It's dinnertime, and you don't have time to go get your son's favorite meal: chicken nuggets from a specific fast-food restaurant. You feel constricted as you anticipate the outburst. What if he eats nothing tonight?
The scenario is all too familiar for many parents of children with autism spectrum disorder (ASD). The anxiety that builds up as mealtime approaches, the fear of a potential meltdown, and the constant worry about nutrition are daily struggles. While picky eating is common in children, for those on the autism spectrum, it can become a significant challenge that affects not only the child's health but also family dynamics and social interactions.
Picky eating is normal in young children, but it can be more severe for individuals on the autism spectrum. Children with autism are five times more likely to be fussy eaters and fearful of new meals than typically developing children.1
Some autistic children are so fussy that they may refuse to consume entire food groups, such as vegetables, fruit, or meat. Some people would rather be hungry than consume a new brand of their favorite food. Although picky eating typically improves with age,2 some older children, teens, and adults on the spectrum continue to suffer with it.
Nobody knows why choosy eating is more common and lasts longer in autistic children. Autism features could play a role. Many people are extremely sensitive to touch, taste, and smell, which are all triggered by eating. Some people dislike change and unpredictability. "Food is something that's really pretty unpredictable," says autism researcher Emily S. Kuschner, Ph.D., in a Q&A piece.
Recent studies have shed light on the neurological aspects of picky eating in autism. Researchers have found that individuals with ASD may have differences in brain regions responsible for sensory processing and reward systems. These neurological variations could contribute to heightened sensitivity to food textures, tastes, and smells, making it more challenging for autistic individuals to accept a diverse range of foods. Understanding these underlying factors is crucial for developing effective interventions and support strategies.
According to the parents of the SPARK autism study's more than 113,000 youngsters, 16% had a feeding issue.3 A separate SPARK research of autistic individuals discovered that one in every five were at high risk for a type of fussy eating known as avoidant/restrictive food intake disorder.4 According to the experts, genetics could be the culprit.
Dinnertime can be unpleasant if the child's favorite dish is not served, which is usually chicken nuggets, fries, or macaroni. However, parents typically have other concerns: Are their children getting adequate nutrition? Is a restricted diet causing their children's constipation or stomach problems, which are more common among autistic people? Or are gastrointestinal difficulties causing their eating problems?
The First Step to Addressing Picky Eating in Autism
Many parents address their concerns with their child's pediatrician. Doctors can assess nutritional and physiological issues that may affect eating and appetite. They may also refer the youngster to a feeding problem program or a therapist.
Sensory and oral motor therapies are common treatments for autistic children, and they are led by occupational and speech-language therapists. These techniques are commonly utilized for children who are experiencing difficulty transitioning to solid foods. Behavior therapy are extremely popular, especially among older children and teenagers.
However, some parents report that their concerns are dismissed in the doctor's office. Picky eating is typical, and some doctors may not be concerned as long as the child is growing well, according to Dena E. Kelly, a board certified behavior analyst and counselor who offers feeding therapy through her company, Focused Approach.
"When the doctor takes the child's height and weight and sees that he or she is growing and developing normally, they frequently dismiss it and tell the parent, 'Don't worry about it. It is a phase. They will outgrow it," Kelly says.
Even if children are not starving, Kelly believes that fussy eating might limit their social development and interfere with family life. Parties, summer camps, school lunches, vacations, and restaurants may be out of the question if their favored foods are not available. "For most of us, eating is such a social activity," she declares.
Furthermore, children who do not eat correctly may feel hungry more frequently, which can impair their mood and conduct, she explains.
Kelly believes that when working with children, she considers "eating in the same way that we as parents look at other types of nonnegotiable behavior in the child's day." Although children can make choices and have preferences, she believes they must consume a proper amount and variety of food, just as they must hold hands with an adult when crossing the street.
