Selective Eating Research Articles

AUTISM DIAGNOSIS

This document results from a theoretical study, the objective of which was to discuss the importance of conducting high-quality diagnoses of Autism Spectrum Disorder (ASD) and to compare how this screening process is conducted through the Unified Health System (SUS) and specialized private clinics. The research was conducted through a literature review and case study analysis to assess the waiting time, cost, diagnostic quality, and follow-up care after the screening process had been completed. Autism is a neurodevelopmental condition characterized by significant deficits in communication, selective eating, and social interaction, as well as repetitive patterns of behaviors, activities, and/or interests.

Selective Feeding-An Under-Recognised Contributor to Picky Eating.

Background: Amongst children presenting to an interdisciplinary clinic with complaints of picky eating, we aim to identify the proportion who have underlying selective feeding and to describe its implications on growth and nutrition, as well as parental coping responses. Methods: We conducted a retrospective chart review of first-visit consults from January 2020 to July 2022. Caregiver and child mealtime behaviours were assessed using the standardised Caregiver's Feeding Styles Questionnaire (CFSQ) and by direct observation. Caloric intake and oromotor skills were assessed by dietitians and speech therapists, respectively. Medical concerns were addressed by the doctor. Results: Out of 152 children referred for concerns of "picky eating", 128 (84.2%) were diagnosed as having selective eating, while the rest were diagnosed with delayed oromotor skills, poor appetite, oral aversion and 4 were deemed to have normal feeding behaviour for their age. Of the 128 selective eaters, 67 (52%) children had comorbidities such as autism spectrum disorder (ASD) (n = 59), attention-deficit/hyperactivity (ADHD) (n = 2) and underlying medical conditions (n = 6). The remaining 61 children were "otherwise well". Of the "otherwise well" children, 47.5% had inadequate caloric intake and 31% had failure to thrive. The commonest feeding style among caregivers of "otherwise well" picky eaters was authoritarian (36%). The majority (80%) of these caregivers also experienced helplessness. Conclusions: We conclude that picky eating in young children is a symptom with several possible underlying aetiologies. It is associated with nutritional consequences for the child and significant stress on caregivers. Being able to recognise those who need referral for specialist intervention and multidisciplinary management (such as selective feeding and delayed oromotor skills) would be important.

Comparison of clinical presentation and management of children and adolescents with ARFID between paediatrics and child and adolescent psychiatry: a prospective surveillance study

ObjectiveTo compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings.Study designProspective surveillance study.MethodsData were collected during a...

Online occupational therapy group training for mothers of children with feeding problems: A randomized controlled trial.

The aim of this study was to scrutinize how online occupational therapy group training for mothers influenced their attitudes and stress levels relating to feeding their children and the eating behaviours of the children. The secondary purpose of the study is to evaluate the satisfaction of the participants of this program. Twenty-nine mothers of children aged 3-6 years, experiencing feeding issues, were randomly allocated to either an intervention or control group. Feeding problems including selective eating, loss of appetite, and mealtime behaviour problems are prevalent during childhood. Parents play a fundamental role in acquiring knowledge about feeding. Problems in the feeding process may lead to parental stress, feelings of despair, and incorrect attitudes. The mothers in the research group participated in the 4-week training. Results indicated positive effects on both maternal attitudes and their children's eating behaviours (p < 0.05). No significant change was found in mothers' state and trait anxiety levels (p > 0.05). Participants were asked to score their satisfaction level with the program between 1 and 10, and the average of the scores was 9.78 ± 0.42. This study shows that online group education for mothers can support existing treatments and guide clinicians working with children with feeding problems.

Investigating the structure of disordered eating symptoms in adult men: A network analysis.

Eating disorders (EDs) increasingly emerge as a health risk in men, but there is concern that men's symptoms go unnoticed due to stereotypical perceptions and gender-related differences in symptom presentation. Novel assessments focused particularly on attitudes and behaviours towards increasing muscle size and definition. Using network analysis, this study aimed to corroborate and extend previous findings on disordered eating presentation in men by examining the role of muscularity concerns among an extended range of disordered eating symptoms. N=294 adult men (18years or older) completed muscularity-related and disordered eating assessments, among which we included assessments for orthorexic eating and Avoidant/Restrictive Food Intake Disorder for the first time. We selected symptoms empirically, estimated a regularised network, identified symptom communities, evaluated network loadings and bridge centrality estimates, and compared network structures between different groups of participants. We identified five symptom communities related to muscularity-related concerns, features of core ED psychopathology, and selective eating. Symptoms regarding ruminating about healthy eating, guilt for unhealthy eating, weight overvaluation, concerns about muscularity, and selective eating emerged as highly central. The results largely corroborate previous observations but suggest that muscle-building behaviours are part of a broader cluster of male body shaping and rule-based dieting behaviours.

