Mealtime challenges and food selectivity in children with autism spectrum disorder in South Africa

Background: Children with autism spectrum disorder (ASD) have a number of associated feeding difficulties and problematic mealtime behaviours. These problems can have a negative impact on the child’s nutritional intake and little is known about the food preferences and characteristics of food choices. In addition, these difficulties can be exacerbated for children and caregivers living in low- and middle-income countries such as South Africa due to limited access to food, resources and health care. Objectives: The purpose of this study was to determine (1) types of feeding difficulties prevalent in children with ASD, (2) food items that children in South Africa prefer, (3) the relationship between age and ASD severity on food preferences. Method: A cross-sectional quantitative research design was employed using an online questionnaire. There was a total of 40 respondents from different provinces in South Africa. The data were analysed using descriptive statistics as well as multiple linear correlation analysis. Results: The study has identified common feeding difficulties in children with ASD and those being diagnosed as picky eaters in South Africa and compared them with difficulties that were found in the international literature. The study also highlighted the food groups that were preferred by children with ASD, showing a preference for starches and snack items compared with fruits and vegetables. In addition, there were significant correlations between ASD severity and ASD age on food preferences, suggesting that both age and severity may be predictors of food choices made by children with ASD, and highlighted a need for multidisciplinary intervention. Conclusions: This study adds to the existing literature on feeding difficulties in children with ASD but provides additional insights into children living in low- and middle-income countries and can be used to improve appropriate and responsive interventions. This study provides evidence that supports the influence of context and family environment regarding feeding in children with ASD.