Eating problems are not usually the first thing that comes to mind when we think about autism, but they are intricately linked with the developmental disorder.
Of course, it’s fairly normal for young children to be finicky. Most of us can recall a time in our own childhood when we were sustained almost exclusively on peanut butter and jelly sandwiches and macaroni and cheese. For children with autism spectrum disorder (ASD), atypical eating may not be a fleeting phase but one that is more chronic and more extreme.
Mike will only eat white foods
Emily will only eat round food
John requires food at room temperature
Amy needs her mother to feed her
Max is terrified to try anything new
Seth can only eat in silence
Lena throws more food than she eats
Reviews of studies confirm that children with autism are five times more likely to have eating issues than their developmentally normal peers.
According to research, as many as 90 percent of children with autism have some feeding problems with 70 percent described as selective eaters. While more research is needed, studies suggest that feeding difficulties in infancy may be among the earliest signs of the condition.
Research has found that 69 percent of children with ASD are unwilling to try new foods and another 46 percent have rituals surrounding their eating habits.
This complicated relationship with food can have detrimental consequences that include mealtime stress, limited social opportunities, disruptions in family routines and poor nutrition that can impact growth, development, learning and behavior.
Despite the range of challenges and sheer numbers of affected children, there are evidence-based therapies to increase food flexibility, improve nutrition and modify disruptive eating behaviors.
This blog will discuss some of these interventions, as well as the most notable factors that contribute to the development of disordered eating in those with autism.
Abnormal Food Behaviors & Autism
The variety of food-related behaviors linked to autism range from peculiar to harmful.
Selective Eating Disorder
A diet that consists of a small selection of foods, sometimes as few as five, is among the most common food-related challenge for children on the spectrum. Many children with ASD prefer carbohydrates and often reject entire food groups like fruits and vegetables. Mineral and nutritional deficiencies are a primary concern.
Many children with autism frequently refuse to eat. One study found that the number can be as high as 47 percent. In extreme cases, nutritional shakes and even feeding tubes may be necessary.
Eating non-food items is relatively common among those with developmental disabilities like autism. Some of the most frequently ingested items include soap, dirt, fabric and paper. The reasons vary but can include sensory stimulation, confusion over what is food and non-food, and craving nutrients like zinc or iron.
In what seems like a contradiction, children with autism-related eating issues, including extremely limited diets, are more likely to be overweight than their same-age peers. This paradox might be explained by frequent grazing, a preference for calorically dense, starchy carbohydrates and processed foods, as well as overindulging in favored food.
Children with ASD are more likely to have an intense fear of trying new foods compared to their non-ASD peers. Many children on the spectrum report feelings of panic and terror at the prospect of eating something new.
Underlying Causes of Autism Related Feeding Problems
Numerous factors can influence the type and severity of atypical eating patterns in children with autism. Uncovering the source of the problem takes patience and investigative work but it is paramount to find ways to address them.
Through research, we know that children with ASD process sensory information differently. Due to either heightened or diminished sensitivities, children on the spectrum may not experience intense flavors, temperature or textures in normal ways. It is not uncommon for children to find certain foods unbearable and can choke, gag or become ill when they try them. Food often needs to be just right in every way from shape, color, taste, texture, temperature and smell.
Need for Sameness and Consistency
Many children on the autism spectrum prefer consistency and often struggle with minor changes. For instance, many children require the same brand and packaging, even the same seat and plate and timing of meals. The need for sameness may be one explanation behind the preference for processed foods since they tend to be more consistent and uniform.
Repetitive, Routinized Behaviors
Children on the spectrum often engage in rituals and repetitive behaviors in nearly every aspect of their lives; eating is no exception. These ingrained behaviors contribute to food refusal, unwillingness to try new foods and reliance on a narrow, limited diet.
Motor Function Limitations
Motor control, coordination and limited muscle strength are not uncommon in those with ASD, with as many as one in three experiencing significant motor difficulties.
These deficits can create challenges with chewing and swallowing.
Many children with autism have developmental delays that make moving food around their mouths difficult. This may be one reason why children with autism find shakes more palatable and easier to ingest than foods that require chewing.
People with autism have a higher prevalence of gastrointestinal problems like constipation, reflux, and gluten and dairy sensitivities. Getting to the root of the food issue is important, particularly for nonverbal children who may engage in maladaptive behaviors to express pain and discomfort triggered by certain foods.
Professionals Who Can Help with Autism Feeding Problems
It often takes a team of providers to uncover and address feeding problems related to autism.
Because children with autism are more prone to oral health issues that contribute to atypical eating behaviors, dentists can address dental issues caused by poor nutrition, chewing non-food items and even medications.
Occupational Therapists are instrumental in helping children with autism improve motor skills, manage sensory processing disorders and address restrictive eating with techniques to introduce new foods.
Speech therapists work with kids to improve swallowing and chewing and teach exercises that help build mouth muscle strength.
Behavior Health Therapists help to reduce maladaptive mealtime behaviors, reduce pica incidents, motivate the child to expand their dietary repertoire and increase tolerance to new foods.
Effective Behavioral Interventions for Disordered Eating
While the root of feeding problems is biological, eating is a behavior, thus responsive to behavioral intervention methods like Applied Behavior Analysis (ABA).
A Board Certified Behavior Analyst (BCBA) will first identify positive and negative reinforcements that are influencing the child’s conduct. For instance, is a parent unknowingly reinforcing maladaptive behaviors by removing unwanted food (allowing the child to escape eating it) or replacing it with preferred food?
The goal of ABA is to modify disruptive mealtime behaviors, reduce food-related anxiety and encourage food flexibility. Some of the most common methods utilized include escape extinction, simultaneous presentation, behavior momentum and reinforcement procedures.
In its simplest terms, escape extinction removes the motivation to engage in disruptive behaviors that worked in the past to avoid or escape a certain food. It has been widely demonstrated to increase the consumption of new foods by encouraging compliance through desirable rewards like a toy, video or verbal praise.
Simultaneous presentation involves presenting the child’s preferred and non-preferred foods together, an effective technique for increasing tolerance to previously rejected food. One common method is placing the new food on the tip of the spoon with the preferred food on the back.
Behavior momentum is gradually increasing the amount of food on a spoon, working up to a full spoonful. This simple concept has been demonstrated to increase food acceptance and consumption.
Differential Reinforcement Procedures
The foundation of ABA is positive reinforcement as a teaching and behavior modification tool. An example of a differential reinforcement procedure is rewarding the child with a bite of their preferred food after trying a small amount of a new one, gradually expanding the child’s menu of acceptable foods.
Five Parenting Tips to Better Nutrition and Food Flexibility
- Never force a child to eat objectionable food. Research shows that it does little to improve diet and may worsen dietary struggles.
- Respect the child’s sensory challenges while helping them to adapt to new foods and how they look, feel, taste and smell.
- Do not sneak new food into favorite foods, which can increase the likelihood of rejection.
- Encourage relaxation techniques to manage anxiety around new foods and different dining settings.
- Plan regular family dinners. These opportunities familiarize kids to a wide variety of foods, making them more likely to try them in the future.