Xeropthalmia and optic neuropathy secondary to ARFID: a case report

BackgroundPatients with avoidant/restrictive food intake disorder (ARFID) commonly present with loss of weight or faltering growth in the setting of poor nutrition. However, patients with ARFID can present with micronutrient deficiencies without weight loss. In patients with ARFID, clinicians should be vigilant for micronutrient deficiencies and their presentations.Case presentationWe report a unique case of ARFID in a twelve-year-old girl, who developed micronutrient deficiencies and presented with acute visual loss with a preceding history of impaired night vision. Ophthalmic examination revealed xerophthalmia and bilateral optic neuropathy. Investigations showed severe Vitamin A and folate deficiencies which accounted for her clinical findings. In addition, she was also found to have low Vitamin B12, copper, and Vitamin D levels. She had a history of selective eating from a young age with a diet consisting largely of carbohydrates, with no regular intake of meat, dairy, fruit and vegetables. This was not driven by weight or body image concerns. The patient’s symptoms improved significantly with appropriate vitamin replacement and continued multidisciplinary care.ConclusionsThis report describes a patient with ARFID presenting with visual complaints. In this case, the selective eating behaviours resulted in xeropthalmia and optic neuropathy. Micronutrient deficiencies are uncommon in developed countries. When these deficiencies are suspected, eating disorders, such as ARFID, should be considered. Similarly, clinicians caring for patients with restrictive eating disorders including ARFID should be familiar with the clinical presentations of various micronutrient deficiencies and consider evaluation and treatment for micronutrient deficiencies when clinically indicated.

Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa.

In anorexia nervosa (AN), the traits of autism spectrum disorder (ASD) are associated with poor outcomes. However, the subtle nature of these characteristics remains poorly understood. We investigated the in-depth patterns of ASD traits using Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) in women with AN. Of 28 women with ICD-10 AN, 16 (age 19-30 years) participated in the ADOS-2, a video-recorded, semistructured diagnostic assessment for social communication and interaction and restricted, repetitive behaviors and interests related to ASD. None of the participants had previously been diagnosed with ASD. Other measurements included the Eating Disorder Examination Questionnaire and the Wechsler Abbreviated Scale of Intelligence-IV. Five individuals (18% of all, 31% of those assessed) scored above the cutoff for autism in ADOS-2. They had challenges in social communication and interaction, manifesting as sustained difficulties in social relationships and deficits in conversation skills. Few described being frequently misunderstood by others, including in the eating disorder treatment settings. Three individuals showed prominent restricted and repetitive behaviors such as ritual seeking, eating-related routines, sensory sensitivity related to food texture and selective eating, and intense interest in specific topics. The mean duration of AN in women above the cutoff was twice as long compared with those below (12.3 vs. 6.2 years). The ASD-related characteristics and behavior appear to contribute to the manifestation and duration of AN in a subgroup of women. Among these women, the traits of ASD appear to be mixed with eating disorder symptoms, which should be taken into account in the treatment.

Assessment Methods for Problematic Eating Behaviors in Children and Adolescents With Autism Spectrum Disorder.

Autism spectrum disorder (ASD) can be associated with eating problems. However, currently, there is a lack of established guidelines for assessing and addressing eating behaviors in individuals with ASD. This gap in research exists due to the challenges associated with using traditional assessment methods, which may lead to discrepancies in responses and unintentional potential biases from caregivers. In this review, we provided a comprehensive overview of various eating behaviors commonly observed in individuals with ASD. These behaviors include 1) food neophobia, 2) selective eating, 3) binge eating, 4) food avoidance, 5) chewing and swallowing problems, 6) pica, 7) rumination, 8) rituals, and 9) problematic behaviors. Furthermore, we provide a perspective of utilizing digital tools: 1) augmentative and alternative communication; 2) ecological momentary assessment; and 3) video analysis, behavioral analysis, and facial expression analysis. This review explores existing assessment methods and suggests novel assessment aiding together.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7–10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), “partial” BLW and “full” BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; −19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (−0.18, 0.30); current age: 0.06 (−0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Parental experiences of eating concerns in autistic children during COVID-19 lockdowns: implications for future practice

