Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

Food Acceptance and Food Rejection in Children with ASD:
Dietary Preferences and Good Nutrition

Lisa Portela
Master of Science (Nutrition and Dietetics), University of Wollongong
Supervisors: Velencia Soutter, Robert Loblay, Anne Swain
November 2004

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Introduction: There is increasing interest in relation to the involvement of diet in the etiology and treatment of Autistic Spectrum Disorder (ASD). A general concern observed is children with ASD may be at nutritional risk due to their behaviours around food and eating. Minimal research has examined the effect of exclusion diets on nutritional intake. The degree of dietary restrictions required when following an elimination diet has raised concerns that nutritional adequacy may be compromised in those children with ASD who are already vulnerable because of food fussiness, feeding difficulties, limited diets and out of the ordinary eating habits that go beyond the usual “picky eating” behaviour, seen in most children at specific developmental stages. Diet modification of a child with ASD is generally undertaken without the guidance of a qualified health professional. Improvident dietary changes may adversely compromise nutritional adequacy of a child already with difficult eating behaviours.

Methods: The nutritional intake of 73 ASD children who attended the Allergy Clinic at RPAH was analysed and compared to that of 41 Non ASD children. A series of validated questionnaires was used to assess nutritional adequacy of the study participants which included The Four-Day Diary where the child's dietary intake was analysed and nutritional adequacy assessed via the Percentage Recommended Daily Intake (RDI) given for macro- and micro-nutrients. The Food Frequency Questionnaire (FFQ) was used in this study to detect any differences in reported nutrient intakes which may have been apparent between the two dietary intake methodologies. The General Behaviour and Health Checklist for Children was used to establish whether caregivers had received information about various dietary modifications implemented.

Results: The results of our study revealed that the RDI recommendations for both cohorts were adequately met. There was no significant difference between the means of the nutrient intake of the two cohorts for the 4-Day Food Diary when assessed with a T-test. The different diets of the ASD cohort were compared, with only the intake of riboflavin found to be significantly different. A Post Hoc test revealed that it occurred between the Regular and Gluten/Casein Free Diet (GF/CF). The Dietary Guidelines for Children and Adolescences in Australia's (DGCCA) daily intake was not met for the Cereal food group; however, overall intake based on the food groups was similarly spread across the two cohorts. It was found that dietary advice was commonly undertaken without guidance of a qualified health professional.

Discussion: Children with ASD may be considered nutritionally “at risk” on an elimination diet. Dietary investigations highlighted that the nutrient intake of children with ASD was analogous to that of Non ASD children and they adequately met recommendations for all the nutrients.