Vol.:(0123456789) 1 3
Journal of Autism and Developmental Disorders
https://doi.org/10.1007/s10803-019-04211-w
ORIGINAL PAPER
Association Between Feeding Problems and Oral Health Status
in Children with Autism Spectrum Disorder
Beatriz Leiva‑García
1
· Elena Planells
2,3
· Paloma Planells del Pozo
1
· Jorge Molina‑López
2,3,4
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
A number of studies have been made of mealtime behavioral problems and food selectivity in patients with autism spectrum
disorder (ASD), though not from a multidisciplinary perspective where diet and dental care are investigated in children with
ASD. In the present study, the parents of 55 children with ASD and 91 children with typical development (TD) between 6
and 18 years of age completed the Brief Assessment of Mealtime Behavior in Children (BAMBIC) and a food consumption
frequency questionnaire. A pediatric dentist performed an oral exploration of the participants according to the criteria of
the World Health Organization (WHO). Food rejection and limited food variety were associated to an increased prevalence
of malocclusion and altered Community Periodontal Index scores in children with ASD.
Keywords Autism spectrum disorder · Mealtime behavior · Pediatric dentistry · Food selectivity
Introduction
Autism spectrum disorder (ASD) is a chronic neurodevel-
opmental disorder characterized by impairments in social
interaction and communication and restricted, repetitive
patterns of behavior, interests or activities (American Psy-
chiatric Association 2013). The prevalence of ASD has
increased in recent decades, particularly since the late 1990s.
This increase is probably a consequence of the changes in
diagnostic criteria of the disorder. The prevalence has con-
tinued to increase especially among people without intel-
lectual impairments, despite consistent application of the
diagnostic and statistical manual of mental disorders-Fifth
Edition (DSM-V) (Baxter et al. 2015; Fombonne 2018; Wil-
liams et al. 2006). Such individuals may be at an increased
risk of sufering oral health problems because of their spe-
cial circumstances and certain limitations referred to oral
hygiene (Murshid 2014; Sarnat et al. 2015). Likewise, chil-
dren with ASD usually present eating habits characterized
by rejection and/or preferences for certain foods (Chistol
et al. 2018; Gray and Chiang 2017)—a situation that may
lead to malnutrition and oral disorders (da Silva et al. 2017;
Kotha et al. 2018; Murshid 2014), thereby complicating their
nutritional status (Liu et al. 2016; Malhi et al. 2017; Mari-
Bauset et al. 2015).
Certain restricted, repetitive patterns of behaviors and
interests of individuals with ASD may be related to sensory
characteristics, as well as to sensory processing and integra-
tion difculties (Boudjarane et al. 2017; Castro et al. 2016;
Curtin et al. 2015). In this regard, diferent authors (Bandini
et al. 2017; Castro et al. 2016; Curtin et al. 2015; Johnson et al.
2014; Lockner et al. 2008) have suggested that certain sensory
features may contribute to mealtime behavioral problems in
children with ASD. As an example, food hyperselectivity is
characterized by a narrow range of foods chosen by the child,
* Jorge Molina-López
jrgmolinalopez@ugr.es
Beatriz Leiva-García
bealeiva@ucm.es
Elena Planells
elenamp@ugr.es
Paloma Planells del Pozo
pplanells@odon.ucm.es
1
Faculty of Dentistry, Madrid Complutense University, Plaza
Ramón y Cajal, 28040 Madrid, Spain
2
Department of Physiology, Faculty of Pharmacy, University
of Granada, Campus de la Cartuja, 18071 Granada, Spain
3
Institute of Nutrition and Food Technology. Biomedical
Research Center, Health Sciences Technological Park,
University of Granada, Avenida del Conocimiento—Armilla,
18100 Granada, Spain
4
Department of Physiology. Faculty of Pharmacy, University
of Granada, Campus de la Cartuja, 18071 Granada, Spain