Prior to the COVID-19 pandemic, some autistic children exhibited maladaptive eating behaviours, yet the pandemic presented additional challenges for families beyond the general disruption COVID-19. The present study investigated parental perspectives of their autistic child’s eating behaviours in the United Kingdom during the COVID-19 pandemic. Using reflexive thematic analysis, semi-structured interviews of 15 caregivers of children diagnosed with autism spectrum disorder were analysed. Three main themes were constructed: importance of control; exposure to food and family mealtimes; and an increase in snack and ‘junk’ food. Eating behaviours in autistic children were both positively and negatively affected by the COVID-19 lockdown. Whilst all parents felt under pressure with extra care responsibilities, some described less concern over food intake during the first lockdown because they were able to support their child’s mealtimes and have new food experiences. By the end of the lockdowns, many parents reported worsening of eating behaviours, with children more likely to have a restricted diet, and eating more snack foods. Food shortages also triggered additional stress with parents unable to access their child’s preferred food. The findings suggested reducing anxiety triggers and increasing food exposure in safe contexts may aid autistic children in trying new varieties of food. However, to minimise long-term eating difficulties during times of uncertainty when food access may be difficult, parents of autistic children would benefit from wider understanding, acceptance and support managing their child’s selective eating.

Effects of the Safe and Sound Protocol TM (SSP) on Sensory Processing, Digestive Function and Selective Eating in Children and Adults with Autism: A Prospective Single-Arm Study

Effects of the Safe and Sound Protocol TM (SSP) on Sensory Processing, Digestive Function and Selective Eating in Children and Adults with Autism: A Prospective Single-Arm Study

Avoidant/Restrictive Food Disorder (ARFID), Food Neophobia, Other Eating-Related Behaviours and Feeding Practices among Children with Autism Spectrum Disorder and in Non-Clinical Sample: A Preliminary Study.

Previous research shows that children with autism spectrum disorder (ASD) may experience several difficulties-including those related to eating-and this area of research needs to be explored further. This study had two main objectives: (1) comparison of the clinical (autism spectrum disorder) and non-clinical sample of children in terms of avoidant/restrictive food disorder, food neophobia, other eating-related behaviours and feeding practices; (2) assessment of selected predictors of food neophobia. The final sample included 54 children and parents from the clinical sample (ASD) and 51 from the non-clinical sample. Parents completed: the autism spectrum rating scales (ASRS), the eating disorders in youth questionnaire (EDY-Q), the children food neophobia scale (CFNS), the child eating behaviour questionnaire (CEBQ), the child feeding questionnaire (CFQ), and a socio-demographic survey. Our analysis allowed us to partially confirm the first hypothesis since the clinical sample (vs. the non-clinical group) had significantly higher scores in such variables as (a) avoidant/restrictive food disorder (ARFID), (b) food neophobia, (c) other eating-related behaviours: emotional under-eating, desire to drink, food fussiness, (d) feeding practices: pressure to eat. Moreover, our analysis of predictors of food neophobia in the clinical and non-clinical samples also allowed us to partially confirm the second hypothesis because it turned out that only in the clinical sample (vs. the non-clinical sample) were the predictors significantly associated with food neophobia, but only two of them (food fussiness and selective eating). In conclusion, our study showed that children with ASD (compared to children without this diagnosis) experience increased difficulties in eating behaviours, and their parents present a stronger intensity of the feeding practice based on pressure to eat. This study showed that feeding problems for children in the ASD sample are a significant problem, and it is still worth exploring this area in research.

Feeding/Eating problems in children: Who does (not) benefit after behavior therapy? A retrospective chart review.

