Are eating disorders more common in children with autism compared to children in the general population?

Date First Published:

September 18, 2016

Last Updated:

October 2, 2016

Report by:

Zara Bowling, Speciality trainee, Bristol Children's Hospital (Bristol NHS Trust )

Search checked by:

Zara Bowling, Bristol NHS Trust

Three-Part Question:

In [children aged 5 to 15 years old with autism] are [eating disorders] [more common compared to children aged 5 to 15 years old in the general population]?

Clinical Scenario:

A 12 year old girl with autism was admitted for elective orthopaedic surgery, requiring a 4 week inpatient stay for post-op physiotherapy. She required significant dietetic and psychiatric input, and had lost weight at successive outpatient appointments prior to hospital admission. She was diagnosed with anorexia during her admission. This case, is one of many, that highlighted the need for dietetic and psychiatric input intervention early in children with autism.

Patient group: Children aged 5-15 years old with Autism
Intervention: Eating Disorders (Anorexia AND/ OR Bulimia)
Control group: Children aged 5-15 years old without Autism
Outcome: Data on the prevalence of Eating Disorders in children with Autism compared to children without Autism

Search Strategy:

NHS Evidence: Medline, EMBASE, AMED, HMIC, BNI

Search Details:

"Autism" AND "Eating Disorders"
"Autism" AND "Anorexia"
"Autism" AND "Bulimia"
"Autism" AND "Anorexia" AND "Bulimia"
"Developmental disorders" AND "Eating Disorders"
"Neurodevelopmental disorders" AND "Eating Disorders"

Outcome:

17 search results, 2 directly related to the question.

Relevant Paper(s):

Study Title	Patient Group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
A Comparison of Eating Behaviors between Children with and without Autism Kimberly A. Schreck, Keith Williams, and Angela F. Smith Aug-04 USA	Caregivers of children between the ages of 5 and 12 years (n = 472; range 7–9.5 years) were recruited to complete questionnaires pertaining to their family’s and child’s eating habits. Caregivers of the children with autism were recruited through membership lists for local, state, and national autism societies, schools for children with autism, and from local doctors.	This study compared caregiver report of eating problems of children with and without autism on a standardized questionnaire. The questionnaire included items pertaining to food refusal and acceptance patterns as well as food presentation requirements. Caregivers of children between the ages of 5 and 12 years (n 1⁄4 472; actual range 1⁄4 7–9.5 years) were recruited to complete questionnaires pertaining to their family’s and child’s eating habits.	Results indicated children with autism have significantly more feeding problems and eat a significantly narrower range of foods than children without autism.		The selection process for the families of children with autism could have provided skewed results. The number of children with autism within the sample (138) constituted approximately 32% of the total sample. This was higher than the estimated occurrence of autism within the population (American Psychiatric Association, 1994) and also could have indicated a selection bias for children with autism with feeding problems. Because the sample of children could also have been restricted due to the chosen target age group, the results of this study are also limited to the feed- ing problems of older children with autism. Conse- quently, the chosen target age restrictions can be viewed as a partial limitation to this study. Additionally, the use of parental report of foods eaten by children may have also created less Food types Autism group Control group M SD M SD Fruits 8.09 Dairy 4.32 Vegetables 4.00 Proteins 7.82 Starches 15.82 6.52 15.75 3.30 8.07 3.48 5.00 8.23 6.06 5.98 14.24 7.40 8.80 24.08 11.38 7.62 438 accurate results than method of actual presentation of foods (see Ahearn et al., 2001). For example, parents may limit exposure (not supported by this study), present foods to the child that he will read- ily accept, or inaccurately report what the child eats.
Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children Linda G. Bandini, PhD, RD, Sarah E. Anderson, PhD, Carol Curtin, MSW, Sharon Cermak, EdD, OTR/L, E. Whitney Evans, MS, RD, Renee Scampini, MS, RD, Melissa Maslin, MEd, and Aviva Must, PhD 2010 USA	Food selectivity was defined as food refusal, limited food repertoire, and high frequency single food intake using a modified food frequency questionnaire and 3-day food record. Food selectivity was compared between 53 children with ASDs and 58 typically developing children ages 3–11 years. Nutrient adequacy was assessed relative to the Dietary Reference Intakes.	Children with ASDs exhibited more food refusal than typically developing children (41.7% vs. 18.9% of foods offered, p < 0.0001). A more limited food repertoire was reported for children with ASDs than typically developing children (19.0 vs. 22.5 foods, p < 0.001). Only four children with ASDs and one typically developing child were reported to demonstrate high frequency single food intake. Children with a more limited food repertoire had inadequate intakes of a greater number of nutrients.			Methodology for determining food refusal and high frequency single food intake was based on a modified food frequency questionnaire. A parent may not offer a food that he/she believes the child would refuse, therefore it cannot be determined whether not offering a food is influenced by the child’s presumed or historical refusal of that food. There was a great deal of variability in the number of foods that were not offered to children, which was greater among children with Autism (range of 0 to 90 foods not offered, compared with a range of 3 to 46 foods not offered to typically developing children). Among the children with Autism, being on a special diet was associated with more foods not being offered but not with percent of foods refused of those offered. Thus, some parents of children with Autism offered a limited number of foods; this would preclude the child refusing those foods.

Author Commentary:

There is a significant lack of data on autism and the prevalence of eating disorders available, as highlighted by my search strategy.

There were only 2 studies directly related to the clinical question.

The results from the 2 studies highlight that feeding difficulties appear to be more common in children with autism. There is a demand for further studies to investigate this further.

Bottom Line:

Further studies are required, the search strategy highlighted a significant lack of data directly answering the clinical question. The data available, indicates feeding problems are more common in children with autism compared to children without autism. More research is definitely required in this field.

Suggestion: All children with autism should receive prompt nutritional +/- psychiatric support on arrival into hospital.

References:

Kimberly A. Schreck, Keith Williams, and Angela F. Smith. A Comparison of Eating Behaviors between Children with and without Autism
Linda G. Bandini, PhD, RD, Sarah E. Anderson, PhD, Carol Curtin, MSW, Sharon Cermak, EdD, OTR/L, E. Whitney Evans, MS, RD, Renee Scampini, MS, RD, Melissa Maslin, MEd, and Aviva Must, PhD. Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children