only a few empirical studies have compared food intake and eating patterns of children with ASDs to that of typically developing children or other clinical populations. Furthermore, food selectivity has not been operationally defined in a consistent manner and has been used to refer to picky eating, frequent food refusals, limited repertoires of foods, excessive intake of a few foods, and selective intake of certain food categories such as carbohydrates. In this narrative literature review, studies that have examined the phenomenon of food selectivity and nutritional intake in children with ASDs are reviewed. Numerous anecdotal reports and autobiographies of individuals with ASDs suggest that sensory factors such as smell, texture, color, and temperature can contribute to food selectivity. Thus, we have included in our review the literature on sensory sensitivity in children with ASDs and explore how this may be an important dimension in understanding food selectivity. This paper concludes with a discussion of the need to understand food selectivity in this population and the importance of an interdisciplinary approach in addressing the needs of children who demonstrate significant food selectivity.
