The Link Between Autism and Atypical Eating Patterns in Your Child or Adolescent-Part 1
An Introduction to Strategies to Manage “Picky Eating”
By: Amber Whittemore RD BSN MHSc
**Disclaimer: the following are ideas that may or may not work with your child. You are the expert of your own child and going at your own pace and picking strategies that work for you and your family is key.**
Autism, or autism spectrum disorder (ASD), refers to a complex group of neurodevelopmental differences characterized by varying degrees of challenges with social functioning, verbal or nonverbal communication, and common co-morbidities such as ADHD, OCD, and/or anxiety1,2. Individuals with ASD are also more likely to experience repetitive or rigid behaviours, fixed or obsessive special interests, and/or sensory sensitivities2. A 2018 survey estimated that 1 in 66 children in Canada meets the criteria for ASD3, making it a highly prevalent diagnosis and one that parents should be aware of.
One very common occurrence in children with ASD is atypical eating patterns, which may present as picky or disordered eating. A recent study found that 70% of children with ASD experience some form of atypical eating behaviour, making it 15 times more common than in children considered “neurotypical”4. Disturbances in eating behaviours associated with the presentation of “picky eating” may be influenced by sensory issues with certain foods, gastrointestinal discomfort or disorders, underdeveloped oral muscles for chewing, and/or the environment surrounding mealtimes5,6. We also know from the literature that disordered eating is much more common among individuals with ASD, likely being influenced by the tendency for rigidity in thinking, lack of flexibility with food and patterns, challenges with executive functioning, and/or perfectionistic tendencies2.
As you may know, if you are a parent of a child diagnosed with ASD, it can be overwhelming to try and support their nourishment if there are atypical, or “picky”, eating patterns taking place. To try and support parents through this task, the remaining focus on this blog (part 1), as well as next week’s blog (part 2), will be strategies that may help ease into more normalized or sustaining eating patterns!
Part 3 of this blog, coming in a few weeks, will be diving deeper into the warning signs of disordered eating in your child with ASD, as well as strategies to help support your child if disordered eating does occur.
#1 Rule Out Any Gastrointestinal (GI) or Swallowing Problems
If your child is experiencing troubles with regular mealtimes, without being able to express what is going on for them, the first step should be to rule out any GI or swallowing complications. GI disorders are reportedly one of the most common medical conditions associated with ASD, with complications ranging from constipation to diarrhea to abdominal pain6. Discomfort with eating may be aggravated by reflux, difficulty chewing, or impaired swallowing function – which may be triggered by certain foods or an allergy5. Underdeveloped oral muscles may make it difficult for your child to chew certain foods, especially if they have had a longstanding preference for primarily soft foods5.
A pediatric gastroenterologist will be able to rule out any organic causes for your child’s “picky eating” before moving on to other strategies. An occupational therapist (OT) and speech language pathologist (SLP) should also be involved in your child’s care to manage any troubles with eating and/or swallowing.
#2 Familiarize Yourself with Your Childs Triggers
Take note of if there are certain textures, colours, flavours, or temperatures of foods your child is especially averse to. If so, this may indicate there is a sensory aversion taking place. If you can pinpoint the sensory aversion(s) your child is experiencing, it may be easier to offer foods that fall within their accepted or preferred sensory experiences.
If possible, talk to your child about what they experience when faced with a new or old food they are fearful of consuming. If this is not possible, consider if there has been any history of events when your child either experienced or saw someone experience a traumatic event with food. This could be choking, vomiting, and allergic reaction, etc. If your child has been exposed to events like this, there could be a fear of choking or getting sick with the consumption of said or similar foods.
Pay attention to the environment surrounding mealtimes, and if there are any additional sensory experiences taking place concurrent to meals in which your child seems to be especially struggling. These could include auditory (loud music, the television, traffic, arguing), smell (strong foods, something baking, perfume), etc… notice if there is any link to additional sensory experiences and changes in your child’s eating patterns.
#3 Experiment with New Strategies for Managing Mealtimes
Adapt to your child’s sensory experiences
Tuning into your child’s sensory aversions can give great clues into what foods they would be more accepting of. The Queensland Government has a great resource7 titled “Suggestions for texture/taste/nutrition modification to increase food acceptability”, which was developed to aid in pinpointing possible issue(s) your child may be experiencing with food. Using this resource (linked above) you may be able to get to the bottom of your child’s sensory aversions. Once this is accomplished, adapting meals to align them closer with these needs can be much easier!
