new diagnostic indicator for autism

Researchers investigate whether atypical eating habits could be used to diagnose autism spectrum disorder.

Autism spectrum disorder (ASD) is characterized by two core symptoms namely difficulty with social interaction and communication, as well as repetitive and obsessive behaviors. People with ASD have difficulty forming relationships and often respond inappropriately during conversations. They engage in repetitive or routine behaviors and can develop fixations or obsessive-like interests. The secondary symptoms for ASD include hyperactivity, aggression, self-injury, anxiety, and major depression. Autism is classified as a spectrum disorder, meaning that these symptoms can range from mild to server in different individuals. ASD is more prevalent in men and affects boys three to four more times than girls; girls, however, usually have more severe symptoms than boys.

Diagnosis

ASD is usually diagnosed at the age of four but the patterns of some symptoms can be detected before the age of two. There are various scale rating systems used to diagnose ASD some examples include autism diagnostic observation schedule, the autism diagnostic interview-revised,  Checklist for Autism in Toddlers (CHAT), the modified CHAT, and the Childhood Asperger Syndrome Test. Early diagnosis of ASD is thought to be critically important as it will allow for timely access to therapeutic interventions. ASD is usually treated through the use of various behavior modifying techniques such as focused intervention or comprehensive treatment models. The difficulty with early diagnosis of ASD is that roughly 15-30% of children with ASD develop normally for the first two years of life and then begin to regress. This can also be seen as a plateau effect with developmental progress slowing. This makes it particularly difficult to diagnose ASD in young children.

Can your child’s eating habits be used to diagnose autism?

In a recent US study published in Research in Autism Spectrum Disorders, scientists wanted to know if they could use abnormal eating habits as a tool for diagnosing ASD. The group wanted to know if they could use atypical eating behaviors to distinguish between children with Autism, ADHD, and other disorders, and those with typical development.

It is well known that food selectivity is common in children with ASD. It is thought that hypersensitivity to taste, smell, and textures of various foods contribute to their highly selective eating habits. Other common atypical food behaviors associated with ASD children include rituals and routines such as using specific cutlery and plates or smelling food before it is eaten, separating food so that it does not touch, aversion to new food or neophobia and preference for specific food brands.

The scientists used information from psychiatry child diagnostic clinics and the CASD national standardization sample to find information on 2102 children. They followed 1462 children with autism, 327 with other disorders (e.g., ADHD, intellectual disability, language disorder, and learning disability), and 313 typical children. The children included in the study were 1-18 years old. The scientists then performed statistical analysis on these different groups of children to determine if there was a difference in the eating habits between these groups. The researchers found that autistic children were five times more likely to have atypical eating habits when compared to other disorders. They were also 15 times more likely to have atypical eating habits when compared to typical children. The researchers found that the most common behavior was limited food preference followed by sensitivity to food texture. They also found that autistic children often had two or more atypical eating behaviors in addition to being picky eaters.

Results from this study seem to indicate that atypical eating habits could be a useful tool for diagnosing ASD however there were some limitations to the work presented that need consideration. The behavior of being a picky eater is rather common in young children and is in fact viewed as part of normal development. This selective behavior in children begins to decline at the age of 4-5 years old. In this study, they only found a prevalence of atypical behaviors in typical children of 5 percent, which is a lot lower than the 28 percent prevalence reported in the general population. The study used statistics to show the eating patterns occurred more frequently in children with ASD. They did not test whether or not these distinctive eating behaviors were predictive of an ASD diagnosis. The study included children ranging from 1 -18 years old. This age range may not be beneficial in helping to establish techniques to promote early diagnosis of ASD. The study also included children under one year in age. The accurate diagnosis of autism may not be possible at this age due to the regression seen in some ASD patients

The study did show an association between atypical eating habits and autism. This insight may be helpful for primary caregivers when confronted with these unusual eating habits it may be worthwhile screening the patient for ASD. Dr. Mayes, the lead author on this study had this to say in a press release, “If a primary care provider hears about these behaviors from parents, they should consider referring the child for an autism screening,”

Written by Tarryn Bourhill, MSc

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References:

1 Fakhoury, M. Autistic spectrum disorders: A review of clinical features, theories and diagnosis. International Journal of Developmental Neuroscience 43, 70-77 (2015).

2  de la Torre-Ubieta, L., Won, H., Stein, J. L. & Geschwind, D. H. Advancing the understanding of autism disease mechanisms through genetics. Nature medicine 22, 345 (2016).

3 Matson, J. L., Wilkins, J. & Gonzalez, M. Early identification and diagnosis in autism spectrum disorders in young children and infants: How early is too early? Research in Autism Spectrum Disorders 2, 75-84 (2008).

4 Boyd, B. A., Odom, S. L., Humphreys, B. P. & Sam, A. M. Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention 32, 75-98 (2010).

5 Kral, T. V., Eriksen, W. T., Souders, M. C. & Pinto-Martin, J. A. Eating behaviors, diet quality, and gastrointestinal symptoms in children with autism spectrum disorders: a brief review. Journal of pediatric nursing 28, 548-556 (2013).

6 Matson, J. L. & Fodstad, J. C. The treatment of food selectivity and other feeding problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders 3, 455-461 (2009).

7 Cano, S. C., Hoek, H. W. & Bryant-Waugh, R. Picky eating: the current state of research. Current opinion in psychiatry 28, 448-454 (2015).

8  Mayes, S. D. & Zickgraf, H. Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders 64, 76-83 (2019).

9 Press release: Sweger, Z. Unusual eating behaviors may be a new diagnostic indicator for autism, <https://news.psu.edu/story/579983/2019/07/09/research/unusual-eating-behaviors-may-be-new-diagnostic-indicator-autism> (2019).

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