Treating disordered feeding at a young age reduces risks of future feeding problems, but not all children profit equally; can we define predictors of a worse prognosis? In 252 children, with a mean age of 4; 7 years (SD = 3 years; range 5 months to 17; 10 years), who had undergone behavioral day treatment in the past, several variables were investigated, retrieved from initial consultation (t1) and re-assessed at follow-up (t2). Logistic regressions were carried out with sex, gastro-intestinal problems, refusal of the first nutrition, syndrome/intellectual disability, Down's syndrome, autism spectrum disorder, comorbidity of medical diseases (other than gastro-intestinal problems), restrictive caloric food intake and selective food intake, as the predictor variables from t1, and age-appropriate food intake at t2 as the dependent variable. The potential role of sensory processing problems was reviewed at t2. About 73% had improved towards an age-appropriate food intake. Sex (boys), syndrome/intellectual disability, and a lack of varied nutritional intake at t1 were predictors of a worse prognosis. We found a small, but significant correlation between current selective eating patterns and general sensory processing problems. Feeding disordered children, especially boys, with intellectual disabilities or selective eating patterns are at risk for not achieving an age-adequate food intake at a later age, despite behavioral treatment.

Food preferences and eating behavior among children with autism spectrum disorder: A causal-comparative study in Lahore

This study aims to compare the eating behaviors, food preferences, and body mass index of children with and without Autism residing in Lahore, Pakistan. The study participants were aged 5-12 years, and were divided into two groups: 60 children with Autism spectrum disorder (ASD), and 120 typically developing (TD) school children. The sample was drawn from three Autism schools and three private schools through the purposive sampling technique. Data regarding the participants’ basic personal history, food preferences, and eating behavior were obtained from their parents using a self- administered structured questionnaire. BMI for age percentiles of the children was obtained from standard charts, based on their height and weight measurements. Among participants with Autism, 46.7% were obese, compared to 23.3% of the participants without Autism. Children with Autism exhibited a significantly greater degree of limited variety (U= 2797.000, p= 0.009) and food refusal (U= 1586.000, p= 0.000) as compared to children without Autism. Greater preference for food in the vegetable group was related to a higher BMI for the age percentile, for children with Autism (r = 0.327, p = 0.011). A p-value &lt; 0.05 was considered to be statistically significant. Children with Autism exhibited selective eating and food refusal to a greater degree than children without Autism.

The home environment and its relation to bottle feeding outcomes in the first year of life

BackgroundThe home environment and caregiver interactions have an impact on infant development. However, there is a paucity of research surrounding the home environment and its relation to early feeding outcomes within the first year of life. Therefore, the aim of this study was to examine the relationship between the home environment and infant bottle feeding outcomes at 3 and 12 months of age. MethodsSeventy-two full-term infants completed this study at 3 months of age and fifty-five infants completed the study at 12 months. Data in the current study were collected from a larger, ongoing study completed in the infant's home at 3 and 12 months of age. The Infant-Toddler Home Observation for Measurement of Environment Inventory (IT-HOME) was utilized to assess the infant's home environment. The Oral Feeding Skills (OFS) scale was completed while the infant was observed during a bottle feed. Caregivers completed a questionnaire about their infant's feeding abilities via the Neonatal Eating Assessment Tool (Neo-EAT) at 3 months and Pediatric Eating Assessment Tool (Pedi-EAT) at 12 months. ResultsAt 3 months of age, the IT-HOME Involvement subscale was associated with an increase in the amount of milk provided in the infant's bottle. There were no significant associations between the IT-HOME and caregiver report of feeding at 3 months of age. At 12 months of age, the IT-HOME Acceptance subscale was associated with an increase in oral transfer rate and the IT-HOME Variety subscale was associated with a decrease in oral transfer rate. Additionally, the IT-HOME Organization subscale was associated with caregiver report of feeding on the following Pedi-EAT scales: Mealtime Behaviors, Selective Restrictive Eating, and Oral Processing at 12 months. ConclusionsThese findings reveal that the home environment is significantly related to different infant bottle feeding outcomes over the first year of life. At 3 months, IT-HOME Involvement was associated with the amount of milk offered in the bottle, whereas at 12 months of age, subscales of the IT-HOME were associated with oral feeding transfer rate and caregiver report of feeding. Clinically, these findings point to the importance of considering the infant's bottle feeding skills in conjunction with certain aspect within the infant's environment. Additional research is needed to further explore these relationships in greater detail, with a larger sample size and across patient populations.