The following chart has many examples of ways you could experiment with food to try and increase its acceptance for your child, many of which were derived from the Queensland resource7:
|Food group in question||Possible Issue(s) your child may be experiencing||Strategies to trial for increased acceptance|
|Breads||Crust on bread|
Food sticks to teeth
Hard grains/seeds in bread
Toast breadUse taco shells or tortillas
Offer high fibre/fortified white bread
|Breakfast cereals||Mushy texture||Add dried or fresh fruit for crispinessAdd seeds/nuts for crunchinessEat cereal soon after milk addedReplace milk with yogurt in cereal|
|Rice||Chewy texture||Try quinoa or couscous in place of riceAdd seeds for crunchinessCook for longer for a softer texture|
|Pasta||Difficulty managing long noodles (spaghetti, fettuccini)||Cook longer to provide a softer textureTry smaller noodles like penne or macaroni|
|Tough fibrous texture (i.e., celery)|
Hard crunchy texture (i.e., carrot)
Bitterness (i.e., dark green vegetables)Hot or spicy sensation (i.e., peppers, onion)
|Cut stalks into smaller pieces to break up fibres, pull fibres out of celery|
Grate raw crunchy vegetables and offer in sandwiches or saladsCook vegetables until soft
Use a vegetable shape cutter to create fun shapes
Remove bitter or hot sensation foods from child’s diet and replace with other vegetables
|Tangy or sour tastes (i.e., citrus, grapefruit)|
Waxy or hairy texture (i.e., peach)
Pulp in fruit creates surprise pop while eating (i.e., oranges)
Seeds in fruit (i.e., cherries, watermelon, kiwi)
|Avoid sour fruits if needed and replace them with sweeter optionsAdd honey or syrup to fruit or choose naturally sweeter options (navel oranges)|
Avoid fruit that contains pulp and replace with other fruit options
Remove all inedible seeds from the fruit before offering (i.e., cherries)Opt for seedless varieties of fruit (i.e., seedless grapes, kiwi, watermelon)
|Tough or chewy texture (i.e., red meats)|
Fishy smell of seafood
Bones in meat (i.e., chicken wings, fish, T-bone)
Blood in meat
|Remove all skin and fat from meatStew meat dishes to make more tenderOffer minced or ground meats|
Cook fish with strong herbs to mask the smellOffer canned fish
Offer fillets of meat without bones (chicken breast, boneless thigh, salmon fillet)Remove bones before serving
Cook meat wellRemove bones before cooking
|Milk, liquids||Dislikes the thick or creamy textureDislikes the waxy feeling left on tongue/throat||Try a low-fat milk productOffer a dairy-alternative that is fortified with calcium, such as soy, almond, oat, or cashewAdd chocolate syrup to milk|
|Yogurt, purees||Dislike the waxy coating left on tongue/throatDislike the thick pureed consistency (i.e., yogurt)||Offer a milkshake made with yogurt and a low-fat milkOffer a dairy-alternative such as a coconut or almond yogurt|
|Ice cream/custards, semi-viscous||Dislikes the changing texture in their mouth (solid to liquid)Sensitive to cold temperaturesMushy texture||Offer home-made fruit popsicles as an alternative in hot weather|
|Cheese, solids||Strong flavourDislikes chalky taste||Opt for milder cheeses (i.e., mild cheddar)Try lower-fat cheeses|
Stay tuned for next week, where we will be getting into more strategies to try and increase your child’s nutritional intake. These strategies include:
- Try to get your child to “eat the rainbow”
- Try a new food 3 days in a row to increase acceptance
- Play with new foods to create a fun environment
- Try to neutralize the environment during mealtimes
- Praise your child for progress, however small
- Work with an Occupational Therapist, Speech Language Pathologist, Counsellor, Social Worker, or Registered Dietitian to overcome fears around certain foods
If you are a parent of a child with ASD and are struggling to meet your child’s nutritional needs, know that you are not alone! Taking this process at you and your child’s own pace is important, as you are the expert of your own child.
We hope that today’s blog, as well as parts 2 and 3 coming soon, can aid in your journey. You can also reach out to HEC to work with an occupational therapist, counsellor or dietitian to strategize around personalized strategies to help with your child’s intake!
1National Institute of Neurological Disorders and Stroke. (2020). Autism Spectrum Disorder Fact Sheet. Received from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Autism-Spectrum-Disorder-Fact-Sheet
2Sara Garner for Northern Health. (2020). 6th Annual Interior Region Eating Disorder Forum: Eating Disorders and Autism Spectrum Disorder: Recognizing and Responding to the Needs of Girls and Women in Eating Disorder Treatment.
3Government of Canada (2018). Autism Spectrum Disorder among Children and Youth in Canada 2018. Received from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/autism-spectrum-disorder-children-youth-canada-2018.html
4Mayes, S. D. & Zickgraf, H. (2019). Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders, 64(76). doi: 10.1016/j.rasd.2019.04.002
5Child Mind Institute. (2021). Autism and Picky Eating. Received from: https://childmind.org/article/autism-and-picky-eating/
6Hsiao, E. Y. (2014).Gastrointestinal Issues in Autism Spectrum Disorder. Harvard Review of Psychiatry, 22(2), 104-111. doi: 10.1097/HRP.0000000000000029
7Queensland Government. (2020). Suggestions for texture/taste/nutrition modification to increase food acceptability. Received from: https://www.health.qld.gov.au/__data/assets/pdf_file/0023/154634/paed_asdsuggestions.pdf