Food selectivity is an emerging health concern among children with autism spectrum disorder (ASD). Food selectivity is used to describe food refusal, limited food choices, and/or food fussiness.
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-Scoping Review Guidelines to systematically identify the relationship between food selectivity and oral sensory sensitivity and the possible consequences of food selectivity on nutrient intake in children with ASD.Thirty studies were included in the review based on search terms from three online databases.
Assessment of food selectivity, oral sensory sensitivity, and nutrient intake was found to be focused primarily on the parent-report technique. Only a handful of studies have used Cronbach’s alpha to measure the psychometric properties. Twenty-one of the included studies reported a higher rate of food selectivity in children with ASD than typically developing (TD) children. Notably, several studies (n =7) have identified oral hypersensitivity (e.g., taste/smell) as a significant risk factor for food aversion and/or limited variety in children with ASD. Compared with TD children, the ASD group significantly consumed significantly fewer fruits/vegetables (n = 8). The intake of micronutrients, including vitamin A, vitamin B6, folate, vitamin B12, vitamin C, vitamin D, calcium, iron, and zinc that associates with food selectivity, was also low (n=13).
Implementation of screening and assessment protocols using valid and reliable instruments to identify food selectivity and oral sensory sensitivity is crucial for the medical evaluations of children with ASD.
Children with autism spectrum disorder (ASD) are five times more likely to develop feeding difficulties associated with food selectivity than children without ASD, and the ASD group has a higher risk of dietary inadequacies (Sharp et al., 2013). Available evidence supports that food selectivity correlates with children with ASD, indicating that taste, smell, and texture play important sensory roles in accepting or rejecting food (Marí-Bauset, Llopis-González, Zazpe-García, Marí-Sanchis, & Morales-Suárez-Varela, 2014; Marí-Bauset, Zazpe, Mari-Sanchis, Llopis-González, & Morales-Suárez-Varela, 2014). Food selectivity is often used to describe food refusal, limited food variety based on type or food texture, and increased consumption of specific food items, or rejection of certain food groups such as vegetables (Bandini et al., 2010; Field, Garland, & Williams, 2003). In addition, Williams, Dalrymple, and Neal (2000) identified that food selectivity in children with ASD is affected by various factors, such as restricted food selection (88 %), texture (69 %), food presentation (58 %), gustatory sensitivity (45 %), olfactory sensitivity (36 %), and food temperature(22 %). Similarly, the results of a survey among parents of children with ASD indicated that 72 % of children with ASD had a limited dietary range of foods and strong food preferences for sweet and salty tastes (e.g., ice cream, cookies, chicken nuggets, hot dogs, pizza, potato chips, and French fries) (Schreck & Williams, 2006).
In summary, food selectivity is more common in children with ASD than in those TD. Previous studies have highlighted that hypersensitivity to oral stimuli can exacerbate this problem. Inadequate micronutrient intake in children with ASD was also found more prevalent than in TD peers, including vitamin A, vitamin B6, folate, vitamin B12, vitamin C, vitamin D, calcium, iron, magnesium, and zinc due to food selectivity. Therefore, health practitioners should consider the relationship between food selectivity and oral sensory hypersensitivity in assessment and intervention protocols for children with ASD. Unique dietary habits displayed by children with ASD require multidisciplinary intervention strategies to minimise food-avoidant behaviours that may hamper their nutritional status and cognitive and social-behavioural performances. To date, no instrument has comprehensively evaluated food selectivity and oral sensitivity. Nevertheless, the BPFAS, BAMBI, CEBQ, and SP showed satisfactory results in the six methodology quality assessments for validity and reliability testing.