Kelly works with families on a weekly basis for months, gradually introducing the kid to new foods. She begins with items that are comparable to what they currently eat. For example, a child who enjoys macaroni and cheese may be given a taste of a buttered noodle one week in addition to his regular food. The following week, the kid may be introduced a mouthful of macaroni and tomato sauce. A cheese quesadilla, which has a similar flavor and texture to mac and cheese, may be offered another week.
If the child meets their meal target for the day, they may earn anything they want, such as screen time, a trip to the park, or a toy. Kelly creates personalised feeding regimens for babies up to teenagers. Teens may be motivated to eat more pizza with their buddies. A 12-year-old boy once told her that his pickiness sprang from fear. "He said, 'I was so scared to try new food, and I don't know why, but after trying it I realized it wasn't so bad,'" Kelly tells me.
While professional interventions are crucial, the role of parents and caregivers in addressing picky eating cannot be overstated. Creating a supportive and understanding environment at home is essential for progress. Parents can implement strategies such as involving children in meal planning and preparation, using visual schedules to establish routine, and modeling positive eating behaviors. Additionally, celebrating small victories and being patient with the process can help reduce stress and anxiety around mealtimes for both the child and the family.
How Can Families Help Their Picky Eater?
How can you prevent or treat fussy eating?
Eating in the car or at different times at home, while normal in many busy families, is not beneficial to a finicky eater, according to Kelly. She suggests creating rituals around eating and mealtime. For example:
Set specific times for breakfast, lunch, dinner, and snacks. Do not allow children to snack so frequently that they are not hungry at meals.
Offer them several brands and varieties of their favorite foods so that they can develop accustomed to variation.
Do not utilize food during playtime, such as drawing with pudding or imagining broccoli is a tree. Although parents may be encouraged to utilize food for sensory play activities, Kelly believes that food should only be served for meals and snacks.
Introduce a new food once a week and urge the youngster to try a taste. Do not serve new dishes on other days of the week.
In addition to these strategies, experts recommend incorporating sensory-friendly approaches to mealtime. This can include using adaptive utensils, plates with dividers to prevent foods from touching, or even experimenting with different textures and temperatures of foods. Some families find success in creating a calm eating environment by reducing noise, dimming lights, or using comfortable seating arrangements. The key is to tailor these approaches to the individual child's needs and preferences, recognizing that what works for one may not work for another.
When Picky Eating is More Severe
Picky eating, also known as selective eating, may extend beyond what families can solve on their own.
A severe variant, known as avoidant/restrictive food intake disorder, or ARFID, appears to be more common among autistic persons and their families, according to a SPARK study with than 10,000 participants.4
ARFID comprises extremely fussy eating, anxiety of new foods, and sensory avoidance. Unlike some eating problems, patients with ARFID do not have skewed body images. However, children with it may struggle to gain weight, while adults may lose weight. They may also have severe dietary inadequacies, according to the American psychiatric diagnostic manual.
A study of 5,100 autistic people in SPARK and 5,000 of their parents discovered that 21% of the children and up to 17% of the parents are at high risk for ARFID. Only 1% had a medical diagnosis of ARFID.
The diagnostic manual states that autistic people frequently have inflexible eating habits and sensory sensitivities. According to the handbook, ARFID should only be identified when the autistic person exhibits the symptoms and the eating disorder requires specific treatment.
The research findings from SPARK participants show that ARFID may be underdiagnosed. "A lot of people, and certainly a lot of professionals, do not see ARFID as something that requires care. But, in the long run, the poor nutrition it creates will have a cumulative effect on a person's health, which may not be completely apparent until maturity," said one of the researchers, Jacob J. Michaelson, Ph.D., associate psychiatry professor at the University of Iowa.
As awareness of ARFID and its prevalence in the autism community grows, there is an increasing call for more specialized training for healthcare providers and educators. Early identification and intervention are crucial in preventing long-term health consequences associated with restrictive eating patterns. Collaborative efforts between medical professionals, therapists, dietitians, and families are essential in developing comprehensive treatment plans that address both the physical and psychological aspects of ARFID in individuals with autism. By fostering a multidisciplinary approach, we can hope to improve outcomes and quality of life for those affected by this challenging condition.
