Food as a reward and weight status in children with autism

Abstract

Obesity is a public health concern for typically developing (TD) children and children with autism spectrum disorders (ASD). Food is often used as a behavior management tool for children with ASD, yet whether this practice impacts their weight status is unknown. We assessed use of food as a reward by parental responses to our Meals In Our Household questionnaire in a cross‐sectional study of 53 children with ASD and 58 TD children aged 3–11 y. Six items query the frequency with which parents use food to reward or modify their child's behavior; 1 item asks about use of food as a reward at school. We calculated BMI z‐scores from measured height and weight. As expected, use of food rewards was more common among children with ASD than TD children, overall and by item. For example, 15 (28%) parents of children with ASD responded often or very often to the item “I give my child food to reward him/her for good behavior,” compared to no parents of TD children. Use of food as a reward was not associated with sex‐specific BMI‐for‐age z‐score among TD children. Some evidence of an association with BMI z‐score was observed among children with ASD; one item, “my child expects to be given a favorite food for a reward,” was significantly associated with BMI z‐score in children with ASD (p<0.02). Among children with ASD, use of food to reward behavior is common; our findings suggest this practice may increase their obesity risk. [HD048989 HD004147 DK046200].