Onset, Trajectory, and Pattern of Feeding Difficulties in Toddlers Later Diagnosed with Autism

OBJECTIVE: To examine the emergence and trajectory of feeding difficulties in young children who are later diagnosed with autism spectrum disorder (ASD). METHOD: The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was administered to a sample of 93 toddlers with an older sibling with ASD -- the high-risk group -- and 62 toddlers with no known familial ASD -- the low-risk group -- as part of a larger infant sibling study. The BPFAS was completed by parents at 15, 18, 24, and 36 months of age. At 36 months, participants underwent a diagnostic assessment and were classified into one of four outcome groups: ASD, Non-Typical Development, High-risk Typically Developing, and Low-risk Typically Developing. The BPFAS was scored for total frequency of feeding difficulties, as well as autism-specific factor scores previously described in the literature. RESULTS: The frequency of feeding difficulties increased significantly more rapidly in the ASD group between 15 and 36 months of age, and by 36 months, they exhibited a significantly higher total frequency score than all other groups. Analysis of the factor scores revealed a similar pattern for the food acceptance and mealtime behavior domains, but no significant differences in the medical/oral motor domain. CONCLUSION: Feeding difficulties develop significantly more rapidly in children with ASD, with longitudinal monitoring revealing the steeper trajectory earlier than can be detected with cross-sectional analysis. Children with ASD are at risk of health and social consequences of poor feeding behavior that may potentially be minimized if addressed early and appropriately.