ORIGINAL PAPER Relationships Between Feeding Problems, Behavioral Characteristics and Nutritional Quality in Children with ASD Cynthia R. Johnson • Kylan Turner • Patricia A. Stewart • Brianne Schmidt • Amy Shui • Eric Macklin • Anne Reynolds • Jill James • Susan L. Johnson • Patty Manning Courtney • Susan L. Hyman Ó Springer Science+Business Media New York 2014 Abstract Many children with autism spectrum disorders (ASD) have co-occurring feeding problems. However, there is limited knowledge about how these feeding habits are related to other behavioral characteristics ubiqitious in ASD. In a relatively large sample of 256 children with ASD, ages 2–11, we examined the relationships between feeding and mealtime behaviors and social, communica- tion, and cognitive levels as well repetitive and ritualistic behaviors, sensory behaviors, and externalizing and inter- nalizing behaviors. Finally, we examined whether feeding habits were predictive of nutritional adequacy. In this sample, we found strong associations between parent reported feeding habits and (1) repetitive and ritualistic behaviors, (2) sensory features, and (3) externalizing and internalizing behavior. There was a lack of association between feeding behaviors and the social and communi- cation deficits of ASD and cognitive levels. Increases in the degree of problematic feeding behaviors predicted decre- ments in nutritional adequacy. Keywords Feeding problems Á Mealtime behaviors Á Nutrition Introduction Autism spectrum disorders (ASD) are neurodevelopmental disorders that are characterized by deficits in social com- munication and social interactions, as well as a presence of restricted repetitive and stereotyped patterns of behavior, interests, and activities (American Psychiatric Association 2013). Many children with ASD have co-occurring feeding problems with reported prevalence rates of 46–89 % (Bandini et al. 2010; Ledford and Gast 2006; Schmitt et al. 2008; Seiverling et al. 2011) compared to a rate of 25 % for typically developing children (Manikam and Perman 2000). In studies of children with ASD compared to chil- dren without ASD, results have consistently shown that children with ASD have a greater number of feeding problems and eat a more narrow range of food than chil- dren without ASD including children with developmental disabilities or other atypical development (Badalyan and Schwartz 2011; Bandini et al. 2010; Dominick et al. 2007; Martins et al. 2008; Matson et al. 2009; Nadon et al. 2011a; Schreck et al. 2004). C. R. Johnson (&) Á K. Turner Autism Center, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA 15213, USA e-mail: Cynthia.johnson@chp.edu P. A. Stewart Á B. Schmidt Á S. L. Hyman Department of Pediatrics, University of Rochester School of Medicine, 601 Elmwood Ave, Box MED-CRC, Rochester, NY 14642, USA P. A. Stewart Clinical and Translational Science Institute, University of Rochester School of Medicine, Rochester, NY 14642, USA A. Shui Á E. Macklin MGH Biostatistics, Massachusetts General Hospital, Ste 560, 50 Staniford Street, Boston, MA 02114, USA A. Reynolds Á S. L. Johnson University of Colorado, 13123 E. 16th Avenue, B140, Aurora, CO 80045-7106, USA J. James University of Arkansas Children’s Hospital, 13 Children’s Way, Little Rock, AR 77202-3591, USA P. Manning Courtney Cincinnati Children’s Hospital, MLC 4002, 3333 Burnet Avenue, Cinicinnati, OH 45229-3039, USA 123 J Autism Dev Disord DOI 10.1007/s10803-014-2095-9