SIGNIFICANCE: One in 68 children in the United States has autism spectrum disorder (ASD). The odds that a child with ASD will have selective eating are increased fivefold compared with other populations. Limited diet variety may affect health outcomes and may cause stress for parents. We must understand selective eating to develop effective interventions to improve long-term health and participation outcomes.

INNOVATION: A standard, objective definition of selective eating has not yet been established. In our study, we use a definition of selective eating derived from a population-based sample to analyze differences between children with ASD who are or who are not selective eaters. In addition, we look at differences in parent stress and mental health, which has not yet been explored.

APPROACH: We hypothesized that (1) there would be significant differences in measures of food acceptance and refusal between groups; (2) participants in the selective eating group would have more challenging behaviors, anxiety, repetitive behaviors, and sensory reactivity; (3) parents of selective eaters would have more parenting stress and anxiety and engage in more behaviors to increase their child’s intake; and (4) behavioral variables would be highly correlated with measures of food variety and refusal. The identification of factors associated with selective eating can lead to improved treatments.

METHOD: We gathered and analyzed data using a cross-sectional design. Data were collected during outpatient visits or in the home, depending on parent preference and availability. Children with ASD aged 4 to 10 yr (N = 35) were recruited through flyers and clinician referrals and were screened for inclusion using the Social Communication Questionnaire. Participants were assigned to the selective or nonselective groups on the basis of the total number of foods that parents indicated they ate compared with a population-based sample.

Instruments included a food frequency questionnaire, a validated screening for food insecurity, the Child Behavior Checklist, the Repetitive Behavior Scales—Revised, the Short Sensory Profile, the Brief Assessment of Mealtime Behaviors in Children, the Parent Mealtime Action Scale, the Parenting Stress Index—Fourth Edition Short Form, and the Beck Anxiety Inventory. We analyzed differences between groups using one-way multivariate analysis of variance. Associations among key variables were analyzed with Pearson’s r.

RESULTS: On average, selective eaters ate significantly fewer foods and had higher food refusal rates. There was no overall effect of group for behavioral differences or for parenting stress, anxiety, or food insecurity. Parents of selective eaters were more likely to use special meals. Correlations were significant and moderately strong among variables relating to food intake and behavior, respectively, but there were no significant correlations between food intake and behavior. Parenting stress was positively correlated with child aggression.

CONCLUSION: Further research is needed to validate the definition of selective eating and to identify salient targets for intervention. Contextual factors such as food security status should be considered when making treatment recommendations. Limitations of this study include the lack of independent validation of ASD diagnosis, use of parent report measures, and small sample size.