Examination of Feeding Difficulties and Dysphagia in Children With and Without Autism Who Present for Sleep Evaluation

Abstract

Research Question: In children with and without Autism Spectrum Disorder (ASD), how does the presence of various feeding difficulties influence the spectrum of sleep difficulties?

Background and Significance: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by restricted, repetitive patterns of behavior and unusual responses to sensory stimuli. The DSM V has integrated various clinical conditions into the unified diagnosis of ASD, contributing to its diverse nature and variations in age of diagnosis. Sleep and feeding difficulties are noted in the pediatric autism population, however, limited studies explore the relationships between these difficulties. The purpose of this study was to examine the relationships between sleep and feeding disorders in a cohort of children aged 3-17 with and without ASD.

Materials and Methods: A secondary data analysis was conducted of de-identified data from Nationwide Children¿s Hospital (NCH) Sleep DataBank, a collection of encounters with children referred for polysomnography. Data were filtered for ages 3-17 years and further filtered for the presence of an autism diagnosis.

Results: There were 3,053 unique participants (M = 7.26 years) with a total of 83,045 encounters between 2006 and 2020. Of these, 239 (8%) were diagnosed with ASD, Asperger's Syndrome, or Pervasive Developmental Disorder. Chi-square analysis revealed a significant association between autism and feeding difficulties, x2=81.36, p<.001, OR=3.83, and dysphagia, x2=18.95, p<.001, OR=2.19. Children with autism were 3.8 and 2.2 times more likely to develop feeding difficulties or dysphagia than children without autism. Since there was a significant association among these variables, feeding difficulties and dysphagia were then used in logistic regressions to predict the likelihood of developing various sleep disorders. In children with autism, those with feeding difficulties were more likely to develop insomnia (OR=2.12) and sleep disturbance (OR=2.20) than those who are not diagnosed with feeding difficulties. Children with autism who also have dysphagia were more likely to develop sleep apnea (OR=2.30) than children without dysphagia.

Conclusion: The research reveals a significant correlation, indicating that children with ASD are 3.8 times more likely to experience feeding difficulties and 2.19 times more likely to experience dysphagia compared to neurotypical children. Moreover, the data highlights a link between feeding challenges and sleep disorders, showing that children with ASD and feeding difficulties are more likely to develop sleep disturbances and insomnia. The data also suggests an increased likelihood of sleep apnea in children with ASD who have dysphagia. Overall, these findings emphasize the complex nature of ASD and its co-morbid conditions, underscoring the necessity for an integrated approach in assessing and caring for affected children to improve their overall quality of life. The study advocates for continued research to comprehend the mechanisms underlying these comorbid conditions and develop effective strategies for early identification and intervention, aiming to enhance clinical practices and support services for individuals impacted by ASD.