Picky Eating of Autism
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by difficulty with social interactions, communication and sensory processing. Picky eating or selective eating behaviours are among the many behavioural manifestations associated with ASD that may significantly impact daily life and overall health. Understanding the correlation between autism and picky eating requires taking note of an individual’s sensory sensitivities, structured routines and potential nutritional ramifications that influence eating behaviour in those on the spectrum. Addressing these challenges requires taking an individualized approach that considers both sensory and dietary preferences, while simultaneously encouraging healthy eating habits while respecting individual sensory profiles. This introduction sets the scene to explore how picky eating intersects with autism spectrum disorder and the need for tailored strategies and support in creating positive mealtime experiences and overall well-being for individuals living with ASD.
Working with children who exhibit restrictive eating behaviours should aim at eventually helping them consume a range of healthy food that fits with the culture of their family, while simultaneously decreasing household tension.
Understanding what may be behind rigid eating behaviours is the first step toward helping children become more open-minded about trying new foods and making mealtimes less stressful for all involved.
Ruling Out GI Problems
If a child on the autism spectrum is experiencing eating issues, parents should consult a pediatric gastroenterologist immediately in order to rule out organic causes. Autistic kids may suffer from many of the same childhood GI disorders that other kids do; according to Joseph Levy MD from NYU Langone Hospital who specializes in working with autistic kids (he also works at NYU Langone), yet may not be able to verbalize or localize their discomfort as easily. Therefore parents need to take proactive measures in order to locate sources. Below are some more frequent causes that children may encounter.
- Acid Reflux is a common childhood disorder, but in kids on the spectrum “we have observed that behavioural changes like jumping around, becoming wild, or crying can correspond to when acid backs up into their throat,” according to Dr Levy.
- Constipation caused by limited diet or delayed toileting (common in children with autism), can make eating uncomfortable for children who feel full or experience stomachache while eating.
- Eosinophilic Esophagitis (EoE) is an allergic swallowing disorder, often triggered by food, that makes a child feel as if they’re gagging or choking. EoE can often result in pain and discomfort for autistic kids which could potentially result in behavioral issues.
- Problems with diarrhea in children may stem from their diet; however, other causes include malabsorption of certain sugars or rapid transit through the GI tract which does not allow enough time for stool to firm up.
Mealtime Behaviour Issues
Mealtime behaviours that pose issues for autistic kids and their families include:
Sensory Issues with Food: Children on the autism spectrum tend to show strong preferences for foods that feel different in their mouths. Some prefer soft or creamy textures like yogurt, soup or ice cream while others may need the stimulation provided by crunchy snacks like Cheetos or — in rare instances — carrots. Either way, this may limit what types of foods children will eat.
Underdeveloped oral motor musculature: Children who predominantly prefer and eat soft foods as they grow may lack the muscle development required to chew foods such as steak or hamburger, according to Dr. Lee. He noted that children may get fatigued from eating these items and find them unpleasant, leading to parents who don’t recognize this issue allowing their child to forgo eating foods that strengthen those muscles – creating a vicious cycle in which both children and parents suffer in silence.
Time and Behavior at the Table: Many parents know the difficulty of trying to get their child(ren) to sit still long enough at a meal table for them to finish, yet with autistic kids this difficulty is compounded further by issues surrounding safety: “it isn’t simply whether your child remains at their table or eating area as intended by you; rather it should include whether they engage in dangerous or unsafe acts or disruptive behaviours within that area,” according to Dr Lee: these might include throwing utensils or repeatedly standing up and running away.
How These Behaviors Escalate
Parents of children with autism tend to focus on multiple needs at once. Speech therapy, toileting issues, school placement decisions and overall compliance typically take precedence over food restrictions for the child and are prioritised over feeding issues until either they become untenable or parents have time and can address them accordingly.
Dr. Lee asserts that parents will inevitably default to those foods which keep their child alive and safe, without question. But neglecting these issues only compounds them further: as these negative mealtime behaviours persist longer they become entrenched and take longer to treat successfully. That doesn’t mean parents should give up, just that treatment might take more persistence and patience from all involved parties involved.
Techniques for Tackling Mealtime Issues
Approaches for dealing with mealtime behaviour issues can often be similar; however, parents need a step-by-step plan in place to address them successfully and reduce mealtime stress. Here’s an essential practical guide designed to assist both themselves and their children achieve their respective goals and reduce mealtime stress.
