martes, 19 de febrero de 2019

Picky Eating and Autism: Tips & Advice

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By Osman Shabir, M.Sc.Reviewed by Jennifer Logan, MD, MPH

In addition to the classical symptoms of autism, such as behavioural disturbances, delay in learning to speak, inappropriate social interaction, obsession over particular objects or foods, lack of eye contact, and language comprehension issues, there may also be signs of abnormal eating behaviour, which may or may not be attributed to specific eating disorders.

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Eating Habits of Children with Autism

One key feature of autism is hyposensitivity or hypersensitivity; thus, children with autism can have different sensory experiences compared with children without autism. As such, textures, smells, tastes, and the feel of food (and non-food) items may be important contributors to their eating habits.

In one study investigating eating habits of children with intellectual disabilities compared with those without, the refusal rate of particular food groups was examined. Refusal, or avoidance, of most food types was significantly higher in children with intellectual disabilities compared with those without.

It is important to note, however, that refusal of food items is not exclusive to children with autism, rather many children who do not have autism also refuse food items, as in Avoidant and Restrictive Food Intake Disorder. However, the refusal rates are significantly higher in children with autism compared to those without.

So what types of foods do children with autism prefer? Answering this question is not simple, as autistic children are on a spectrum (ASD) and therefore different children will have different preferences. However, there is significant research that suggests a majority of autistic children prefer foods of a similar texture, be it all-soft, or all-hard/crunchy.

Eating habits are variable in autism, but the most common ones experienced are:

Refusal to eat particular food types (due to texture, smell or appearance)
Preference of carbohydrates (e.g. bread, pasta, rice)
Preference of one texture type (e.g. all-soft textures, or all-hard/crunchy)
Some children will only want all bland foods, whereas others only strong foods
Some children will only consume food of one colour (e.g. brown or beige)
Extreme reactions (e.g. gagging or extreme repulsion to new food items)
Repetitive behaviour of eating the same food item every day at the same time
Some children may suffer from pica – eating non-food items like paper or dirt

How to Improve Eating Habits in Children with Autism

Improving eating habits in children can be a difficult and often a draining task. It may take months, if not years to change their habits, and it is important to keep persisting.

Some generic tips and advice for improving eating behaviour include (but not limited to):

Try to prevent ‘grazing’ or continuous eating throughout the day, as this takes the edge of being hungry and therefore results in unhealthy feeding patterns – setting set times for mealtimes is one way of driving this
Having meals together as a family will reinforce strong environmental cues around mealtime and therefore will be more willing to eat seeing others eat
Avoid making a separate meal for your child as this will prevent them accepting that they will get a specially prepared meal if they are fussy and will not bother improving
Reward your child if they successfully try new foods, but do not punish them by taking away their favourite foods – try not to get angry over refusal or spitting food
Try modifying food e.g. puree of vegetables if your child only prefers soft textures, or adding food dyes if they prefer a particular colour
Try being creative with food and joint cooking sessions encouraging your child to explore the food in detail – by making meal preparation exciting your child may end up eating the food
Pay close attention to detail – how the food is presented, as often autistic children may not even eat their usual meal if it is on a different plate/cutlery being used, or something as trivial as different positioning or angles of food items
If your child is over-eating, gradually reduce portion sizes and limit access to food by keeping it out of sight may be a good start
If your child is under-eating, gradually increase portion sizes and encourage positive associations with food by making simple things like sandwiches

These tips can actually be applied for any family, as they reinforce healthful eating practices for all children.

As with any of these tips, they most certainly will not work first time, and you need to persist for sometimes months. A gradual change or introduction is often a good start to gage your child’s reactions. Often with these behaviours, the goal is to learn and be comfortable with different foods rather than eating everything you present to them.

Finally, if despite persistent active changes to your child’s mealtime routine does not yield fruitful results, then it is worth seeking the guidance and advice of a medical professional such as a paediatrician, dentist, or clinical nutritionist. They will rule out physiological conditions and tooth problems and provide referral to specialists such as clinical psychiatrists who will try to use behavioural strategies to change behaviour. If the problem is a swallowing problem, speech and language therapists may help with such issues. Sometimes, a counsellor or occupational therapist with autism experience may be needed.