Randomized trial of a self-administered parenting intervention for selective eating in young children

Selective eating is a common childhood feeding problem associated with family stress and micronutrient deficiencies. While there are empirically-supported behavioral strategies for addressing selective eating, there are significant systems-level barriers to implementing them. The aim of this study was to develop and test a self-administered intervention for parents of children with selective eating. Participants were 156 parents of children with selective eating ages 18 months-6 years who were randomly assigned to either the handout + video condition (8-module video intervention and detailed handout) or handout condition (detailed handout only). Outcome measures were administered pre-intervention and 4 weeks post-intervention. Only 23 % of participants in the handouts plus video condition played more than one video module. Both groups had significant decreases in maladaptive mealtime parenting practices, undesired child mealtime behaviors, and number of foods offered. No significant effect of study condition was found on the outcome measures. Further research is needed to determine how to encourage engagement of parents with self-administered intervention materials.

Relationships between autistic traits, taste preference, taste perception, and eating behaviour.

Individuals with autism spectrum disorder exhibit atypical taste perception and eating behaviours. However, little is known about the effect of autistic traits on eating behaviours in the general population. This study explored the relationships between autistic traits, taste preferences, taste perceptions, and eating behaviours among Japanese population using an online questionnaire survey. The results showed significant effect of autistic traits on eating behaviours, that people with higher autistic traits tended to have higher selective eating behaviours, such as increased sensitivity to food texture and mixed flavours. Moreover, selective eating behaviours were correlated with the preference for sour taste and aftertaste sensitivity. Those results suggest that eating behaviours can be influenced by the relationship between autistic traits, taste perceptions, and taste preferences. We discuss these results in the context of previous findings, and future investigations into the possibility of solving selective eating problems in individuals with autism.

Convergent validity of the Autism Spectrum Disorder Mealtime Behavior Questionnaire (ASD-MBQ) for children with autism spectrum disorder

There was a growing interest in difficulties with eating as one of the most problematic symptoms in children with autism spectrum disorder (ASD). The purpose of this study is to examine the convergent validity of the Autism Spectrum Disorder Mealtime Behavior Questionnaire (ASD-MBQ) with the Asahide’s test for social adjustment skills, the Japanese version of the short version of the sensory profile questionnaire, the Japanese version of the Social Communication Questionnaire, and the Parenting Strain Index in Japanese children with ASD. The final sample contained 294 children who were diagnosed as the ASD based on the DSM-5 criteria, the mean age of children was 10 ± 4 years (range: 3–18 years). The ASD-MBQ is a questionnaire that comprised of 42 items that are classified into five subdomains: selective eating, clumsiness/manners, interest in/concentration on eating, oral-motor function, and overeating. Spearman’s rank correlation coefficient revealed that the ASD-MBQ showed the moderate to high correlation coefficient with all four external criteria. Our results in this study supported the sufficient convergent validity in the ASD-MBQ. Therefore, the ASD-MBQ could be a useful tool for research and practice in a wide range of children with ASD aged 3 to 18.

Exploring the role of disgust sensitivity and propensity in selective eating

While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.

Parental experiences of adopting healthy lifestyles for children with disabilities living with overweight and obesity.

Children with disabilities present with high obesity rates. This study explored the parental experience of adopting healthy lifestyle choices, for children with disabilities, who received dietetic weight management advice. Semi-structured qualitative interviews were carried out with eight parents/carers in their own homes or healthcare setting in an inner London locality, or by telephone. Data was analyzed using an interpretative phenomenological analysis (IPA) approach. Five superordinate themes emerged: 1. Strategies to promote healthy lifestyles: encouraging physical activity, limiting access to food and taking a gradual approach to making lifestyle changes. 2. Challenges to adopting healthy lifestyles: selective eating patterns, the high cost of healthy foods and parental/carer lack of time. 3. The role of healthcare professionals (HCPs): revealed that not all parents/carers received advice or support, prior to dietetic referral, when managing their child's weight. Feeling reassured by HCPs was valued. Parents/carers reported a positive experience of seeing the dietitian, as they appreciated receiving practical and individualized advice. 4. Support needs: family support and support from families with children with disabilities was explored. 5. Parent/carer wellbeing: such as stress was found to have a detrimental impact on parents making healthy lifestyle changes. Adopting a healthy lifestyle involved a variety of strategies and challenges, some of which are specific to this population group and should be considered by HCPs, when having weight-related discussions and offering advice. Parental/carer support needs and wellbeing should also be taken into consideration when planning weight management services for this population group.