Prioritize: Too often parents attempt to address all mealtime behaviours simultaneously, which often leaves both kids and parents overwhelmed and giving up. Dr. Lee encourages families she works with to prioritize their goals: for instance increasing food consumption or sitting less disruptively at mealtime are all worthy targets that parents need to focus on first.
Start small: No matter what the goal, it is crucial to start small and take baby steps toward it. When trying a new food with children, Dr. Lee begins with small bites that may even go undetected by them at first. Once the child takes their first taste of something unfamiliar, she provides praise and counts that as one bite towards their “no thank you bite”, which allows them to say no thank you without consequence for the rest of that meal.
Parents shouldn’t push their luck: Parents might feel tempted to extend the mealtime experience past 10 minutes; but this would be a mistake, according to Dr. Lee. “Sometimes we feel they’re doing well, so let’s push for another 10 minutes,” but more time could result in less successful meal outcomes; especially important is providing children who struggle at mealtime with experiences that help shape positive attitudes about eating and mealtime.
Meet Your Child Where They Are: If your child isn’t eating any of the food presented to them, setting expectations that involve cleaning out an entire plate wouldn’t likely work in their favour. Parents need to set realistic expectations that meet where their child currently stands with regard to mealtime behaviours.
Provide clear expectations: Parents, caregivers and your child all must understand your goal for this meal and the expectations surrounding its completion or success. Visual timers can make expectations easier to grasp for children who may struggle with understanding them – e.g. counting down minutes during which your child needs to sit at the table.
Make the Most of Praise: Dr Lee stresses the importance of lavishing praise upon your child for every bit of progress they have made, in any form or fashion, throughout their development process. Dr. Lee lists numerous types of praise: praise can come in different forms such as gifts or other forms of recognition that come your child’s way.
- General praise can include telling your child they have done an outstanding job or providing general encouragement by telling them “good job”, “way to go”, or giving them a high five.
- Labelled praise involves telling your child specifically which aspect of their behaviour was pleasing to you, such as saying thanks for sitting so quietly at the table; I love how you tried that new food; “Great job sitting with your fork at the table;” “Thanks for placing your plate in the sink;”. Labelled praise can reinforce positive behaviours parents want their children to adopt, such as sitting quietly or placing plates into sinks. Parent-directed praise reinforces positive behaviours. It plays an especially vital role as reinforcement.
- Five to one ratio: Dr Lee recommends setting an ambitious rule of thumb at mealtime: for every direction or reprimand given, parents or caregivers should give five portions of praise – “not arbitrarily but heavily and sincerely: thanking children for coming quickly to the table; complimenting them on getting going right away; applauding efforts like asking for seconds!’ and so forth”.
Consistency, Perseverance and Patience: Keep in mind that it often takes multiple exposures to a food — Dr. Lee suggests seven to 12 — for someone to determine if they like or don’t like something, so perseverance and patience are crucial. Just because kids say once that they don’t like something doesn’t mean that it won’t change over time,” according to Lee; so we make sure we revisit any items they say they disliked initially.
How to Handle Temper Tantrums: Don’t expect your child to change long-standing mealtime behaviours without some form of resistance from them; verbal aggression or disruptive behaviours (whining or crying), may all be present when making changes – yet that doesn’t mean progress is being made! Dr Lee advises parents on “planned to ignore”, which involves intentionally disregarding behaviour as long as it’s safe.
Food Journaling: Parents and other caregivers should attempt to keep an accurate record of each meal consumed by their child so that both they (and the clinician) can measure progress made, challenges encountered and how best to address them in the future. A written record makes being patient easier while helping everyone stay on track with treatment goals.
Create a Poop Journal: Dr. Lee advises parents, caregivers and even teachers to keep a written record of children’s bowel movements on an ongoing basis. If chronic constipation becomes an issue for your child, visiting either their pediatrician or gastroenterologist might be beneficial; especially for children with autism who often have toileting issues that involve withholding their bowels resulting in less comfortable eating experiences according to Dr Lee. Adding that eating more carbohydrates than vegetables could impact digestion negatively causing children to become uncomfortable so parents should consult both pediatrician/GI doctor promptly in such instances if their gastrointestinal health concerns arise.
Model good mealtime behaviour: What we model for children often has the greatest influence over what they perceive of us as parents, according to Dr Lee. “If you tell your kids they should eat a balanced diet but then don’t model that behaviour yourself, chances are slim they’ll develop positive eating habits,” according to Lee. In order to create positive associations between you and mealtime activities and your kids’ development. Therefore, try something new yourself and enjoy meals sans distractions such as phones or television at meal times; that may have an influence that makes an impactful impression upon them both!
